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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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Collins-Pisano C, Leggett AN, Gambee D, Fortuna KL. Usability, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology-Supported Mental Health Intervention for Family Caregivers of People With Dementia: Field Usability Study. JMIR Hum Factors 2024; 11:e41202. [PMID: 38801660 PMCID: PMC11165281 DOI: 10.2196/41202] [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: 07/18/2022] [Revised: 01/02/2023] [Accepted: 04/13/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. OBJECTIVE The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. METHODS A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. RESULTS The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non-statistically significant improvements in burden, stress, and strain levels. CONCLUSIONS This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms.
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Affiliation(s)
- Caroline Collins-Pisano
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
- Department of Psychology, University of Colorado, Colorado Springs, Colorado Springs, CO, United States
| | - Amanda N Leggett
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - David Gambee
- Department of Psychiatry, Dartmouth College, Hanover, NH, United States
| | - Karen L Fortuna
- Department of Psychiatry, Dartmouth College, Hanover, NH, United States
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Singla DR. Promise of telemedicine for older people with depression and anxiety. Evid Based Nurs 2024:ebnurs-2023-103797. [PMID: 38228385 DOI: 10.1136/ebnurs-2023-103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Daisy R Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry and Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
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Mbao M, Keefe B, Almeida J, Hamilton-Mason J. Care Managers in the Aging Network: Increasing Self-Efficacy in Human Service Providers. J Appl Gerontol 2023:7334648231156134. [PMID: 36786301 DOI: 10.1177/07334648231156134] [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: 02/15/2023] Open
Abstract
One in four older adults has Behavioral Health (BH) concerns, and over 63% are not receiving services. Older adults living in the community depend on the aging network for home- and community-based services and care managers are critical providers in this network. However, most care managers' current education and training are inadequate to care for older adults with BH needs. This study evaluated the effectiveness of training on the perceived self-efficacy of care managers working with older adults with BH needs. The study used a quasi-experimental design with a pre- and post-test approach and convenience sampling (n = 90). We found a significant difference in mean self-efficacy scores, from pre-test (M = 62.31, SD = 10.11) to post-test (M = 65.88, SD = 7.40) related to working with clients with mental health problems. In addition, we found a significant difference between the mean pre-test (M = 59.81, SD = 10.68) and post-test score (M = 65.60, SD = 9.85) related to working with clients with substance use problems.
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Affiliation(s)
- Mbita Mbao
- School of Social Work, Salem State University, Salem, MA, USA
| | - Bronwyn Keefe
- School of Social Work, Boston University, Boston, MA, USA
| | - Joanna Almeida
- School of Social Work, Simmons University, Boston, MA, USA
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Dang L, Ananthasubramaniam A, Mezuk B. Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions. Clin Interv Aging 2022; 17:1037-1056. [PMID: 35855744 PMCID: PMC9288177 DOI: 10.2147/cia.s336301] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/14/2022] [Indexed: 12/02/2022] Open
Abstract
As a major life transition characterized by changes in social, behavioral, and psychological domains, retirement is associated with numerous risk factors that can contribute to the development of depression in later life. Understanding how these risk factors intersect with overall health and functioning can inform opportunities for mental health promotion during this transition. The objective of this review is to summarize the literature on risk and protective factors for depression during retirement transitions, discuss challenges related to appropriate management of depression in later life, and describe opportunities for prevention and intervention for depression relating to retirement transitions, both within and beyond the health care system. Key implications from this review are that 1) the relationship between depression and retirement is multifaceted; 2) while depression is a common health condition among older adults, this syndrome should not be considered a normative part of aging or of retirement specifically; 3) the existing mental health specialty workforce is insufficient to meet the depression management needs of the aging population, and 4) therefore, there is a need for interprofessional and multidisciplinary intervention efforts for preventing and managing depression among older adults. In sum, both healthcare providers, public health practitioners, and community organizations have meaningful opportunities for promoting the mental health of older adults during such major life transitions.
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Affiliation(s)
- Linh Dang
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Landreville P, Gosselin P, Grenier S, Carmichael PH. Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial. BMC Geriatr 2021; 21:324. [PMID: 34022795 PMCID: PMC8140311 DOI: 10.1186/s12877-021-02221-x] [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: 03/04/2021] [Accepted: 04/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults. Methods We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes. Discussion This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce. Trial registration The trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.
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Affiliation(s)
- Philippe Landreville
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec City, Quebec, G1V 0A6, Canada. .,Centre d'Excellence sur le Vieillissement de Québec, Quebec City, Canada. .,VITAM - Centre de Recherche en Santé Durable, Quebec City, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Canada.
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Canada.,Institut Universitaire de Première Ligne en Santé et Services Sociaux (IUPLSSS), Sherbrooke, Canada
| | - Sébastien Grenier
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Canada
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Rodie DJ, Fitzgibbon K, Perivolaris A, Crawford A, Geist R, Levinson A, Mitchell B, Oslin D, Sunderji N, Mulsant BH. The primary care assessment and research of a telephone intervention for neuropsychiatric conditions with education and resources study: Design, rationale, and sample of the PARTNERs randomized controlled trial. Contemp Clin Trials 2021; 103:106284. [PMID: 33476774 DOI: 10.1016/j.cct.2021.106284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
While most patients with depression, anxiety, or at-risk drinking receive care exclusively in primary care settings, primary care providers experience challenges in diagnosing and treating these common problems. Over the past two decades, the collaborative care model has addressed these challenges. However, this model has been adopted very slowly due to the high costs of care managers; inability to sustain their role in small practices; and the perceived lack of relevance of interventions focused on a specific psychiatric diagnosis. Thus, we designed an innovative randomized clinical trial (RCT), the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs). This RCT compared the outcomes of enhanced usual care and a novel model of collaborative care in primary care patients with depressive disorders, generalized anxiety, social phobia, panic disorder, at-risk drinking, or alcohol use disorders. These conditions were selected because they are present in almost a third of patients seen in primary care settings. Innovations included assigning the care manager role to trained lay providers supported by computer-based tools; providing all care management centrally by phone - i.e., the intervention was delivered without any face-to-face contact between the patient and the care team; and basing patient eligibility and treatment selection on a transdiagnostic approach using the same eligibility criteria and the same treatment algorithms regardless of the participants' specific psychiatric diagnosis. This paper describes the design of this RCT and discusses the rationale for its main design features.
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Affiliation(s)
- David J Rodie
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea Levinson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, United States of America
| | - Nadiya Sunderji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults. Geriatrics (Basel) 2019; 4:geriatrics4040059. [PMID: 31640232 PMCID: PMC6960766 DOI: 10.3390/geriatrics4040059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022] Open
Abstract
Primary care practices lack the time, expertise, and resources to perform traditional comprehensive geriatric assessment. In particular, they need methods to improve their capacity to identify and care for older adults with complex care needs, such as cognitive impairment. As the US population ages, discovering strategies to address these complex care needs within primary care are urgently needed. This article describes the development of an innovative, team-based model to improve the diagnosis and care of older adults with cognitive impairment in primary care practices. This model was developed through a mentoring process from a team with expertise in geriatrics and quality improvement. Refinement of the existing assessment process performed during routine care allowed patients with cognitive impairment to be identified. The practice team then used a collaborative workflow to connect patients with appropriate community resources. Utilization of these processes led to reduced referrals to the geriatrics specialty clinic, fewer patients presenting in a crisis to the social worker, and greater collaboration and self-efficacy for care of those with cognitive impairment within the practice. Although the model was initially developed to address cognitive impairment, the impact has been applied more broadly to improve the care of older adults with multimorbidity.
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