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Wells KB, Zhang L, Saks ER, Bilder RM. Impact of Opera on Resilience and Thriving in Serious Mental Illness: Pilot Evaluation of The Center Cannot Hold Part 2 and Resilience Workshop. Community Ment Health J 2024; 60:964-971. [PMID: 38517645 PMCID: PMC11169011 DOI: 10.1007/s10597-024-01248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/03/2024] [Indexed: 03/24/2024]
Abstract
There are few studies of impacts of arts on recovery in schizphrenia, on audience mood and social connection. We developed a pilot evaluation of opera performances in a university setting on Elyn Saks' journey from psychosis, teaching law and falling in love, coupled with pre-opera workshop on approaches to resilience. Using surveys, primary outcomes were pre and post affect (PANAS-X positive, negative; visual "affect grid" touchscreen for affective valence and arousal) and social connectedness with secondary outcomes of increasing understanding, reducing stigma and willingness to socialize or serve persons with mental illness. Of 107 live and 117 online attendees, 64 completed pre, 24 post, and 22 both surveys. Respondent characteristics were similar for those with pre and pre and post surveys: average age mid 50's, half female, 10% sexual minority, half White/Caucasian, 13% Hispanic/Latino, 11% Black/African American and 20% Asian; of 22 with pre and post, 9 (41%) were providers. There were significant post-pre increases in positive affect (PANAS-X) and arousal (visual grid) and social connectedness (Cohen's d = 0.82 to 1.24, each p < .001); and willingness to socialize with someone with schizophrenia (d = 0.68, p = .011). In this pilot evaluation of opera in a university auditorium, despite small sample sizes, there were significant post-pre increases in audience positive affect and social connection, which could reflect selection (those with positive response completing surveys) or may suggest that arts events promote well-being and connection, issues for future larger studies.
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Affiliation(s)
- Kenneth B Wells
- UCLA Jane and Terry Semel Institute Center for Health Services and Society, 760 Westwood Plaza, Suite 17-369B, Los Angeles, CA, 90024, USA.
- David Geffen School of Medicine, Los Angeles, CA, 90024, USA.
- Fielding School of Public Health, Greater Los Angeles Veterans Administration Health System, Los Angeles, CA, USA.
| | - Lily Zhang
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Elyn R Saks
- Saks Institute for Mental Health Law, Policy and Ethics, Gould School of Law, University of Southern California, Los Angeles, CA, USA
| | - Robert M Bilder
- David Geffen School of Medicine, Los Angeles, CA, 90024, USA
- Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
- Stewart & Lynda Resnick Neuropsychiatric Hospital at UCLA, Los Angeles, CA, USA
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2
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Heetderks-Fong E, Bobb A. Community Mental Health Workers: Their Workplaces, Roles, and Impact. Community Ment Health J 2024:10.1007/s10597-024-01306-2. [PMID: 38896213 DOI: 10.1007/s10597-024-01306-2] [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: 11/17/2023] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
Mental health care in the U.S. is at a critical crisis, compounded with a severe shortage of providers. The cost burden is immense, with severe disparity seen in traditionally marginalized communities and rural populations. Community health workers have been used to increase access to physical health care in the U.S. for over seventy years-and have been used abroad for centuries. Their use in mental health care is more recent and can increase access, but raises policy, reimbursement, triage, and scopes-of-practice considerations. They are especially beneficial for many at-risk populations including communities of color, those with serious mental illness, rural communities, the elderly, and youth. This literature review searched PubMed, EMBASE, and Google Scholar and provides a broad review of the different types of community mental health workers (community health workers/promotores de salud, peer support, peer navigators, and lay counselors), how they increase access to care, skill sets, practice locations, and uses for specific at-risk populations. Increasing and expanding the use of community mental health workers expands much needed mental health care to those at risk by task-shifting the burden on the traditional professional workforce, offering a solution to both the workforce shortage and the lack of equity in mental health care.
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Affiliation(s)
| | - Anna Bobb
- Vreds Philanthropy, Washington, DC, USA
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3
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Nuske HJ, Smith T, Levato L, Bronstein B, Sparapani N, Garcia C, Castellon F, Lee HS, Vejnoska SF, Hochheimer S, Fitzgerald AR, Chiappe JC, Nunnally AD, Li J, Shih W, Brown A, Cullen M, Hund LM, Stahmer AC, Iadarola S, Mandell DS, Hassrick EM, Kataoka S, Kasari C. Building Better Bridges: Outcomes of a Community-Partnered New School Transition Intervention for Students on the Autism Spectrum. J Autism Dev Disord 2024:10.1007/s10803-024-06285-7. [PMID: 38865033 DOI: 10.1007/s10803-024-06285-7] [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: 02/12/2024] [Indexed: 06/13/2024]
Abstract
New school transitions can be challenging for students on the autism spectrum. No published, evidence-based interventions exist to support families and teachers of students transitioning to elementary and secondary school during this critical period. Using Community Partnered Participatory Research, we developed Building Better Bridges (BBB), a caregiver coaching intervention that includes training on effective school communication, educational rights, advocacy, and child preparation strategies. We compared BBB (n = 83) to a module/resources-only comparison (n = 87) in a four-site randomized controlled trial in racially and ethnically diverse, under-resourced communities. In our intent-to-treat analysis, caregivers and teachers in BBB rated students' transitions to the new classroom as more positive, relative to the comparison group. Results suggest this low-cost intervention can improve the transition process for families and students at high risk of poor transitions.
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Affiliation(s)
- Heather J Nuske
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Tristram Smith
- Division of Developmental and Behavioral Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Lynne Levato
- Division of Developmental and Behavioral Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Briana Bronstein
- Center for Education, College of Health & Human Services, Widener University, Chester, PA, USA
| | - Nicole Sparapani
- Departments of Psychiatry and Behavioral Sciences, Psychology, and Education, UC Davis MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Consuelo Garcia
- Department of Psychiatry, Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, University of California, Los Angeles, CA, USA
| | - Fernanda Castellon
- Department of Psychiatry, Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, University of California, Los Angeles, CA, USA
| | - Hyon Soo Lee
- Department of Psychiatry, Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, University of California, Los Angeles, CA, USA
| | - Sarah F Vejnoska
- Departments of Psychiatry and Behavioral Sciences, Psychology, and Education, UC Davis MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Samantha Hochheimer
- Division of Developmental and Behavioral Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Amber R Fitzgerald
- Departments of Psychiatry and Behavioral Sciences, Psychology, and Education, UC Davis MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jenny C Chiappe
- Teacher Education Division, Special Education, College of Education, California State University, Dominguez Hills, Carson, CA, USA
| | - Amanda Dimachkie Nunnally
- Departments of Psychiatry and Behavioral Sciences, Psychology, and Education, UC Davis MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jennica Li
- Departments of Psychiatry and Behavioral Sciences, Psychology, and Education, UC Davis MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Wendy Shih
- Department of Psychiatry, Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, University of California, Los Angeles, CA, USA
| | - Ashlee Brown
- Professional Development and Research, Early Learning Services, Elwyn, Philadelphia, PA, USA
| | - Michelle Cullen
- Special Education Department, Rochester City School District, Rochester, NY, USA
| | - Lisa M Hund
- Health Resources and Services Administration, Division of Healthy Start and Perinatal Services, Maternal and Child Health Bureau, Rockville, MD, USA
| | - Aubyn C Stahmer
- Departments of Psychiatry and Behavioral Sciences, Psychology, and Education, UC Davis MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Suzannah Iadarola
- Division of Developmental and Behavioral Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - David S Mandell
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sheryl Kataoka
- Department of Psychiatry, Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, University of California, Los Angeles, CA, USA
| | - Connie Kasari
- Department of Psychiatry, Center for Autism Research & Treatment, UCLA Semel Institute, Los Angeles, University of California, Los Angeles, CA, USA
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Yang KG, Blackmore MA, Cook BL, Chung H. Collaborative Care for Depression and Anxiety: Racial-Ethnic Differences in Treatment Engagement and Outcomes. Psychiatr Serv 2024:appips20230482. [PMID: 38693836 DOI: 10.1176/appi.ps.20230482] [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: 05/03/2024]
Abstract
OBJECTIVE This study aimed to examine racial-ethnic differences in engagement with and clinical outcomes of a collaborative care model (CoCM) implemented in primary care outpatient clinics in an urban academic medical center. METHODS Adult patients (N=4,911) who screened positive for symptoms of depression, anxiety, or both on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 scale and who identified as non-Hispanic Black, Hispanic, or non-Hispanic White were offered participation in a CoCM implementation. The primary outcome was treatment engagement, defined as receipt of any follow-up visit, minimally adequate 4-week follow-up (at least one visit), and minimally adequate 16-week follow-up (at least three visits) after initial assessment. Secondary outcomes were response and remission of depression or anxiety. RESULTS After adjustment of analyses for sociodemographic covariates, Black and Hispanic participants were significantly less likely than White participants to have received any or minimally adequate follow-up. Black and Hispanic participants who received any or minimally adequate 16-week follow-up were more likely than White participants to demonstrate depression symptom response and remission of anxiety symptoms. CONCLUSIONS This CoCM implementation appears to have been effective in treating depression and anxiety among Black and Hispanic patients. However, significant disparities in receipt of follow-up care were observed. Efforts must be made to improve the retention of patients from racial-ethnic minority groups in collaborative care.
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Affiliation(s)
- Kelly Guanhua Yang
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Michelle A Blackmore
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Benjamin Lê Cook
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
| | - Henry Chung
- Department of Psychiatry, NYU Langone Health, New York City (Yang); Department of Psychiatry and Behavioral Sciences (Blackmore, Chung) and PRIME Center for Health Equity (Cook), Albert Einstein College of Medicine/Montefiore Medical Center, New York City; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts (Cook)
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Egger E, Bitewulign B, Rodriguez HG, Case H, Alemayehu AK, Rhodes EC, Estifanos AS, Singh K, Keraga DW, Zahid M, Magge H, Gleeson D, Barrington C, Hagaman A. 'God is the one who give child': An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework. RESEARCH SQUARE 2024:rs.3.rs-4102460. [PMID: 38585722 PMCID: PMC10996821 DOI: 10.21203/rs.3.rs-4102460/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: 04/09/2024]
Abstract
Background Postnatal care is recommended as a means of preventing maternal mortality during the postpartum period, but many women in low- and middle-income countries (LMICs) do not access care during this period. We set out to examine sociocultural preferences that have been portrayed as barriers to care. Methods We performed an abductive analysis of 63 semi-structured interviews with women who had recently given birth in three regions of Ethiopia using the Health Equity Implementation Framework (HEIF) and an inductive-deductive codebook to understand why women in Ethiopia do not use recommended postnatal care. Results We found that, in many cases, health providers do not consider women's cultural safety a primary need, but rather as a barrier to care. However, women's perceived refusal to participate in postnatal visits was, for many, an expression of agency and asserting their needs for cultural safety. Trial registration n/a. Conclusions We propose adding cultural safety to HEIF as a process outcome, so that implementers consider cultural needs in a dynamic manner that does not ask patients to choose between meeting their cultural needs and receiving necessary health care during the postnatal period.
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Affiliation(s)
| | | | - Humberto Gonzalez Rodriguez
- UNC Gillings School of Global Public Health: The University of North Carolina at Chapel Hill Gillings School of Global Public Health
| | - Haley Case
- CDC Foundation Inc: National Foundation for the Centers for Disease Control and Prevention Inc
| | | | - Elizabeth C Rhodes
- Hubert Department of Global Health: Emory University Rollins School of Public Health
| | - Abiy Seifu Estifanos
- Addis Ababa University Department of Community Health: Addis Ababa University School of Public Health
| | - Kavita Singh
- The University of North Carolina at Chapel Hill Carolina Population Center
| | - Dorka Woldesenbet Keraga
- Addis Ababa University Department of Community Health: Addis Ababa University School of Public Health
| | | | - Hema Magge
- Addis Ababa University School of Public Health
| | | | - Clare Barrington
- UNC Gillings School of Global Public Health: The University of North Carolina at Chapel Hill Gillings School of Global Public Health
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Woodward EN, Castillo AIM, True G, Willging C, Kirchner JE. Challenges and promising solutions to engaging patients in healthcare implementation in the United States: an environmental scan. BMC Health Serv Res 2024; 24:29. [PMID: 38178131 PMCID: PMC10768202 DOI: 10.1186/s12913-023-10315-y] [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: 03/08/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. METHODS We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template. RESULTS We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing. CONCLUSION We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places.
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Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
| | - Andrea Isabel Melgar Castillo
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
- Graduate School, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA, 70119, USA
- Section on Community and Population Medicine, School of Medicine, Louisiana State University, 2400 Canal St (11F), New Orleans, LA, USA
| | - Cathleen Willging
- Pacific Institute for Research and Evaluation, 851 University Boulevard, Suite 101, Albuquerque, NM, 87106, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
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7
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Woodward EN, Lunsford A, Brown R, Downing D, Ball I, Gan-Kemp JM, Smith A, Atkinson O, Graham T. Pre-implementation adaptation of suicide safety planning intervention using peer support in rural areas. FRONTIERS IN HEALTH SERVICES 2023; 3:1225171. [PMID: 38188615 PMCID: PMC10766826 DOI: 10.3389/frhs.2023.1225171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Introduction Currently, seventeen veterans die by suicide daily in the United States (U.S.). There are disparities in suicide behavior and access to preventative treatment. One disparity is the suicide rate in rural areas, including the state of Arkansas-suicide deaths among rural veterans increased 48% in the last 2 decades, double that of urban veterans. One major challenge for veterans in rural areas is the lack of healthcare providers to provide Safety Planning Intervention, which is an effective intervention to reduce suicide attempts in the general adult population and among veterans. One solution is more broadly implementing Safety Planning Intervention, by using peers to deliver the intervention in rural communities. Before implementation, the intervention needs to be adapted for peer-to-peer delivery, and barriers and facilitators identified. Methods Since January 2021, using community-based participatory research, we collaboratively developed and executed a 1 year study to adapt Safety Planning Intervention for peer-to-peer delivery in rural communities and identified implementation barriers and facilitators prior to spread. From July 2022 to February 2023, we conducted group interviews with 12 participants: rural veterans with prior suicidal thoughts or attempts in one U.S. state, their support persons, and healthcare professionals with expertise in veteran suicide prevention, Safety Planning Intervention, and/or peer delivery. We collected qualitative data through interviews during nine, 2 h meetings, and quantitative data from one anonymous survey and real-time anonymous voting-all on the topic of core and adaptable components of Safety Planning Intervention and implementation barriers and facilitators for peer delivery in rural communities. Questions about adaptation were designed according to processes in the ENGAGED for CHANGE community-engaged intervention framework and questions about facilitators and barriers were designed according to the Health Equity Implementation Framework. Participants categorized which Safety Planning Intervention components were core or adaptable, and how freely they could be adapted, using the metaphor of a traffic light in red (do not change), yellow (change with caution), and green (change freely) categories. Results Participants made few actual adaptations (categorized according to the FRAME modification system), but strongly recommended robust training for peers. Participants identified 27 implementation facilitators and 47 barriers, organized using the Health Equity Implementation Framework. Two example facilitators were (1) peer-to-peer safety planning intervention was highly acceptable to rural veterans; and (2) some state counties already had veteran crisis programs that could embed this intervention for spread. Two example barriers were (1) some community organizations that might spread the intervention have been motivated initially, wanting to help right away, yet not able to sustain interventions; and (2) uncertainty about how to reach veterans at moderate suicide risk, as many crisis programs identified them when suicide risk was higher. Discussion Our results provide one of the more comprehensive pre-implementation assessments to date for Safety Planning Intervention in any setting, especially for peer delivery (also referred to as task shifting) outside healthcare or clinical settings. One important next step will be mapping these barriers and facilitators to implementation strategies for peer-to-peer delivery. One finding surprised our research team-despite worse societal context in rural communities leading to disproportionate suicide deaths-participants identified several positive facilitators specifically about rural communities that can be leveraged during implementation.
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Affiliation(s)
- Eva N. Woodward
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Amanda Lunsford
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Rae Brown
- Arkansas Freedom Fund, Little Rock, AR, United States
| | | | - Irenia Ball
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Jennifer M. Gan-Kemp
- Department of Medical Humanities and Bioethics, Center for Health Literacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Anthony Smith
- Arkansas Freedom Fund, Little Rock, AR, United States
| | | | - Thomas Graham
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Shim RS, Rodriguez CI. A Mental Health Crisis and Call to Action: Increasing Trends in Suicide Among Black Women in the United States. Am J Psychiatry 2023; 180:871-873. [PMID: 38037408 DOI: 10.1176/appi.ajp.20230819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Ruth S Shim
- Department of Psychiatry, University of California, Davis, (Shim); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Rodriguez); Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez)
| | - Carolyn I Rodriguez
- Department of Psychiatry, University of California, Davis, (Shim); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Rodriguez); Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. (Rodriguez)
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Riccardi M, Pettinicchio V, Di Pumpo M, Altamura G, Nurchis MC, Markovic R, Šagrić Č, Stojanović M, Rosi L, Damiani G. Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review. Health Policy 2023; 137:104905. [PMID: 37716190 DOI: 10.1016/j.healthpol.2023.104905] [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] [Received: 01/28/2022] [Revised: 05/12/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.
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Affiliation(s)
- MariaTeresa Riccardi
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Marcello Di Pumpo
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gerardo Altamura
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Roberta Markovic
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | | | - Miodrag Stojanović
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | - Luca Rosi
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità, ISS), Rome, Italy
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Fein EH, Agbangnin G, Murillo-León J, Parsons M, Sakai-Bismark R, Martinez A, Gomez PF, Chung B, Chung P, Dudovitz R, Inkelas M, Kataoka S. Encouraging "Positive Views" of Mental Illness in High Schools: An Evaluation of Bring Change 2 Mind Youth Engagement Clubs. Health Promot Pract 2023; 24:873-885. [PMID: 36154511 PMCID: PMC10481624 DOI: 10.1177/15248399221098349] [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: 11/16/2022]
Abstract
"Bring Change 2 Mind" (BC2M) high school clubs may destigmatize mental illness among club members, but clubs' (1) reach and impact on non-club members at the same school, (2) connection to student help-seeking attitudes, and (3) mechanisms by which they destigmatize mental illness, are unknown. This community-partnered evaluation involved pre/post surveys of predominantly Latino (72%) students at three urban public schools and focus groups and interviews with a sample of club members (n = 26/65, 40%) and all club staff (n = 7, 100%). Multivariate regressions tested relationships between variables. In 84% of the student body responded in the Fall (n = 1,040) and Spring (n = 1,031). Non-club member engagement in BC2M (reach) increased from 25% (Fall) to 44% (Spring) (p < .01). Engagement with BC2M clubs was associated with decreased stigma among members (p < .05) but not non-members (p = .19). Decreased stigma was associated with help-seeking attitudes (p < .01). Possible BC2M mechanisms identified by students and staff include the following: (1) fostering a positive campus climate, (2) normalizing mental health discussions, (3) increasing peer support and help-seeking, and (4) increasing awareness of positive coping behaviors. While BC2M clubs likely reduce stigma for members, effects did not reach non-members, challenging the potential of BC2M clubs as a schoolwide strategy to destigmatize mental health services. Future projects could investigate how to reach non-BC2M members, complement BC2M with other school climate interventions to increase impact, and measure BC2M impact alongside other outcomes relevant to schools, such as academic achievement.
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Affiliation(s)
| | | | | | - Marni Parsons
- Bright Star Secondary Charter Academy, Los Angeles, CA, USA
| | | | | | | | - Bowen Chung
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Paul Chung
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | | | - Moira Inkelas
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Sheryl Kataoka
- University of California, Los Angeles, Los Angeles, CA, USA
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11
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Wells KB. Increased Emergency Department Stays for Mental Health of Insured Youth in Year 2 of the COVID-19 Pandemic-Moving Forward. JAMA Psychiatry 2023; 80:873-874. [PMID: 37436729 DOI: 10.1001/jamapsychiatry.2023.2030] [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] [Indexed: 07/13/2023]
Affiliation(s)
- Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, California
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
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12
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Ngo VK, Vu TT, Vu QA, McBain R, Yu G, Nguyen NB, Mai Thi Nguyen H, Ho HT, Van Hoang M. Study protocol for type II hybrid implementation-effectiveness trial of strategies for depression care task-sharing in community health stations in Vietnam: DEP Project. BMC Public Health 2023; 23:1450. [PMID: 37507720 PMCID: PMC10386582 DOI: 10.1186/s12889-023-16312-4] [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: 05/06/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND It is not clear what the most effective implementation strategies are for supporting the enactment and sustainment of depression care services in primary care settings. This type-II Hybrid Implementation-Effectiveness study will compare the effectiveness of three system-level strategies for implementing depression care programs at 36 community health stations (CHSs) across 2 provinces in Vietnam. METHODS In this cluster-randomized controlled trial, CHSs will be randomly assigned to one of three implementation conditions: (1) Usual Implementation (UI), which consists of training workshops and toolkits; (2) Enhanced Supervision (ES), which includes UI combined with bi-weekly/monthly supervision; and (3) Community-Engaged Learning Collaborative (CELC), which includes all components of ES, combined with bi-monthly province-wide learning collaborative meetings, during which cross-site learning and continuous quality improvement (QI) strategies are implemented to achieve better implementation outcomes. The primary outcome will be measured based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation quality, and Maintenance) using indicators on implementation, provider, and client factors. The secondary outcome examines factors associated with barriers and facilitators of quality implementation, while the tertiary outcome evaluates the incremental cost-effectiveness ratio of services provided in the ES and CELC conditions, relative to UI condition for depression care. A total of 1,296 clients receiving depression care at CHSs will be surveyed at baseline and 6-month follow-up to assess mental health and psychosocial outcomes (e.g., depression and anxiety severity, health function, quality of life). Additionally, 180 CHS staff and 180 non-CHS staff will complete pre- and post-training evaluation and surveys at baseline, 6, 12, and 24 months. DISCUSSION We hypothesize that the additional implementation supports will make mental health service implementation superior in the ES and CELC arms compared to the UI arm. The findings of this project could identify effective implementation models and assess the added value of specific QI strategies for implementing depression care in primary care settings in Vietnam, with implications and recommendations for other low- and middle-income settings. More importantly, this study will provide evidence for key stakeholders and policymakers to consider policies that disseminate, scale up, and advance quality mental health care in Vietnam. TRIAL REGISTRATION NCT04491045 on Clinicaltrials.gov. Registered July 29, 2020.
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Affiliation(s)
- Victoria Khanh Ngo
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
- Department of Community Health & Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
| | - Thinh Toan Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US.
- Department of Community Health & Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US.
| | - Quan Anh Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
| | | | - Gary Yu
- Columbia University, New York, US
| | | | | | - Hien Thi Ho
- Hanoi University of Public Health, Hanoi, Vietnam
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13
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Stice E, Rohde P, Gau JM, Bearman SK, Shaw H. An experimental test of increasing implementation support for college peer educators delivering an evidence-based prevention program. J Consult Clin Psychol 2023; 91:208-220. [PMID: 36892885 PMCID: PMC10175139 DOI: 10.1037/ccp0000806] [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: 03/10/2023]
Abstract
OBJECTIVE College students are at particularly high risk for mental health problems, such as eating disorders, which are associated with functional impairment, distress, and morbidity, but barriers limit implementation of evidence-based interventions at colleges. We evaluated the effectiveness and implementation quality of a peer educator (PE) delivered eating disorder prevention program (the Body Project [BP]), which has a broad evidence-based using a train-the-trainer (TTT) approach and experimentally evaluated three levels of implementation support. METHOD We recruited 63 colleges with peer educator programs and randomly assigned them to (a) receive a 2-day TTT training in which peer educators were trained to implement the Body Project and supervisors were taught how to train future peer educators (TTT), (b) TTT training plus a technical assistance (TA) workshop (TTT + TA), or (c) TTT plus the TA workshop and quality assurance (QA) consultations over 1-year (TTT + TA + QA). Colleges recruited undergraduates (N = 1,387, 98% female, 55% White) to complete Body Project groups. RESULTS There were no significant differences across condition for attendance, adherence, competence, and reach, though nonsignificant trends suggested some benefit of TTT + TA + QA relative to TTT for adherence and competence (ds = .40 and .30). Adding TA and QA to TTT was associated with significantly larger reductions in risk factors and eating disorder symptoms. CONCLUSIONS Results suggest that the Body Project can be effectively implemented at colleges using peer educators and a TTT approach and that adding TA and QA resulted in significantly larger improvements in outcomes for group participants, and marginally higher adherence and competence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Eric Stice
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | | | | | | | - Heather Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University
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14
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Umfleet LG, Bilder RM, Loring DW, Thames A, Hampstead BM, Bauer RM, Drane DL, Cavanagh L. The Future of Cognitive Screening in Neurodegenerative Diseases. J Alzheimers Dis 2023; 93:47-59. [PMID: 36970899 DOI: 10.3233/jad-221077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Cognitive screening instruments (CSI) have variable sensitivity and specificity to the cognitive changes associated with dementia syndromes, and the most recent systematic review found insufficient evidence to support the benefit of cognitive screening tools in older adults residing within the community. Consequently, there is a critical need to improve CSI methods, which have not yet incorporated advances in psychometrics, neuroscience, and technology. The primary goal of this article is to provide a framework for transitioning from legacy CSIs to advanced dementia screening measurement. In line with ongoing efforts in neuropsychology and the call for next-generation digital assessment for early detection of AD, we propose a psychometrically advanced (including application of item response theory methods), automated selective assessment model that provides a framework to help propel an assessment revolution. Further, we present a three-phase model for modernizing CSIs and discuss critical diversity and inclusion issues, current challenges in differentiating normal from pathological aging, and ethical considerations.
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Affiliation(s)
| | - Robert M Bilder
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - April Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Benjamin M Hampstead
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucia Cavanagh
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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15
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Kavi A, Kinshella MLW, Ramadurg UY, Charantimath U, Katageri GM, Karadiguddi CC, Honnungar NV, Bannale SG, Mungarwadi GI, Bone JN, Vidler M, Magee L, Mallapur A, Goudar SS, Bellad M, Derman R, von Dadelszen P, Working Group TCI. Community engagement for birth preparedness and complication readiness in the Community Level Interventions for Pre-eclampsia (CLIP) Trial in India: a mixed-method evaluation. BMJ Open 2022; 12:e060593. [PMID: 36600428 PMCID: PMC9772674 DOI: 10.1136/bmjopen-2021-060593] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the process of community engagement (CE) in northern Karnataka, India and its impact on pre-eclampsia knowledge, birth preparedness and complication readiness, pregnancy-related care seeking and maternal morbidity. DESIGN This study was a secondary analysis of a cluster randomised trial of Community Level Interventions for Pre-eclampsia (CLIP). A total of 12 clusters based on primary health centre catchment areas were randomised to intervention or control. CE was conducted in intervention clusters. CE attendance was summarised according to participant group using both quantitative and qualitative assessment. Pre-eclampsia knowledge, birth preparedness, health services engagement and perinatal outcomes was evaluated within trial surveillance. Outcomes were compared between trial arms using a mixed effects logistic regression model on RStudio (RStudio, Boston, USA). Community feedback notes were thematically analysed on NVivo V.12 (QSR International, Melbourne, Australia). SETTING Belagavi and Bagalkote districts in rural Karnataka, India. PARTICIPANTS Pregnant women and women of reproductive age, mothers and mothers-in-law, community stakeholders and male household decision-makers and health workers. RESULTS A total of 1379 CE meetings were conducted with 39 362 participants between November 2014 and October 2016. CE activities may have had an effect on modifying community attitudes towards hypertension in pregnancy and its complications. However, rates of pre-eclampsia knowledge, birth preparedness, health services engagement and maternal morbidities among individual pregnant women were not significantly impacted by CE activities in their area. CONCLUSION Evaluation of our CE programme in India demonstrates the feasibility of reaching pregnant women alongside household decision-makers, community stakeholders and health workers. More research is needed to explore the pathways of impact between broad community mobilisation to strengthen support for maternal care seeking and clinical outcomes of individual pregnant women. TRIAL REGISTRATION NUMBER NCT01911494.
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Affiliation(s)
- Avinash Kavi
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Umesh Y Ramadurg
- Women's and Children's Health Research Unit, S Nijalingappa Medical College, Bagalkote, Karnataka, India
| | - Umesh Charantimath
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Geetanjali M Katageri
- Women's and Children's Health Research Unit, S Nijalingappa Medical College, Bagalkote, Karnataka, India
| | - Chandrashekhar C Karadiguddi
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Narayan V Honnungar
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Shashidhar G Bannale
- Women's and Children's Health Research Unit, S Nijalingappa Medical College, Bagalkote, Karnataka, India
| | - Geetanjali I Mungarwadi
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Jeffrey N Bone
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Magee
- King's College London School of Medical Education, London, UK
| | - Ashalata Mallapur
- Women's and Children's Health Research Unit, S Nijalingappa Medical College, Bagalkote, Karnataka, India
| | - Shivaprasad S Goudar
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Mrutyunjaya Bellad
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Richard Derman
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - The Clip India Working Group
- Women's and Children's Health Research Unit, J N Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Women and Children's Health, King's College London Faculty of Life Sciences and Medicine, London, UK
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16
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Boivin A, Dumez V, Castonguay G, Berkesse A. The Ecology of Engagement: Fostering cooperative efforts in health with patients and communities. Health Expect 2022; 25:2314-2327. [PMID: 35923116 PMCID: PMC9615077 DOI: 10.1111/hex.13571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/20/2022] [Accepted: 07/12/2022] [Indexed: 12/30/2022] Open
Abstract
CONTEXT Patients and community members are engaged in nearly every aspect of health systems. However, the engagement literature remains siloed and fragmented, which makes it difficult to connect engagement efforts with broader goals of health, equity and sustainability. Integrated and inclusive models of engagement are needed to support further transformative efforts. METHODS This article describes the Ecology of Engagement, an integrated model of engagement. The model posits that: (1) Health ecosystems include all members of society engaged in health; (2) Engagement is the 'together' piece of health and healthcare (e.g., caring for each other, preventing, researching, teaching and building policies together); (3) Health ecosystems and engagement are interdependent from each other, both influencing health, equity, resilience and sustainability. CONCLUSION The Ecology of Engagement offers a common sketch to foster dialogue on engagement across health ecosystems. The model can drive cooperative efforts with patients and communities on health, equity, resilience and sustainability. PATIENTS AND PUBLIC CONTRIBUTION Three of the authors have lived experiences as patients. One has a socially disclosed identity as a patient partner leader with extensive experience in engagement (individual care, education, research, management and policy). Two authors have significant experience as patients and informal caregivers, which were mobilized in descriptive illustrations. A fourth author has experience as an engaged citizen in health policy debates. All authors have professional lived experience in health (manager, researcher, health professional, consultant and educator). Six patient and caregiver partners with lived experience of engagement (other than the authors) contributed important revisions and intellectual content.
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Affiliation(s)
- Antoine Boivin
- Canada Research Chair in Partnership with Patients and CommunitiesMontrealQuebecCanada
- Center of Excellence for Partnership with Patients and the Public, Montreal University Hospital Research CenterUniversité de MontréalMontrealQuebecCanada
- Department of Family MedicineUniversité de MontréalMontrealQuebecCanada
| | - Vincent Dumez
- Center of Excellence for Partnership with Patients and the Public, Montreal University Hospital Research CenterUniversité de MontréalMontrealQuebecCanada
- Faculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Geneviève Castonguay
- Canada Research Chair in Partnership with Patients and CommunitiesMontrealQuebecCanada
| | - Alexandre Berkesse
- Center of Excellence for Partnership with Patients and the Public, Montreal University Hospital Research CenterUniversité de MontréalMontrealQuebecCanada
- French School of Public Health (EHESP)RennesFrance
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Barceló NE, Castillo EG, Ijadi-Maghsoodi R, Goodsmith N, Tang L, Okikawa D, Jones F, Williams P, Benitez C, Chung B, Wells KB. Multi-Sector Assessment and Client-Perception of Social Need at Long-Term Follow-Up of a Group-Randomized Trial of Community-Engaged Collaborative Care for Adults with Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10212. [PMID: 36011843 PMCID: PMC9407841 DOI: 10.3390/ijerph191610212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Understanding client perceptions of need for underlying social determinant support may improve services for depression care. This secondary analysis examines perceptions of "social needs" related to housing and employment, financial, and legal (EFL) concerns among individuals with depression. Data were analyzed from Community Partners in Care, a randomized comparative effectiveness trial of multi-sector collaborative care for depression among a sample of people who were predominantly racial/ethnic minorities and low-income. Adults with depression (n = 980) in both interventions were surveyed at 36-month follow-up for (1) being asked about and (2) having social needs for housing or EFL concerns. In multivariate models, life difficulty and mental health visits in non-healthcare sectors predicted being asked about housing and EFL. Lower social determinants of health-related life satisfaction increased the odds of having unmet housing and EFL needs. These findings underscore the role of non-healthcare organizations as community resources for depression care and in screening and addressing social needs.
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Affiliation(s)
| | - Enrico G. Castillo
- Center for Social Medicine and Humanities, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Roya Ijadi-Maghsoodi
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Nichole Goodsmith
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Lingqi Tang
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
| | - David Okikawa
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA 90008, USA
| | - Pluscedia Williams
- Healthy African American Families II, Los Angeles, CA 90008, USA
- The Practice of Community Faculty, Charles R. Drew University of Science and Medicine, Los Angeles, CA 90059, USA
- Lundquist Institute, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA
- Emergency Medicine Palliative Care Access (EMPallA), NYU—Langone Health Care, New York City, NY 10016, USA
| | | | - Bowen Chung
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- Los Angeles County Department of Mental Health, Los Angeles, CA 90020, USA
- Department of Psychiatry, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Los Angeles, CA 90502, USA
| | - Kenneth B. Wells
- UCLA National Clinician Scholars Program, Los Angeles, CA 90024, USA
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Greater Los Angeles Veterans Administration Health System, Los Angeles, CA 90073, USA
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Tieu L, Walton QL, Sherbourne CD, Miranda JM, Wells KB, Tang L, Williams P, Anderson GL, Booker-Vaughns J, Pulido E, Carr T, Heller SM, Bromley E. Life Events, Barriers to Care, and Outcomes Among Minority Women Experiencing Depression: A Longitudinal, Mixed-Method Examination. J Nerv Ment Dis 2022; 210:596-606. [PMID: 35184128 PMCID: PMC9338920 DOI: 10.1097/nmd.0000000000001496] [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] [Indexed: 11/27/2022]
Abstract
ABSTRACT The long-term course of depression is not well-understood among minority women. We assessed depression trajectory, barriers to depression care, and life difficulties among minority women accessing health and social service programs as part of the Community Partners in Care study. Data include surveys ( N = 339) and interviews ( n = 58) administered at 3-year follow-up with African American and Latina women with improved versus persistent depression. The majority of the sample reported persistent depression (224/339, 66.1%), ≥1 barrier to mental health care (226/339, 72.4%), and multiple life difficulties (mean, 2.7; SD, 2.3). Many barriers to care ( i.e. , related to stigma and care experience, finances, and logistics) and life difficulties ( i.e. , related to finances, trauma, and relationships) were more common among individuals reporting persistent depression. Results suggest the importance of past experiences with depression treatment, ongoing barriers to care, and negative life events as contributors to inequities in depression outcomes experienced by minority women.
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Affiliation(s)
- Lina Tieu
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
| | - Quenette L. Walton
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd Room 110HA, Houston, TX, USA
| | | | - Jeanne M. Miranda
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Kenneth B. Wells
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, USA
- RAND Corporation, 1776 Main St, Santa Monica, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
| | - Pluscedia Williams
- Department of Social and Preventive Medicine: Community Engagement, Charles R. Drew University of Medicine & Science,1731 E. 120th St, Los Angeles, CA, USA
| | - Gera L. Anderson
- Asian Americans for Community Involvement, 2400 Moorpark Ave, San Jose, CA, USA
| | - Juanita Booker-Vaughns
- Department of Social and Preventive Medicine: Community Engagement, Charles R. Drew University of Medicine & Science,1731 E. 120th St, Los Angeles, CA, USA
| | - Esmeralda Pulido
- University of Washington Medical Center, 1959 N.W. Pacific St, Seattle, WA, USA
| | - Themba Carr
- Autism Discovery Institute, Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA, USA
| | - S. Megan Heller
- Department of Anthropology, University of California, Los Angeles, 375 Portola Plaza, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, USA
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, USA
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19
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Al-Mondhiry J, D'Ambruoso S, Pietras C, Strouse T, Benzeevi D, Arevian AC, Wells KB. Co-created Mobile Apps for Palliative Care Using Community-Partnered Participatory Research: Development and Usability Study. JMIR Form Res 2022; 6:e33849. [PMID: 35737441 PMCID: PMC9264134 DOI: 10.2196/33849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/28/2022] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background Open design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation. Objective This study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer. Methods In-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback. Results Key themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement. Conclusions The development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation.
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Affiliation(s)
- Jafar Al-Mondhiry
- Division of Medical Oncology, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Sarah D'Ambruoso
- Division of Hematology & Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christopher Pietras
- Palliative Care Program, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Thomas Strouse
- Department of Psychiatry and Biobehavioral Sciences, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Dikla Benzeevi
- UCLA Clinical and Translational Science Institute, Los Angeles, CA, United States
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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20
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Hankerson SH, Moise N, Wilson D, Waller BY, Arnold KT, Duarte C, Lugo-Candelas C, Weissman MM, Wainberg M, Yehuda R, Shim R. The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression. Am J Psychiatry 2022; 179:434-440. [PMID: 35599541 PMCID: PMC9373857 DOI: 10.1176/appi.ajp.21101000] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.
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Affiliation(s)
- Sidney H. Hankerson
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, Department of Population Health Sciences & Policy, 1425 Madison Avenue, New York, NY 10029
| | - Nathalie Moise
- Columbia University Irving Medical Center, Department of Medicine, 622 West 168 Street, PH 9, New York, NY 10032
| | - Diane Wilson
- Icahn School of Medicine at Mount Sinai, New York; Department of Medicine Columbia University Irving Medical Center, New York; City University of New York
| | - Bernadine Y. Waller
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Kimberly T. Arnold
- University of Pennsylvania Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania Center for Public Health Initiatives, University of Pennsylvania Leonard Davis Institute of Health Economics, Penn Presbyterian Medical Center, Andrew Mutch Building, Floor 6, 51 N. 39th Street, Philadelphia, PA 19104
| | - Cristiane Duarte
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Claudia Lugo-Candelas
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Myrna M Weissman
- Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 24, New York, New York 10032
| | - Milton Wainberg
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, The Bronx James J. Peters VA Medical Center, 1 Gustave L. Levy Pl, New York, NY 10029
| | - Ruth Shim
- University of California at Davis, Department of Psychiatry
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21
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Fletcher EH, Gabrielian S, Brown L, Gough JC, Ijadi-Maghsoodi R, Kalofonos I, Nazinyan M, Orellana E, Wells K. Lessons Learned by Collaborating with Structurally Vulnerable Veterans via a Veterans Engagement Group. J Gen Intern Med 2022; 37:109-112. [PMID: 35349015 PMCID: PMC8960678 DOI: 10.1007/s11606-021-07075-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Erica Hua Fletcher
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, USA. .,UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA. .,Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, USA.
| | - Sonya Gabrielian
- UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA.,Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, USA.,Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System Health Services, Los Angeles, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Lidia Brown
- UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA
| | - Juan Carlos Gough
- UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA
| | - Roya Ijadi-Maghsoodi
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, USA.,UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA.,Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System Health Services, Los Angeles, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Ippolytos Kalofonos
- UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA.,Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, USA.,Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System Health Services, Los Angeles, USA.,UCLA Center for Social Medicine and Humanities, Los Angeles, USA
| | - Mariam Nazinyan
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, USA.,UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA.,Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - Erika Orellana
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Kenneth Wells
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, USA.,UCLA/VA Center of Excellence on Veteran Resilience and Recovery, Los Angeles, CA, USA.,Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System Health Services, Los Angeles, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, USA.,UCLA Fielding School of Public Health, Los Angeles, USA
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22
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Knight SJ, Haibach JP, Hamilton AB, Whittle J, Ono SS, Butler J, Flower M, Ray CD, Pugh MJ, Zickmund SL. Veteran Engagement in Health Services Research: a Conceptual Model. J Gen Intern Med 2022; 37:94-98. [PMID: 35349018 PMCID: PMC8993964 DOI: 10.1007/s11606-021-07309-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022]
Abstract
With 20 million living veterans and millions more immediate family members, and approximately 9 million veterans enrolled in the nationally networked VA healthcare system, representing the interests and needs of veterans in this complex community is a substantial endeavor. Based on the importance of engaging Veterans in research, the VA Health Services Research and Development (HSR&D) Service convened a Working Group of VA researchers and Veterans to conduct a review of patient engagement models and develop recommendations for an approach to engage Veterans in health research that would incorporate their unique lived experiences and interests, and their perspectives on research priorities. The Working Group considered the specific context for Veteran engagement in research that includes other VA stakeholders from the operational and clinical leadership of the VA Health Administration (VHA). The resulting model identifies the range of potential stakeholders and three domains of relevant constructs-processes expected to facilitate Veteran engagement in research with other stakeholders, individual stakeholder and external factors, and outcomes. The expectation is that Veteran engagement will benefit research to policy and practice translation, including increasing the transparency of research and producing knowledge that is readily accepted and implemented in healthcare.
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Affiliation(s)
- Sara J Knight
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA. .,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Jeffrey P Haibach
- Veteran Consulting and Research, Eastern Region, USA.,US Department of Veterans Affairs, Washington, DC, USA
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeff Whittle
- Clement J Zablocki VA Medical Center, Medical College of Wisconsin, Center for Advancing Population Science, Milwaukee, WI, USA.,Department of Medicine, Clement J Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA.,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jorie Butler
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA.,Geriatric Research Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Mark Flower
- Department of Medicine, Clement J Zablocki VA Medical Center, Milwaukee, WI, USA.,Veteran Peer Services, Mental Health America of Wisconsin, Milwaukee, WI, USA
| | | | - Mary Jo Pugh
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Susan L Zickmund
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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23
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Derrick T, Mack W, Palinkas L, Kipke M, Javier JR. Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e21867. [PMID: 35175200 PMCID: PMC8895283 DOI: 10.2196/21867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. OBJECTIVE The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. METHODS This study uses a randomized controlled 2-arm individually randomized group treatment pretest-posttest design for 180 parent-child dyads. Individuals are eligible if they are ≥18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics' Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. RESULTS Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. CONCLUSIONS Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. TRIAL REGISTRATION ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21867.
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Affiliation(s)
| | - Wendy Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lawrence Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Michele Kipke
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Division of Research on Child, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Joyce Rivera Javier
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
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24
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Wiles LK, Kay D, Luker JA, Worley A, Austin J, Ball A, Bevan A, Cousins M, Dalton S, Hodges E, Horvat L, Kerrins E, Marker J, McKinnon M, McMillan P, Pinero de Plaza MA, Smith J, Yeung D, Hillier SL. Consumer engagement in health care policy, research and services: A systematic review and meta-analysis of methods and effects. PLoS One 2022; 17:e0261808. [PMID: 35085276 PMCID: PMC8794088 DOI: 10.1371/journal.pone.0261808] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/11/2021] [Indexed: 12/14/2022] Open
Abstract
To assess the effects of consumer engagement in health care policy, research and services. We updated a review published in 2006 and 2009 and revised the previous search strategies for key databases (The Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; PsycINFO; CINAHL; Web of Science) up to February 2020. Selection criteria included randomised controlled trials assessing consumer engagement in developing health care policy, research, or health services. The International Association for Public Participation, Spectrum of Public Participation was used to identify, describe, compare and analyse consumer engagement. Outcome measures were effects on people; effects on the policy/research/health care services; or process outcomes. We included 23 randomised controlled trials with a moderate or high risk of bias, involving 136,265 participants. Most consumer engagement strategies adopted a consultative approach during the development phase of interventions, targeted to health services. Based on four large cluster-randomised controlled trials, there is evidence that consumer engagement in the development and delivery of health services to enhance the care of pregnant women results in a reduction in neonatal, but not maternal, mortality. From other trials, there is evidence that involving consumers in developing patient information material results in material that is more relevant, readable and understandable for patients, and can improve knowledge. Mixed effects are reported of consumer-engagement on the development and/or implementation of health professional training. There is some evidence that using consumer interviewers instead of staff in satisfaction surveys can have a small influence on the results. There is some evidence that consumers may have a role in identifying a broader range of health care priorities that are complementary to those from professionals. There is some evidence that consumer engagement in monitoring and evaluating health services may impact perceptions of patient safety or quality of life. There is growing evidence from randomised controlled trials of the effects of consumer engagement on the relevance and positive outcomes of health policy, research and services. Health care consumers, providers, researchers and funders should continue to employ evidence-informed consumer engagement in their jurisdictions, with embedded evaluation. Systematic review registration: PROSPERO CRD42018102595.
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Affiliation(s)
- Louise K. Wiles
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Debra Kay
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | - Julie A. Luker
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Anthea Worley
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jane Austin
- Health Performance Council, Adelaide, South Australia, Australia
| | - Allan Ball
- National Disability Insurance Agency, Adelaide, South Australia, Australia
| | - Alan Bevan
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | | | - Sarah Dalton
- The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Ellie Hodges
- Lived Experience Representative, Adelaide, South Australia, Australia
| | - Lidia Horvat
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - Ellen Kerrins
- SAHMRI Community Advisory Group, Adelaide, South Australia, Australia
| | - Julie Marker
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | | | - Penelope McMillan
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | - Maria Alejandra Pinero de Plaza
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
| | - Judy Smith
- Royal District Nursing Service, Keswick, South Australia, Australia
| | - David Yeung
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | - Susan L. Hillier
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- * E-mail:
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25
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Abstract
This Open Forum describes the process of integrating personal experience; clinical experience in providing care; and research background, methods, and data in creating an arts project (i.e., an opera) highlighting veterans' resilience and recovery in the context of posttraumatic stress disorder and homelessness. Specifically, an approach of using research interviews to identify storylines and characters for veterans, along with personal and clinical experiences to frame provider characters and stories, is described to illustrate an arts-in-medicine approach to portraying recovery among veterans.
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Affiliation(s)
- Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior Center for Health Services and Society, University of California, Los Angeles, and Healing and Education through the Arts (HEArts), Los Angeles
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26
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Study protocol for comparing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to referral as usual for depression in African American churches. Trials 2022; 23:93. [PMID: 35101100 PMCID: PMC8801931 DOI: 10.1186/s13063-021-05767-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Depression is a leading cause of disability worldwide. African American adults, compared to White adults, are half as likely to be screened for depression in primary care settings. Disparities in depression screening contribute to poor clinical outcomes, as African Americans with depression are more disabled and sicker longer compared to Whites. African American churches are trusted settings that provide access to supports for depression. Indeed, in the first study of its kind, the investigators found that 20% of adults in African American churches screened positive for depression using the Patient Health Questionnaire-9 (PHQ-9). However, no subjects with a positive screen (PHQ-9 ≥ 10) accepted a treatment referral when offered by research personnel. Community Health Workers, who are trusted paraprofessionals from the target community, may bridge the gap between depression screening and treatment. The investigators have trained and certified 112 Community Health Workers from 45 African American churches in New York City to deliver an evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment (SBIRT). Thus, the aim of the current study is to test the impact of Community Health Worker-delivered depression screening in Black churches on engagement with clinical services. Methods Using a hybrid type 1 effectiveness-implementation design, we propose a 2-arm, mixed-methods cluster randomized controlled trial. Church study sites will be randomized to either SBIRT (intervention arm) or referral as usual (usual care arm). This trial will be conducted with 600 church members across 30 churches (300 intervention; 300 usual care). Our primary outcome is treatment engagement, defined as attending a depression-related clinical visit. Secondary outcomes will be changes in Mental Health-Related Quality of Life and depressive symptoms at 3 and 6 months post-screening. Lastly, we will conduct a concurrent, mixed-methods (qualitative-quantitative) process evaluation to assess contextual facilitators and barriers of screening and referral. Discussion This is the first randomized trial of a church-placed, community health worker-delivered intervention for depression in African American populations. This study may provide a novel and effective approach to increasing depression identification and treatment linkage in economically disadvantaged populations with high depression rates. Trial registration ClinicalTrials.govNCT04524767. Registered on 21 August 2020.
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27
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Woodward EN, Willging C, Landes SJ, Hausmann LRM, Drummond KL, Ounpraseuth S, Ball IA, Kirchner JE. Determining feasibility of incorporating consumer engagement into implementation activities: study protocol of a hybrid effectiveness-implementation type II pilot. BMJ Open 2022; 12:e050107. [PMID: 35042705 PMCID: PMC8768923 DOI: 10.1136/bmjopen-2021-050107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Implementation researchers could draw from participatory research to engage patients (consumers of healthcare) in implementation processes and possibly reduce healthcare disparities. There is a little consumer involvement in healthcare implementation, partially because no formal guidance exists. We will create and pilot a toolkit of methods to engage consumers from the US' Veterans Health Administration (VHA) in selecting and tailoring implementation strategies. This toolkit, Consumer Voice, will provide guidance on what, when, where, how and why an implementer might engage consumers in implementing treatments. We will pilot the toolkit by implementing Safety Planning Intervention for suicide prevention with rural veterans, a population with suicide disparities. Safety Planning Intervention is effective for reducing suicidal behaviours. METHODS AND ANALYSIS In Aim 1, we will use participatory approaches and user-centred design to develop Consumer Voice and its methods. In Aim 2, we will pilot Consumer Voice by implementing the Safety Planning Intervention in two clinics serving rural VHA patients. One site will receive a current implementation strategy (Implementation Facilitation) only; the second will receive Implementation Facilitation plus Consumer Voice. We will use mixed methods to assess feasibility and acceptability of Consumer Voice. We will compare sites on preliminary implementation (reach, adoption, fidelity) and clinical outcomes (depression severity, suicidal ideation, suicidal behaviour). In Aim 3, we will evaluate Aim 2 outcomes at 20 months to assess sustained impact. We will gather qualitative data on sustainability of the Safety Planning Intervention. ETHICS AND DISSEMINATION These studies are overseen by the Institutional Review Board at the Central Arkansas Veterans Healthcare System. We plan to use traditional academic modalities of dissemination (eg, conferences, publications). We plan to disseminate findings through meetings with other trainers in implementation practice so they may adopt Consumer Voice. We plan to share results with local community boards.
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Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Sara J Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - Leslie R M Hausmann
- Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen L Drummond
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Irenia A Ball
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
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Zibrowski E, Carr T, McDonald S, Thiessen H, van Dusen R, Goodridge D, Haver C, Marciniuk D, Stobart C, Verrall T, Groot G. A rapid realist review of patient engagement in patient-oriented research and health care system impacts: part one. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:72. [PMID: 34629118 PMCID: PMC8504114 DOI: 10.1186/s40900-021-00299-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Patient-oriented research affords individuals with opportunities to genuinely contribute to health care research as members of research teams. While checklists and frameworks can support academic researchers' awareness of patient engagement methods, less guidance appears available to support their understanding of how to develop and maintain collaborative relationships with their patient partners. This knowledge is essential as patient partners report that the social atmospheres of research teams significantly impacts the quality of their experiences. This study sought to develop theory regarding how academic researchers support and sustain patient engagement in patient-oriented research. METHODS A six-step, rapid realist review was conducted: (1) research question development, (2) preliminary theory development, (3) search strategy development; (4) study selection and appraisal, (4) data extraction, analysis and synthesis (5) identification of relevant formal theories, and (6) theory refinement with stakeholders. Findings were additionally distilled by collective competence theory. RESULTS A program theory was developed from 62 international studies which illuminated mechanisms supporting academic researchers to engage patient partners, contexts supporting these mechanisms, and resources that enabled mechanism activation. Interaction between seven contexts (patient-oriented research belief, prior interaction with a healthcare system, prior interaction with a particular academic researcher, educational background of patient partner, prior experience with patient-oriented research, study type, and time lived in a rural-urban setting) and seven mechanisms (deciding to become involved in patient-oriented research, recognizing valuable experiential knowledge, cultural competence, reducing power differentials, respectful team environment, supporting patient partners to feel valued, and readiness to research) resulted in an intermediate outcome (sense of trust). Trust then acted as an eighth mechanism which triggered the final-level outcome (empowered patient-centred lens). CONCLUSIONS Our theory posits that if patient partners trust they are a member of a supportive team working alongside academic researchers who authentically want to incorporate their input, then they are empowered to draw upon their experiential knowledge of health care systems and contribute as researchers in patient-oriented research. Our theory extends conceptual thinking regarding the importance of trust on patient-oriented research teams, how patient partners' trust is shaped by team interactions, and the role that academic researchers have within those interactions.
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Affiliation(s)
- Elaine Zibrowski
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | | | | | | | - Donna Goodridge
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Charlene Haver
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Darcy Marciniuk
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Christine Stobart
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tanya Verrall
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
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Let Go and Let God: A Study of Religiosity and Depressive Symptoms in the Black Church. Community Ment Health J 2021; 57:1340-1347. [PMID: 33386532 DOI: 10.1007/s10597-020-00757-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to examine the relationship between dimensions of religiosity (organizational, non-organizational, subjective) and depressive symptoms in the Black church. Surveys were administered to attendees of four churches in the northeastern U.S. The Multidimensional Measure of Religious Involvement for African Americans examined religiosity and the Patient Health Questionnaire-8 items assessed depressive symptoms. Logistic regression analysis was employed to examine the relationship between religiosity and depressive symptoms adjusting for potentially influential covariates. Participants reporting high organizational religiosity were significantly more likely to report non-significant depressive symptoms (adjusted odds ratio (AOR) = 1.80, 95% confidence interval (CI) = 1.05, 3.08) in comparison with those reporting low organizational religiosity, when controlling for potentially influential covariates. Our findings suggest that organizational religiosity may be protective against depression. These findings inform the development of initiatives seeking to reduce the burden of depression in the Black church.
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Halvorsrud K, Kucharska J, Adlington K, Rüdell K, Brown Hajdukova E, Nazroo J, Haarmans M, Rhodes J, Bhui K. Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature. J Public Health (Oxf) 2021; 43:197-208. [PMID: 31608396 PMCID: PMC8042368 DOI: 10.1093/pubmed/fdz126] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/03/2019] [Accepted: 09/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background To investigate and address the evidence gap on the effectiveness of co-creation/production in international health research. Methods An initial systematic search of previous reviews published by 22 July 2017 in Medline, Embase, PsycINFO, Scopus and Web of Science. We extracted reported aims, elements and outcomes of co-creation/production from 50 reviews; however, reviews rarely tested effectiveness against intended outcomes. We therefore checked the reference lists in 13 included systematic reviews that cited quantitative studies involving the public/patients in the design and/or implementation of research projects to conduct meta-analyses on their effectiveness using standardized mean difference (SMD). Results Twenty-six primary studies were included, showing moderate positive effects for community functions (SMD = 0.56, 95%CI = 0.29–0.84, n = 11) and small positive effects for physical health (SMD = 0.25, 95%CI = 0.07–0.42, n = 9), health-promoting behaviour (SMD = 0.14, 95%CI = 0.03–0.26, n = 11), self-efficacy (SMD = 0.34, 95%CI = 0.01–0.67, n = 3) and health service access/receipt (SMD = 0.36, 95%CI = 0.21–0.52, n = 12). Non-academic stakeholders that co-created more than one research stage showed significantly favourable mental health outcomes. However, co-creation was rarely extended to later stages (evaluation/dissemination), with few studies specifically with ethnic minority groups. Conclusions The co-creation of research may improve several health-related outcomes and public health more broadly, but research is lacking on its longer term effects.
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Affiliation(s)
- Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Justyna Kucharska
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.,Westminster University, 115 New Cavendich Street, London, W1W 6UW, UK
| | - Katherine Adlington
- East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Homerton Row, London, E9 6SR, UK
| | - Katja Rüdell
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Eva Brown Hajdukova
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - James Nazroo
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - Maria Haarmans
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - James Rhodes
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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Rusch A, DeCamp LM, Liebrecht CM, Choi SY, Dalack GW, Kilbourne AM, Smith SN. A Roadmap to Inform the Implementation of Evidence-Based Collaborative Care Interventions in Communities: Insights From the Michigan Mental Health Integration Partnership. Front Public Health 2021; 9:655999. [PMID: 34109147 PMCID: PMC8180904 DOI: 10.3389/fpubh.2021.655999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Despite increasing calls for further spread of evidence-based collaborative care interventions (EBIs) in community-based settings, practitioner-driven efforts are often stymied by a lack of experience in addressing barriers to community-based implementation, especially for those not familiar with implementation science. The Michigan Mental Health Integration Partnership (MIP) is a statewide initiative that funds projects that support implementation and uptake of EBIs in community-based settings. MIP also provides an in situ implementation laboratory for understanding barriers to the uptake of EBIs across a variety of settings. We report findings from a statewide qualitative study of practitioners involved in MIP projects to garner their perspectives of best practices in the implementation of EBIs. Methods: Twenty-eight semi-structured interviews of practitioners and researchers from six MIP Projects were conducted with individuals implementing various MIP EBI projects across Michigan, including stakeholders from project teams, implementation sites, and the State of Michigan, to identify common barriers, challenges, and implementation strategies deployed by the project teams, with the purpose of informing a set of implementation steps and milestones. Results: Stakeholders identified a number of barriers to and strategies for success, including the need for tailoring program deployment and implementation to specific site needs, development of web-based tools for facilitating program implementation, and the importance of upper-level administration buy-in. Findings informed our resultant community-based Implementation Roadmap, which identifies critical steps across three implementation phases—pre-implementation, implementation, and sustainability—for implementation practitioners to use in their EBI implementation efforts. Conclusion: Implementation practitioners interested in community-based EBI implementation often lack access to operationalized implementation “steps” or “best practices” that can facilitate successful uptake and evaluation. Our community-informed MIP Implementation Roadmap, offering generalized steps for reaching successful implementation, uses experiences from a diverse set of MIP teams to guide practitioners through the practices necessary for scaling up EBIs in community-based settings over pre-implementation, implementation and sustainability phases.
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Affiliation(s)
- Amy Rusch
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | | | - Celeste M Liebrecht
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Seo Youn Choi
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Gregory W Dalack
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States.,U.S. Department of Veterans Affairs, Quality Enhancement Research Initiative, Washington, DC, United States
| | - Shawna N Smith
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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Salerno J, Coleman KJ, Jones F, Peters ES. The ethical challenges and opportunities of implementing engagement strategies in health research. Ann Epidemiol 2021; 59:37-43. [PMID: 33894383 DOI: 10.1016/j.annepidem.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The American College of Epidemiology (ACE) held its 2019 Annual Meeting in Pasadena, California, September 7-10 with a theme of "Real-World Epidemiologic Evidence in Policy and Practice". The ACE Ethics Committee hosted a symposium session at the annual meeting on the ethical challenges of stakeholder engagement in the health research setting. The purpose of this paper is to further examine the design and conduct of stakeholder engagement and reflect on the ethical challenges with the goal of offering best practices and identifying areas where future guidance, critical reflection and teaching may be needed. METHODS Three speakers with diverse affiliations were selected to present on the opportunities and ethical challenges of stakeholder engagement in epidemiology and community health. Dr. K Coleman presented an "Overview of Stakeholder-Engaged Research Strategies" and "Engaging Stakeholders in Retrospective Observational Studies"; Dr. J Salerno presented on "An Ethical Perspective to Optimize Engagement Strategies"; and Ms. F Jones presented on the "Structure of Community-Partnered Participatory Research". RESULTS Three main insights were identified: (1) the need for a unifying framework of ethical principles for the implementation of stakeholder engagement, (2) an expanded set of research activities for stakeholders aligned with their engagement in epidemiology studies, and (3) strengths of a community-based partnership model of stakeholder engagement in community health, known as community-partnered participatory research (CPPR). CONCLUSIONS There is a need to broaden the dialogue and understanding of stakeholder engagement for researchers who are increasingly faced with the ethical challenges of implementing approaches and strategies to engage patients, communities, policy makers and the public as stakeholders. To address current challenges, we offered a unifying framework to guide best practices of stakeholder engagement by integrating the core ethical principles of research conduct involving human subjects with the guiding principles of patient engagement. We shared 2 model overviews of implementing stakeholder engagement: (1) a 4-staged model when implementing stakeholder engagement using an epidemiological study design, (2) a stakeholder engagement model rooted in authentic academic-community partnerships, known as community-partnered participatory research (CPPR) to address depression disparities. By critically reflecting on stakeholder engagement across disciplines and appraising the opportunities and ethical challenges of implementing stakeholder engagement in health research, we have provided insights on how to operationalize, conduct and implement stakeholder engagement and have contributed to moving this important field forward.
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Affiliation(s)
- Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; McMaster Institute for Research on Aging
- Collaborative for Health and Aging, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Edward S Peters
- Epidemiology Program, School of Public Health, Louisiana State University, New Orleans, LA
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Mendel P, O'Hora J, Zhang L, Stockdale S, Dixon EL, Gilmore J, Jones F, Jones A, Williams P, Sharif MZ, Masongsong Z, Kadkhoda F, Pulido E, Chung B, Wells KB. Engaging Community Networks to Improve Depression Services: A Cluster-Randomized Trial of a Community Engagement and Planning Intervention. Community Ment Health J 2021; 57:457-469. [PMID: 32430557 PMCID: PMC7906961 DOI: 10.1007/s10597-020-00632-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 05/06/2020] [Indexed: 11/27/2022]
Abstract
This paper explores the effects of a group-randomized controlled trial, Community Partners in Care (CPIC), on the development of interagency networks for collaborative depression care improvement between a community engagement and planning (CEP) intervention and a resources for services (RS) intervention that provided the same content solely via technical assistance to individual programs. Both interventions consisted of a diverse set of service agencies, including health, mental health, substance abuse treatment, social services, and community-trusted organizations such as churches and parks and recreation centers. Participants in the community councils for the CEP intervention reflected a range of agency leaders, staff, and other stakeholders. Network analysis of partnerships among agencies in the CEP versus RS condition, and qualitative analysis of perspectives on interagency network changes from multiple sources, suggested that agencies in the CEP intervention exhibited greater growth in partnership capacity among themselves than did RS agencies. CEP participants also viewed the coalition development intervention both as promoting collaboration in depression services and as a meaningful community capacity building activity. These descriptive results help to identify plausible mechanisms of action for the CPIC interventions and can be used to guide development of future community engagement interventions and evaluations in under-resourced communities.
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Affiliation(s)
- Peter Mendel
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Jennifer O'Hora
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
| | - Lily Zhang
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
| | - Susan Stockdale
- Greater Los Angeles Veteran's Affairs, Los Angeles, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - Jim Gilmore
- Behavioral Health Services, Gardena, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Andrea Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | | | - Mienah Zulfacar Sharif
- Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Zoe Masongsong
- Healthy African American Families II, Los Angeles, CA, USA
| | - Farbod Kadkhoda
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
| | | | - Bowen Chung
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kenneth B Wells
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, USA
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35
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Goodsmith N, Zhang L, Ong MK, Ngo VK, Miranda J, Hirsch S, Jones F, Wells K, Chung B. Implementation of a Community-Partnered Research Suicide-Risk Management Protocol: Case Study From Community Partners in Care. Psychiatr Serv 2021; 72:281-287. [PMID: 33502218 PMCID: PMC7920897 DOI: 10.1176/appi.ps.202000095] [Citation(s) in RCA: 1] [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 Suicidality is common among participants in clinical trials and health services research, but approaches to suicide risk assessment and mitigation vary widely. Studies involving vulnerable populations with limited access to care raise additional ethical concerns. The authors applied a community-partnered approach to develop and implement a suicide-risk management protocol (SRMP) in a depression study in an underresourced setting in Los Angeles. METHODS Using a community-partnered participatory research framework, the authors designed and adapted the SRMP. Qualitative data regarding SRMP implementation included notes from SRMP development meetings and from study clinicians conducting outreach calls to study participants. Analyses included baseline and 6- and 12-month telephone survey data from 1,018 enrolled adults with moderate to severe depressive symptoms (8-item Patient Health Questionnaire score ≥10), of whom 48% were Black and 40% Latino. RESULTS Community stakeholders prioritized a robust SRMP to ensure participant safety. Features included rapid telephone outreach by study clinicians in all cases of reported recent suicidality and expedited treatment access. Using a suicidality timeframe prompt of "in the past 2 weeks," endorsement of suicidality was common (15% at baseline, 32% cumulative). Midway through the study, the SRMP was modified to assess for present suicidality, which reduced the frequency of clinician involvement. Overall, 318 outreach calls were placed, with none requiring an emergency response. Treatment referrals were provided in 157 calls, and outreach was well received. CONCLUSIONS SRMP implementation in research involving underresourced and vulnerable communities merits additional considerations. Partnering with community stakeholders can facilitate the development of acceptable and feasible SRMP procedures.
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Affiliation(s)
- Nichole Goodsmith
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Lily Zhang
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Michael K Ong
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Victoria K Ngo
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Jeanne Miranda
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Susan Hirsch
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Felica Jones
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Kenneth Wells
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Bowen Chung
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
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Asarnow JR, Hughes J, Cohen D, Berk M, McGrath E, Huey SJ. The Incubator Treatment Development Model: The SAFETY Treatment for Suicidal/Self-Harming Youth. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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IsHak WW, Korouri S, Darwish T, Vanle B, Dang J, Edwards G, Black JT, Aronow H, Kimchi A, Spiegel B, Hedrick R, Chernoff R, Diniz MA, Mirocha J, Manoukian V, Harold J, Ong MK, Wells K, Hamilton M, Danovitch I. Personalized treatments for depressive symptoms in patients with advanced heart failure: A pragmatic randomized controlled trial. PLoS One 2021; 16:e0244453. [PMID: 33412562 PMCID: PMC7790529 DOI: 10.1371/journal.pone.0244453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Heart Failure is a chronic syndrome affecting over 5.7 million in the US and 26 million adults worldwide with nearly 50% experiencing depressive symptoms. The objective of the study is to compare the effects of two evidence-based treatment options for adult patients with depression and advanced heart failure, on depressive symptom severity, physical and mental health related quality of life (HRQoL), heart-failure specific quality of life, caregiver burden, morbidity, and mortality at 3, 6 and 12-months. Methods Trial design. Pragmatic, randomized, comparative effectiveness trial. Interventions. The treatment interventions are: (1) Behavioral Activation (BA), a patient-centered psychotherapy which emphasizes engagement in enjoyable and valued personalized activities as selected by the patient; or (2) Antidepressant Medication Management administered using the collaborative care model (MEDS). Participants. Adults aged 18 and over with advanced heart failure (defined as New York Heart Association (NYHA) Class II, III, and IV) and depression (defined as a score of 10 or above on the PHQ-9 and confirmed by the MINI International Neuropsychiatric Interview for the DSM-5) selected from all patients at Cedars-Sinai Medical Center who are admitted with heart failure and all patients presenting to the outpatient programs of the Smidt Heart Institute at Cedars-Sinai Medical Center. We plan to randomize 416 patients to BA or MEDS, with an estimated 28% loss to follow-up/inability to collect follow-up data. Thus, we plan to include 150 in each group for a total of 300 participants from which data after randomization will be collected and analyzed. Conclusions The current trial is the first to compare the impact of BA and MEDS on depressive symptoms, quality of life, caregiver burden, morbidity, and mortality in patients with depression and advanced heart failure. The trial will provide novel results that will be disseminated and implemented into a wide range of current practice settings. Registration ClinicalTrials.Gov Identifier: NCT03688100.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- * E-mail:
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jonathan Dang
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Gabriel Edwards
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Jeanne T. Black
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Harriet Aronow
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Asher Kimchi
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Brennan Spiegel
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Marcio A. Diniz
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - James Mirocha
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Vicki Manoukian
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - John Harold
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Michael K. Ong
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Kenneth Wells
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Michele Hamilton
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States of America
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Li L, Black WE, Cheung EH, Fisher WS, Wells KB. Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:795-801. [PMID: 32944874 PMCID: PMC7498111 DOI: 10.1007/s40596-020-01317-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Luming Li
- Yale University School of Medicine, New Haven, CT, USA.
| | - Whitney E Black
- Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Erick H Cheung
- University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Weston S Fisher
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Kenneth B Wells
- University of California Los Angeles School of Medicine, Los Angeles, CA, USA
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Abstract
The literature supports the effectiveness of systems-based integrated care models, particularly collaborative care, to improve access, quality of care, and health outcomes for behavioral health conditions. There is growing evidence for the promise of collaborative care to reduce behavioral health disparities for racial and ethnic, low-income, and other at-risk populations. Using rapid literature review, this article highlights what is known about how collaborative care may promote health equity for behavioral health conditions, by reducing disparities in access, quality, and outcomes of care. Further, it explores innovative intervention and engagement strategies to promote behavioral health equity for at-risk groups.
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Affiliation(s)
- Maga E Jackson-Triche
- UCSF Health, UCSF Weill Institute for Neurosciences, 401 Parnassus Avenue, Suite LP 342, San Francisco, CA 94143-2211, USA.
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6560, USA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024-6505, USA; Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA, USA; Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA; California Center for Excellence in Behavioral Health, Greater Los Angeles VA Health System, Los Angeles, CA, USA
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Starks SM, Hankerson SH, Collins PY. Shifting the Policy Paradigm to Achieve Equity. Psychiatr Clin North Am 2020; 43:439-450. [PMID: 32773073 DOI: 10.1016/j.psc.2020.05.004] [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: 11/16/2022]
Abstract
This article offers a brief history of mental health policies that have shaped current inequities in health care financing and service delivery. Mental health has a unique position within the health care system given the pervasive nature of stigma associated with illness; race and ethnicity often amplify this burden. The acknowledgment of disparities in mental health and the development of policies that address the needs of minority groups are relatively recent phenomena. Highlighted are legislative actions that have influenced reforms of the health care landscape. This text outlines opportunities to advance a targeted, community-based approach to mental health policy development.
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Affiliation(s)
- Steven M Starks
- Department of Clinical Sciences, University of Houston College of Medicine, Health 2 Building, 4849 Calhoun Road, Room 6014, Houston, TX 77201-6064, USA.
| | - Sidney H Hankerson
- Columbia University, Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington Schools of Medicine and Public Health, 1959 Northeast Pacific Street, Box 356560, Seattle, WA 98195-6560, USA; Department of Global Health, University of Washington Schools of Medicine and Public Health, 1959 Northeast Pacific Street, Box 356560, Seattle, WA 98195-6560, USA
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Lakatos K, Uy-Smith E. Landscape analysis for a community-designed intervention to enhance early childhood development in San Francisco. Prev Med Rep 2020; 19:101101. [PMID: 32637299 PMCID: PMC7330604 DOI: 10.1016/j.pmedr.2020.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/05/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022] Open
Abstract
To determine the appropriate components for a community-based intervention for early childhood development, a broad series of stakeholder interviews was completed in a three-month period (January-March 2019) and a systematic review of their responses was performed. Additionally, 11 citywide assessment reports for child equity were reviewed and added to the information matrix. We performed this population-based assessment in San Francisco, a dense urban environment with roughly 43,000 children under the age of 5. The city has high rates of income inequity, with roughly half of the children considered to be living in low-income or poverty conditions. Interviews were conducted with 34 stakeholders representing various sectors, including community organizations, government, healthcare, and academia. Nine main concerns surrounding low-income families and children (LIFC) living in San Francisco were extracted from stakeholder interviews. The concerns were divided into subcategories based on a socioecological health model. City-funded, community-based, family resource centers were an identified space for performing an early childhood health intervention supporting LIFC. Furthermore, any proposed intervention to support LIFC must be implemented with a culturally tailored focus, as a one-size-fits-all, clinic-based model is not desired. Community-engaged and culturally specific activities are requested and required for effectively promoting early childhood development in an urban environment. In this article we propose that additional work towards implementing community-based interventions with support from the clinic are needed.
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Affiliation(s)
- Kyle Lakatos
- Department of Family and Community Medicine, University of California, San Francisco, Family Health Center, Zuckerberg San Francisco General, 995 Potrero Ave. Bldg. 80, Ward 83., San Francisco, CA 94110, United States
| | - Elizabeth Uy-Smith
- Department of Family and Community Medicine, University of California, San Francisco, Family Health Center, Zuckerberg San Francisco General, 995 Potrero Ave. Bldg. 80, Ward 83., San Francisco, CA 94110, United States
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Wells KB, Jones F, Norris KC. Applying Community-Partnered Participatory Research Approaches to Develop COVID-19 Solutions. Ethn Dis 2020; 30:433-436. [PMID: 32742147 DOI: 10.18865/ed.30.3.433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Ethn Dis. 2020;30(3):433-436; doi:10.18865/ed.30.3.433
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Affiliation(s)
- Kenneth Brooks Wells
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Department of Health Policy and Management, Fielding School of Public Health at UCLA, Los Angeles, CA.,RAND Corporation Health Program, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Arevian AC, O'Hora J, Rosser J, Mango JD, Miklowitz DJ, Wells KB. Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study. JMIR Mhealth Uhealth 2020; 8:e12655. [PMID: 32723714 PMCID: PMC7424494 DOI: 10.2196/12655] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 08/05/2019] [Accepted: 03/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Mobile technologies hold potential for improving the quality of care and engagement of patients. However, there are considerable challenges in ensuring that technologies are relevant, useful, and engaging. While end users such as patients and providers are increasingly involved in the design of health technologies, there are limited examples of their involvement in directly creating technologies for their personal use. Objective We aim to evaluate the feasibility and acceptability of patients and providers creating mobile texting apps to support treatment goals. Methods In an 11-month usability study, we enrolled 4 providers and 28 patients in an intensive outpatient program for obsessive-compulsive disorder. Patients and providers created their own mobile texting apps using a visual app development platform. A subsample of 10 patients and 4 providers completed a usability measure. Results Participants created a total of 360 unique mobile text messages (1787 total messages sent). There were 4 types of messages identified, including personalized reminders, clinical exposures, interactive prompts, and encouraging/informational messages. A total of 9 out of 10 (90%) patients agreed that the messages were relevant to their recovery, and 8 out of 10 (80%) agreed that the messages were effective at helping complete treatment plans. Conclusions Enabling patients and providers to cocreate apps for their own use by using a visual application platform is feasible and holds potential for increasing the relevance, sustainability, and effectiveness of digital health technologies.
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Affiliation(s)
- Armen C Arevian
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - Jennifer O'Hora
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - James Rosser
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - Joseph D Mango
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - David J Miklowitz
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
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A conversation with Thomas (Tom) R. Belin- 2020 HPSS long-term excellence award winner. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2020; 20:195-207. [PMID: 32837267 PMCID: PMC7328877 DOI: 10.1007/s10742-020-00212-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022]
Abstract
At the 2020 International Conference on Health Policy Statistics held in San Diego, Thomas (Tom) R. Belin was awarded the Long-Term Excellence Award from the Health Policy Statistics Section of the American Statistical Association. Dr. Belin was exceptionally and uniquely qualified for this award. Highlights include his innovative statistical applications for health care research and his substantial contributions to the statistics and health policy communities through mentoring and service. In this interview, we asked Tom to share stories about his upbringing, schooling, and career phases to gain insights into his numerous achievements.
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Parker M, Wallerstein N, Duran B, Magarati M, Burgess E, Sanchez-Youngman S, Boursaw B, Heffernan A, Garoutte J, Koegel P. Engage for Equity: Development of Community-Based Participatory Research Tools. HEALTH EDUCATION & BEHAVIOR 2020; 47:359-371. [PMID: 32437292 PMCID: PMC10792999 DOI: 10.1177/1090198120921188] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We developed a set of four community-based participatory research (CBPR) partnership tools aimed at supporting community-academic research partnerships in strengthening their research processes, with the ultimate goal of improving research outcomes. The aim of this article is to describe the tools we developed to accomplish this goal: (1) the River of Life Exercise; (2) a Partnership Visioning Exercise; (3) a personalized Partnership Data Report of data from academic and community research partners; and (4) a Promising Practices Guide with aggregated survey data analyses on promising CBPR practices associated with CBPR and health outcomes from two national samples of CBPR projects that completed a series of two online surveys. Relying on Paulo Freire's philosophy of praxis, or the cycles of collective reflection and action, we developed a set of tools designed to support research teams in holding discussions aimed at strengthening research partnership capacity, aligning research partnership efforts to achieve grant aims, and recalling and operationalizing larger social justice goals. This article describes the theoretical framework and process for tool development and provides preliminary data from small teams representing 25 partnerships who attended face-to-face workshops and provided their perceptions of tool accessibility and intended future use.
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Fond G, Tinland A, Boucekine M, Girard V, Loubière S, Boyer L, Auquier P. Improving the treatment and remission of major depression in homeless people with severe mental illness: The multicentric French Housing First (FHF) program. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109877. [PMID: 31987919 DOI: 10.1016/j.pnpbp.2020.109877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022]
Abstract
AIMS The objectives of the present study were to determine the rates and associated factors of (i) MDD, (ii) antidepressant prescription and (iii) MDD non-remission in homeless subjects with bipolar disorder (BD) or schizophrenia (SZ). METHODS This multicenter study was conducted in 4 French cities. MDD was defined with the section L of the MINI. Unremitted MDD was defined by current antidepressant treatment and current MDD. RESULTS 700 subjects, mean aged 38 years and 82.5% men were included: 55.4% were diagnosed with MDD but only 10.4% were administered antidepressants. Violent victimization in the past 6 months, alcohol use disorder and current substance abuse disorder were associated with increased rates of MDD. 71.2% antidepressant-treated subjects were unremitted. BD diagnosis and substance abuse disorder were found to be associated with increased risk of unremitted MDD. BD-MDD patients were found to be twice more frequently administered antidepressants than SZ-MDD ones, however the non-remission rates were higher in BD subjects compared to SZ. No antidepressant class and no specific antipsychotic or mood stabilizer has been associated with higher or lower rates of remitted MDD. CONCLUSION MDD seems to be highly prevalent, underdiagnosed and undertreated in BD and SZ homeless subjects. Beyond antidepressants, add-on strategies including complementary agents, lithium, lamotrigine/carbamazepine or anti-inflammatory drugs and the specific care of alcohol and substance use disorders may be recommended to improve the prognosis of this specific population in addition to other interventions including housing and resocialization. Violent victimization is also frequent and should be specifically prevented in this vulnerable population.
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Affiliation(s)
- G Fond
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France.
| | - A Tinland
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France
| | - M Boucekine
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Epidémiologie et Economie de la Santé, Marseille, France
| | - V Girard
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - S Loubière
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Epidémiologie et Economie de la Santé, Marseille, France
| | - L Boyer
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - P Auquier
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France
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Pollock MJ, Wennerstrom A, True G, Everett A, Sugarman O, Haywood C, Johnson A, Meyers D, Sato J, Wells KB, Arevian AC, Massimi M, Berry J, Riefberg L, Onyewuenyi N, Springgate B. Preparedness and Community Resilience in Disaster-Prone Areas: Cross-Sectoral Collaborations in South Louisiana, 2018. Am J Public Health 2020; 109:S309-S315. [PMID: 31505147 DOI: 10.2105/ajph.2019.305152] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To determine how community-based organizations (CBOs) define priorities for bolstering community resilience, challenges in addressing these priorities, and strategies to address challenges.Methods. The Community Resilience Learning Collaborative and Research Network (C-LEARN) is a multiphase study examining opportunities to improve community resilience to the threats of disaster and climate change in South Louisiana. Phase I of C-LEARN involved using the National Health Security Strategy and Implementation Plan for directed content analysis of key informant interviews with CBO representatives from 47 agencies within South Louisiana between February and May 2018.Results. CBO interviewees highlighted the importance of forging relationships and building trust through diverse cross-sector collaborations and partnerships before disasters. Such collaborations and partnerships were shown to tailor disaster response to the needs of particular communities and populations as well as address key challenges such as gaps in information, services, and resources.Conclusions. Our results encourage a culture of community resilience and community preparedness through partnerships and community-engaged strategies. C-LEARN will utilize the results of our interviews in the design of phase II of our agency-level coalition-building intervention.
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Affiliation(s)
- Miranda Joy Pollock
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Ashley Wennerstrom
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Gala True
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Ashley Everett
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Olivia Sugarman
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Catherine Haywood
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Arthur Johnson
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Diana Meyers
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Jennifer Sato
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Kenneth B Wells
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Armen C Arevian
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Michael Massimi
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Jasmine Berry
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Leah Riefberg
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Nkechi Onyewuenyi
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
| | - Benjamin Springgate
- Miranda Joy Pollock, Ashley Wennerstrom, Gala True, Ashley Everett, Olivia Sugarman, Jennifer Sato, Jasmine Berry, Leah Riefberg, Nkechi Onyewuenyi, and Benjamin Springgate are with Louisiana State University Health Sciences Center-New Orleans, School of Medicine, New Orleans. Catherine Haywood is with Louisiana Community Health Outreach Network, New Orleans. Arthur Johnson is with Center for Sustainable Engagement and Development, New Orleans. Diana Meyers is with St Anna's Episcopal Church, New Orleans. Kenneth B. Wells and Armen C. Arevian are with University of California Los Angeles Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA. Michael Massimi is with Barataria-Terrebonne National Estuary, Thibodaux, LA
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Arevian AC, Jones F, Tang L, Sherbourne CD, Jones L, Miranda J. Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016. Am J Public Health 2020; 109:S205-S213. [PMID: 31242001 DOI: 10.2105/ajph.2019.305082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To explore effects of coalitions (Community Engagement and Planning [CEP]) versus technical assistance (Resources for Services [RS]) for depression collaborative care and the effects of social determinants on long-term remission outcomes. Methods. We randomized 95 health care and community programs in Los Angeles County, California, to CEP or RS. In 2010, 1246 depressed (Patient Health Questionnaire [PHQ-8] ≥ 10) adults enrolled and were invited for baseline and 6-, 12-, and 36-month surveys. Of 598 3-year completers, 283 participated at 4 years (2016). We examined effects of CEP versus RS, social factors (e.g., family income, food insecurity) on time to and periods in clinical (PHQ-8 < 10) and community-defined (PHQ-8 < 10 or PHQ-2 < 3; mental health composite score [MCS-12] > 40, or mental wellness) remission during the course of 3 years, and at 4 years. Results. We found that CEP versus RS increased 4-year depression remission and, for women, community-defined remission outcomes during the course of 3 years. Social factors and clinical factors predicted remission. Conclusions. At 4 years, CEP was more effective than RS at increasing depression remission. Public Health Implications. Coalitions may improve 4-year depression remission, while addressing social and clinical factors associated with depression may hold potential to enhance remission.
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Affiliation(s)
- Armen C Arevian
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Felica Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Lingqi Tang
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Cathy D Sherbourne
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Loretta Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Jeanne Miranda
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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Baumann AA, Cabassa LJ. Reframing implementation science to address inequities in healthcare delivery. BMC Health Serv Res 2020; 20:190. [PMID: 32164706 PMCID: PMC7069050 DOI: 10.1186/s12913-020-4975-3] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Research has generated valuable knowledge in identifying, understanding, and intervening to address inequities in the delivery of healthcare, yet these inequities persist. The best available interventions, programs and policies designed to address inequities in healthcare are not being adopted in routine practice settings. Implementation science can help address this gap by studying the factors, processes, and strategies at multiple levels of a system of care that influence the uptake, use, and the sustainability of these programs for vulnerable populations. We propose that an equity lens can help integrate the fields of implementation science and research that focuses on inequities in healthcare delivery. MAIN TEXT Using Proctor et al.' (12) framework as a case study, we reframed five elements of implementation science to study inequities in healthcare. These elements include: 1) focus on reach from the very beginning; 2) design and select interventions for vulnerable populations and low-resource communities with implementation in mind; 3) implement what works and develop implementation strategies that can help reduce inequities in care; 4) develop the science of adaptations; and 5) use an equity lens for implementation outcomes. CONCLUSIONS The goal of this paper is to continue the dialogue on how to critically infuse an equity approach in implementation studies to proactively address healthcare inequities in historically underserved populations. Our examples provide ways to operationalize how we can blend implementation science and healthcare inequities research.
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Affiliation(s)
- Ana A. Baumann
- Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
| | - Leopoldo J. Cabassa
- Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
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Pellecchia M, Beidas RS, Mandell DS, Cannuscio CC, Dunst CJ, Stahmer AC. Parent empowerment and coaching in early intervention: study protocol for a feasibility study. Pilot Feasibility Stud 2020; 6:22. [PMID: 32082608 PMCID: PMC7020349 DOI: 10.1186/s40814-020-00568-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 02/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children’s cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-mediated early interventions for ASD is clinician use of parent coaching and occurs when a clinician actively teaches the parent techniques to improve their child’s functioning. Available evidence suggests that community-based EI clinicians rarely coach parents when working with families of these children, although specific barriers to coaching are unknown. This consistent finding points to the need to develop strategies to improve the use of parent coaching in community EI programs. The purpose of this community-partnered study is to iteratively develop and pilot test a toolkit of implementation strategies designed to increase EI clinicians’ use of parent coaching. Methods This study has four related phases. Phase 1: examine how EI clinicians trained in Project ImPACT, an evidence-based parent-mediated intervention, coach parents of children with ASD. Phase 2: identify barriers and facilitators to clinician implementation of parent coaching by administering validated questionnaires to, and conducting semi-structured interviews with, clinicians, parents, and agency leaders. Phase 3: partner with a community advisory board to iteratively develop a toolkit of implementation strategies that addresses identified barriers and capitalizes on facilitators to improve clinician implementation of evidence-based parent coaching. Phase 4: pilot test the feasibility and effectiveness of the implementation strategy toolkit in improving EI clinicians’ use of parent coaching with nine EI clinicians and parent-child dyads using a multiple-baseline-across-participants single-case design. Discussion Completion of these activities will lead to an in-depth understanding of EI clinicians’ implementation of parent coaching in usual practice following training in an evidence-based parent-mediated intervention, barriers to their implementation of parent coaching, a toolkit of implementation strategies developed through an iterative community-partnered process, and preliminary evidence regarding the potential for this toolkit to improve EI clinicians’ implementation of parent coaching. These pilot data will offer important direction for a larger evaluation of strategies to improve the use of parent coaching for young children with ASD.
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Affiliation(s)
- Melanie Pellecchia
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA
| | - Rinad S Beidas
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA.,2Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.,3Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, USA
| | - David S Mandell
- 1Penn Center for Mental Health, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Floor, Philadelphia, PA 19104, 215-746-1950 USA
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