Impact of Collaborative Documentation on Completeness and Length of Clinical Notes in Behavioral Health Settings

OBJECTIVE

This study aimed to examine differences in community mental health visit notes before and after initiation of collaborative documentation, a practice in which clinicians and consumers jointly document clinical encounters.

METHODS

Using a clinical informatics approach, the authors sampled visit notes (N=1,875) from nine providers in one mental health clinic. The authors compared notes from before and after the implementation of collaborative documentation by using fixed-effects regression models, controlling for therapist-level effects.

RESULTS

Significant changes in visit note structure were found after the implementation of collaborative documentation. Most sections (N=6 of 10) contained more information (i.e., higher word and character counts) after collaborative documentation implementation, but sections describing a client's feelings were less likely to have any content (OR=0.01, p<0.001).

CONCLUSIONS

These findings demonstrate that collaborative documentation influences clinical notes, providing much-needed research about a widely adopted practice in community mental health settings.

Factors Associated With Indirect Exposure to and Knowledge of Fentanyl Among Youth

PURPOSE

Using data from an online assessment of youth in the United States, this study examined factors associated with youth's indirect exposure to fentanyl; factors related to youth's level of knowledge of fentanyl; and sources of substance use information obtained by youth.

METHODS

This is a secondary analysis of data from a cross-sectional online assessment of youth ages 13 to 18 in the United States in 2022. Participants self-reported on substance use knowledge and concerns, indirect exposure to substance use, access to substance use information and resources, the extent to which youth discussed drug use harms with someone, and COVID-related stress.

RESULTS

Analyses revealed that most youth did not have knowledge of fentanyl even though they reported indirect likely exposure to fentanyl. Youth concerned about alcohol or drug use in their own life were less likely to have knowledge of fentanyl and more likely to know someone who, if using drugs, would likely be exposed to fentanyl. A significant risk factor of indirect likely exposure to fentanyl was COVID-related stress. Prevalent sources of information included the internet, social media, friends or peers, and school classes.

DISCUSSION

While youth may have close proximity to fentanyl exposure and a degree of understanding of fentanyl, there is a general lack of knowledge of the substance, a critical gap that future substance use prevention initiatives could fill.

Recency of Cannabis Vaping in Sexual Minorities in Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study

BACKGROUND

Cannabis vaping is increasing in the United States. Among populations at-risk are sexual minorities (SM) who are more likely to vape cannabis compared to their heterosexual counterparts. Cannabis vaping has been associated with negative health outcomes and concomitant use of other substances with increased risk with more recent use.

OBJECTIVES

This study examined the association between SM identification and recency of cannabis vaping (the last occasion that a participant used their vape device with cannabis) and number of puffs (the count of puffs that the participant took during their most recent use of their vape device with cannabis) using Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study.

RESULTS

In a weighted sample of participants who reported ever vaping cannabis (N = 5,331), 15% identified as SM, about 60% vaped cannabis in the past 3 or more days, and the mean number of puffs was 2 (SE = 0.17). Using multinomial logistic regression and zero-inflated negative binomial regression, the results showed that compared to heterosexual adults who reported not recently vaping cannabis, SM had higher probabilities of vaping cannabis in the past 3 or more days, 1-2 days, and the day of interview.

CONCLUSION

SM individuals were more likely to recently vape cannabis, placing them at higher risk for respiratory diseases and use of other substances. Public health researchers and practitioners need to identify reasons for cannabis vaping in this population and implement targeted public health messaging to inform SM communities of the potential health effects of cannabis vaping.

Perspectives on the implementation and collaborative facilitation of an intervention to engage young adults in psychiatric rehabilitation

OBJECTIVE

Increasing service user involvement and collaboration with providers has become an important facet of the recovery movement. This study explored perspectives on the implementation and delivery of an intervention (Just Do You [JDY]) designed to improve treatment engagement among marginalized young adults diagnosed with serious mental illnesses.

METHOD

Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted in-depth interviews (N = 11) with nine participants that included agency leaders, clinical providers, and researchers involved with the planning, delivery, and evaluation of JDY. We used grounded theory coding techniques and constant comparison to develop themes that capture the data on implementation and collaboration related to the delivery of JDY.

RESULTS

Two broad themes emerged: (a) collaboration between the clinician and person with lived experience and (b) collaborative culture within and between organizations. Findings capture how collaboration occurred between providers within the clinical encounter (e.g., combined strengths of clinicians and peers) and within and between organizations, clustering around several CFIR domains (e.g., inner setting, process, characteristics of individuals, intervention characteristics). Findings speak to the importance of a "culture of collaboration" in which collaboration is occurring across multiple levels of an organization to support the delivery and implementation of JDY.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

JDY can complement other collaborative approaches given its focus on improving initial engagement. Findings point to the perceived benefits of interventions that are facilitated by a clinician and a person with lived experience along with how their combined expertise can support recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Developing a Tool to Measure Person-Centered Care in Service Planning

Background: Delivering person-centered care is a key component of health care reform. Despite widespread endorsement, medical and behavioral health settings struggle to specify and measure person-centered care objectively. This study presents the validity and reliability of the Person-Centered Care Planning Assessment Measure (PCCP-AM), an objective measure of the extent to which service planning is person-centered. Methods: Based upon the recovery-oriented practice of person-centered care planning, the 10-item PCCP-AM tool rates service plans on the inclusion of service user strengths, personal life goals, natural supports, self-directed actions and the promotion of community integration. As part of a large randomized controlled trial of person-centered care planning, service plans completed by community mental health clinic providers were rated using the PCCP-AM. Reliability was tested by calculating inter-rater reliability across 168 plans and internal consistency across 798 plans. To test concurrent validity, PCCP-AM scores for 84 plans were compared to expert rater scores on a separate instrument. Results: Interrater reliability for each of the 10 PCCP-AM items as measured by Kendall's W ranged from W = 0.77 to W = 0.89 and percent of scores within ± 1 point of each other ranged from 85.7 to 100%. Overall internal consistency as measured by Cronbach's alpha across 798 plans was α = 0.72. Concurrent validity as measured by Kendall's W ranged from W = 0.55 to W = 0.74 and percent of item scores within ± 1 point of expert rater scores ranged from 73.8 to 86.8%. Conclusions: Findings demonstrated that the 10-item PCCP-AM was a valid and reliable objective measure of person-centered care. Using the service plan as an indicator of multiple domains of person-centered care, the measure provides a valuable tool to inform clinical supervision and quality improvement across programs. More psychometric testing is needed to strengthen the measure for research purposes.