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Greenwald R, Camden AA, Gamache N, Lasser KA, Chapman R, Rattner B. Intensive trauma-focused therapy with victims of crime. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2020.100146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Masters GA, Li N, Lapane KL, Liu SH, Person SD, Byatt N. Utilization of Health Care Among Perinatal Women in the United States: The Role of Depression. J Womens Health (Larchmt) 2020; 29:944-951. [PMID: 32077784 PMCID: PMC7371545 DOI: 10.1089/jwh.2019.7903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Individuals with depression have increased nonpsychiatric health care utilization. Associations between depression and utilization have not been studied in perinatal women, despite their heightened depression risk. We examined patterns of nonpsychiatric health care utilization by symptoms of perinatal depression, expecting more frequent use of acute services while being less likely to have routine medical care. Materials and Methods: We identified 1,103 perinatal participants from the 2005 to 2016 National Health and Nutrition Examination Surveys. The Patient Health Questionnaire was used to identify depression (score ≥10). We evaluated associations between perinatal depressive symptoms and health care utilization using logistic models and relative excess risk due to interaction (RERI) using adjusted models with appropriate weighting to provide national estimates. Results: Among perinatal U.S. women, 7.3% had depressive symptoms. Relative to those without these symptoms, women experiencing depressive symptoms were younger, more impoverished, and uninsured (p < 0.05). Women with depressive symptoms, compared with those without them, had twice the odds of being without routine medical care (21.6% vs. 12.5%, adjusted odds ratio [aOR]: 2.1, 95% confidence interval [CI]: 1.1 to 4.1) and of using urgent care more frequently (26.5% vs. 15.1%, aOR: 1.9, 95% CI: 1.0 to 3.9). Depressive symptoms combined with lack of insurance generally increased the odds of not having routine care (RERI: 8.4, 95% CI: -0.5 to 17.3) and more frequent use of urgent care (RERI: 7.1, 95% CI: -2.7 to 17.0). Conclusions: Perinatal depression is a prevalent, high-risk illness that requires more nonpsychiatric services and increased psychiatric care. Approaches that facilitate establishing a place for routine care and decreasing acute care use are necessary.
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Affiliation(s)
- Grace A. Masters
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nienchen Li
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sharina D. Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts
- UMass Memorial Health Care, Worcester, Massachusetts
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Abouljoud M, Ryan M, Eshelman A, Bryce K, Jesse MT. Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm. J Clin Psychol Med Settings 2018; 25:267-277. [PMID: 29468571 DOI: 10.1007/s10880-017-9532-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient's presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.
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Affiliation(s)
- Marwan Abouljoud
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Michael Ryan
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Anne Eshelman
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Kelly Bryce
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA.
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA.
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, 48202, USA.
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Kass AE, Balantekin KN, Fitzsimmons-Craft EE, Jacobi C, Wilfley DE, Taylor CB. The economic case for digital interventions for eating disorders among United States college students. Int J Eat Disord 2017; 50:250-258. [PMID: 28152203 PMCID: PMC5391044 DOI: 10.1002/eat.22680] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are serious health problems affecting college students. This article aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. METHODS Using a payer perspective, we estimated the costs of (1) delivering an online guided self-help (GSH) intervention to individuals with EDs, including the costs of "stepping up" the proportion expected to "fail"; (2) delivering an online preventive intervention compared to a "wait and treat" approach to individuals at ED risk; and (3) applying the stepped care model across a population of 1,000 students, compared to standard care. RESULTS Combining results for online GSH and preventive interventions, we estimated a stepped care model would cost less and result in fewer individuals needing in-person psychotherapy (after receiving less-intensive intervention) compared to standard care, assuming everyone in need received intervention. CONCLUSIONS A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses. Model assumptions highlight the complexities of cost calculations to inform resource allocation, and considerations for a disseminable delivery model are presented. Efforts are needed to systematically measure the costs and benefits of a stepped care model for EDs on college campuses, improve the precision and efficacy of ED interventions, and apply these calculations to non-US care systems with different cost structures.
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Affiliation(s)
- Andrea E. Kass
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA,Address correspondence to: Andrea E. Kass, Ph.D.; The University of Chicago, 5841 S. Maryland Avenue, MC 1000, Chicago, IL 60637; Telephone: 773-702-4186;
| | | | | | - Corinna Jacobi
- Technische Universität Dresden, Klinische Psychologie und Psychotherapie, Dresden, Germany
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University, Palo Alto, CA, and Stanford University, Stanford, Ca, USA
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Jiménez J, Rivera D, Benítez P, Tarrats H, Ramos A. Integrating mental health services into a general hospital in Puerto Rico. J Clin Psychol Med Settings 2014; 20:294-301. [PMID: 23543328 DOI: 10.1007/s10880-012-9352-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The prevalence of mental health problems in the general population should be carefully considered. The literature has reported a high co-morbidity of medical and mental illnesses; therefore, collaborative efforts incorporating psychological services into medical settings are imperative. In Puerto Rico, this is not a regular practice in general hospitals. Improving access to mental health services is a challenge and requires the creation of new venues within the healthcare system. This paper describes the theoretical framework, mission, and objectives of the Clinical Psychology Services Program (CPSP) implemented at Damas Hospital in Puerto Rico. From December 2002 to December 2010, a total of 13,580 visits were made to inpatients in diverse clinical units of the hospital; 61% of all inpatients evaluated met the criteria for at least one mental health disorder based on the DSM-IV-TR. The CPSP's outcomes highlight the acceptance and relevance of incorporating mental health services and clinical psychologists into general hospitals.
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Affiliation(s)
- J Jiménez
- Clinical Psychology Department, Ponce School of Medicine and Health Sciences, P.O. Box 7004, Ponce, PR 00732-7004, USA.
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Fox MA, Hodgson JL, Lamson AL. Integration: Opportunities and Challenges for Family Therapists in Primary Care. CONTEMPORARY FAMILY THERAPY 2012. [DOI: 10.1007/s10591-012-9189-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brosig CL. Commentary: the use of health and behavior codes in a pediatric cardiology setting. J Pediatr Psychol 2012; 37:514-8. [PMID: 22262918 DOI: 10.1093/jpepsy/jsr125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Statewide initiative of intensive psychiatric rehabilitation: outcomes and relationship to other mental health service use. Psychiatr Rehabil J 2011; 35:9-19. [PMID: 21768073 DOI: 10.2975/35.1.2011.9.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examines the outcomes of a statewide implementation of Intensive Psychiatric Rehabilitation (IPR) for improving residential and employment status and earnings among individuals with severe mental illnesses and also examines its implementation with respect to mental health service utilization and costs. METHODS This study employs a pre-post design with participants acting as their own controls for rehabilitation outcomes (residential status, vocational outcomes and earnings) comparing those who "completed" or had a sufficiently intense dose of IPR (one year) to those who dropped out early (before six months of service) and those who dropped out later in service (6-12 months). A separate analysis was conducted examining the relationship of IPR to other mental service use and costs using a quasi-experimental design that contrasted IPR completers with a control group matched via propensity scores. RESULTS The results suggested significant improvement in residential status, employment status and gross monthly earnings for IPR completers relative to other groups. IPR completers also tended to use more mental health services or have more shallow decreases in use and cost of services relative to matched controls. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Gains in rehabilitation outcomes can be expected for those who engage in and complete IPR services, but IPR cannot be expected to result in reduced overall mental health service use and costs. Rather, IPR may improve service access or perhaps ameliorate any containment effect of managed care on service use.
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Integrated primary care: an inclusive three-world view through process metrics and empirical discrimination. J Clin Psychol Med Settings 2008; 16:21-30. [PMID: 19294518 DOI: 10.1007/s10880-008-9137-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022]
Abstract
Integrating behavioral health services within the primary care setting drives higher levels of collaborative care, and is proving to be an essential part of the solution for our struggling American healthcare system. However, justification for implementing and sustaining integrated and collaborative care has shown to be a formidable task. In an attempt to move beyond conflicting terminology found in the literature, we delineate terms and suggest a standardized nomenclature. Further, we maintain that addressing the three principal worlds of healthcare (clinical, operational, financial) is requisite in making sense of the spectrum of available implementations and ultimately transitioning collaborative care into the mainstream. Using a model that deconstructs process metrics into factors/barriers and generalizes behavioral health provider roles into major categories provides a framework to empirically discriminate between implementations across specific settings. This approach offers practical guidelines for care sites implementing integrated and collaborative care and defines a research framework to produce the evidence required for the aforementioned clinical, operational and financial worlds of this important movement.
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