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Heilemann MV, Lai J, Cadiz MP, Meza JI, Flores Romero D, Wells KB. Community Members' Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis. JMIR Form Res 2024; 8:e55517. [PMID: 38526558 PMCID: PMC11002734 DOI: 10.2196/55517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. OBJECTIVE This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. METHODS After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. RESULTS Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) "Feels like home"-experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) "It's a one-stop-shop"-judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. CONCLUSIONS The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too "professional" or "clinical." The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma.
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Affiliation(s)
- MarySue V Heilemann
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jianchao Lai
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Madonna P Cadiz
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jocelyn I Meza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniela Flores Romero
- Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kenneth B Wells
- Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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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 2024:10.1007/s10597-024-01248-9. [PMID: 38517645 DOI: 10.1007/s10597-024-01248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jones AL, Chu K, Rose DE, Gelberg L, Kertesz SG, Gordon AJ, Wells KB, Leung L. Quality of Depression Care for Veterans Affairs Primary Care Patients with Experiences of Homelessness. J Gen Intern Med 2023; 38:2436-2444. [PMID: 36810631 PMCID: PMC10465405 DOI: 10.1007/s11606-023-08077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Persons who experience homelessness (PEH) have high rates of depression and incur challenges accessing high-quality health care. Some Veterans Affairs (VA) facilities offer homeless-tailored primary care clinics, although such tailoring is not required, within or outside VA. Whether services tailoring enhances care for depression is unstudied. OBJECTIVE To determine whether PEH in homeless-tailored primary care settings receive higher quality of depression care, compared to PEH in usual VA primary care. DESIGN Retrospective cohort study of depression treatment among a regional cohort of VA primary care patients (2016-2019). PARTICIPANTS PEH diagnosed or treated for a depressive disorder. MAIN MEASURES The quality measures were timely follow-up care (3 + completed visits with a primary care or mental health specialist provider, or 3 + psychotherapy sessions) within 84 days of a positive PHQ-2 screen result, timely follow-up care within 180 days, and minimally appropriate treatment (4 + mental health visits, 3 + psychotherapy visits, 60 + days antidepressant) within 365 days. We applied multivariable mixed-effect logistic regressions to model differences in care quality for PEH in homeless-tailored versus usual primary care settings. KEY RESULTS Thirteen percent of PEH with depressive disorders received homeless-tailored primary care (n = 374), compared to usual VA primary care (n = 2469). Tailored clinics served more PEH who were Black, who were non-married, and who had low income, serious mental illness, and substance use disorders. Among all PEH, 48% received timely follow-up care within 84 days of depression screening, 67% within 180 days, and 83% received minimally appropriate treatment. Quality metric attainment was higher for PEH in homeless-tailored clinics, compared to PEH in usual VA primary care: follow-up within 84 days (63% versus 46%; adjusted odds ratio [AOR] = 1.61, p = .001), follow-up within 180 days (78% versus 66%; AOR = 1.51, p = .003), and minimally appropriate treatment (89% versus 82%; AOR = 1.58, p = .004). CONCLUSIONS Homeless-tailored primary care approaches may improve depression care for PEH.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center and Vulnerable Veteran Innovative Patient-Aligned Care Team (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, 84148, USA.
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Lillian Gelberg
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Stefan G Kertesz
- Birmingham VA Health Care System, Birmingham, AL, USA
- Heersink University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center and Vulnerable Veteran Innovative Patient-Aligned Care Team (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, 84148, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kenneth B Wells
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Center for Health Services and Society, Los Angeles, CA, USA
| | - Lucinda Leung
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and Veterans Assessment and Improvement Laboratory (VAIL), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California-Los Angeles (UCLA), Los Angeles, CA, USA
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Abstract
There is an emerging literature on research interviews to inform arts projects, but little on opera. This case study illustrates how research data informed an opera on Veteran recovery. Deidentified interviews were selected from 280 adults with a history of depression at 10-year follow-up to a randomized trial. Interviews were used to inform characters, storyline, and libretto. Ethical strategies included: changing details and merging stories and characters to create two Veterans and one spouse as leads, a storyline, and choral passages, with a focus on recovery from post-traumatic stress and homelessness. To engage a broad audience and address stigma, accessible composition techniques (melody, harmony) were used. We found that qualitative/mixed data can inform libretto and composition for an opera on Veteran recovery, through integrating art and health science.
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Affiliation(s)
- Kenneth B Wells
- UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,UCLA Fielding School of Public Health, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA, USA
| | | | - Joseph Mango
- UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
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6
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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Palinkas LA, O’Donnell M, Kemp S, Tiatia J, Duque Y, Spencer M, Basu R, Del Rosario KI, Diemer K, Doma B, Forbes D, Gibson K, Graff-Zivin J, Harris BM, Hawley N, Johnston J, Lauraya F, Maniquiz NEF, Marlowe J, McCord GC, Nicholls I, Rao S, Saunders AK, Sortino S, Springgate B, Takeuchi D, Ugsang J, Villaverde V, Wells KB, Wong M. Regional Research-Practice-Policy Partnerships in Response to Climate-Related Disparities: Promoting Health Equity in the Pacific. Int J Environ Res Public Health 2022; 19:9758. [PMID: 35955120 PMCID: PMC9368677 DOI: 10.3390/ijerph19159758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Although climate change poses a threat to health and well-being globally, a regional approach to addressing climate-related health equity may be more suitable, appropriate, and appealing to under-resourced communities and countries. In support of this argument, this commentary describes an approach by a network of researchers, practitioners, and policymakers dedicated to promoting climate-related health equity in Small Island Developing States and low- and middle-income countries in the Pacific. We identify three primary sets of needs related to developing a regional capacity to address physical and mental health disparities through research, training, and assistance in policy and practice implementation: (1) limited healthcare facilities and qualified medical and mental health providers; (2) addressing the social impacts related to the cooccurrence of natural hazards, disease outbreaks, and complex emergencies; and (3) building the response capacity and resilience to climate-related extreme weather events and natural hazards.
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Affiliation(s)
- Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Meaghan O’Donnell
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Susan Kemp
- School of Counseling, Human Services and Social Work, University of Auckland, Auckland 1010, New Zealand
| | - Jemaima Tiatia
- Te Wānanga o Waipapa, School of Māori Studies and Pacific Studies at the University of Auckland, Auckland 1010, New Zealand
| | - Yvonette Duque
- Asian Disaster Preparedness Center, Bangkok 10400, Thailand
| | - Michael Spencer
- School of Social Work, University of Washington, Seattle, WA 98195, USA
| | - Rupa Basu
- Office of Environmental Health Hazard Assessment (OEHHA), California Environmental Protection Agency, Sacramento, CA 95812, USA
| | | | - Kristin Diemer
- School of Social Work, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Bonifacio Doma
- Department of Chemical Engineering, Mapua University, Manila 1102, Philippines
| | - David Forbes
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Kari Gibson
- Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Joshua Graff-Zivin
- School of Global Policy and Strategy, University of California, San Diego, CA 92093, USA
| | - Bruce M. Harris
- Provincial Government of New Ireland, Kavieng 631, Papua New Guinea
| | - Nicola Hawley
- Department of Epidemiology and Chronic Disease, School of Public Health, Yale University, New Haven, CT 06520, USA
| | - Jill Johnston
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Fay Lauraya
- Office of the President, University of Nueva Caceres, Naga 4400, Philippines
| | | | - Jay Marlowe
- School of Counseling, Human Services and Social Work, University of Auckland, Auckland 1010, New Zealand
| | - Gordon C. McCord
- School of Global Policy and Strategy, University of California, San Diego, CA 92093, USA
| | - Imogen Nicholls
- International Organization for Migration, Canberra, ACT 2601, Australia
| | - Smitha Rao
- College of Social Work, Ohio State University, Columbus, OH 43210, USA
| | | | - Salvatore Sortino
- International Organization for Migration, Majuro 96960, Marshall Islands
| | - Benjamin Springgate
- School of Medicine, LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA
- School of Public Health, LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA
| | - David Takeuchi
- School of Social Work, University of Washington, Seattle, WA 98195, USA
| | - Janette Ugsang
- Asian Disaster Preparedness Center, Bangkok 10400, Thailand
| | - Vivien Villaverde
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Kenneth B. Wells
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
| | - Marleen Wong
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Skrine Jeffers K, Mango JD, Tang L, Saks ER, Wells KB, Chung B. Impact of Opera on Mental Health Stigma: Pilot of Provider/Community Workshop. Community Ment Health J 2022; 58:992-999. [PMID: 34851491 PMCID: PMC9187532 DOI: 10.1007/s10597-021-00908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/22/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Arts can influence mental health stigma, but little is known about impact of operas. We examined effects of a two-opera workshop on complicated grief and schizophrenia. METHODS Pre-post audience surveys with post-workshop discussion. The primary outcome was a 4-item measure of willingness to engage with persons with grief or schizophrenia. Secondary outcomes were perceptions of art affecting stigma and stigma mediators. Of 47 participants, 33 had pre-post surveys for both operas. RESULTS There was a significant pre-post opera increase in audience willingness to engage with persons with grief or schizophrenia (p < .001). Perceptions of impact on mediators such as empathy, were significantly greater for the opera on schizophrenia relative to grief (p < .001).. CONCLUSION The pre- to post increase in audience willingness to engage with affected persons (primary) with greater impact on secondary mediators for the schizophrenia opera and post-discussion suggest that operas may be a forum for addressing mental health stigma and promoting empathy.
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Affiliation(s)
- Kia Skrine Jeffers
- UCLA School of Nursing, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA.
- Center for the Study of Racism, Social Justice & Health, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Joseph D Mango
- HEArts Program, Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Lingqi Tang
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Elyn R Saks
- Psychology, and Psychiatry and the Behavioral Sciences, USC Gould School of Law, Los Angeles, CA, USA
- Saks Institute for Mental Health Law, Policy and Ethics, USC Gould School of Law, Los Angeles, CA, USA
| | - Kenneth B Wells
- HEArts Program, Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Greater Los Angeles Veterans Administration Health System, Los Angeles, CA, USA
| | - Bowen Chung
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
- Department of Psychiatry, Harbor-UCLA Medical Center, Los Angeles, CA, USA
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Agonafer EP, Jones F, Jones A, Carson S, Richards DL, Scannell C, Soderlund PD, Wells KB. Communities for Wellness Equity: Implementing a Partnered Symposium to Identify Social Determinants of Health Priorities. Prog Community Health Partnersh 2022; 16:105-117. [PMID: 35342115 DOI: 10.1353/cpr.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Social determinants of health (SDoH) affect under-resourced communities. Such communities are seldom involved in defining and prioritizing local SDoH for policy action. OBJECTIVES Apply community-partnered, participatory research (CPPR) to identify community stakeholder priorities for addressing SDoH in South Los Angeles. METHODS Over 10 months, CPPR was applied to develop a multi-sector partnership and working group to plan and host a symposium for community stakeholders. 148 individuals and 16 organizations participated and engaged in focus and symposium-wide discussions. Themes were identified through collaborative inductive content analysis.Results and Lessons Learned: Participants identified ten specific SDoH, such as housing, with structural racism and discrimination as the underlying cause. CONCLUSIONS Using CPPR to gain community members' insight about local factors that drive individual and community health is feasible and viewed by the community as socially responsible, suggesting it holds promise to address root causes of health inequality in under-resourced communities.
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12
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Leung LB, Chu K, Rose D, Stockdale S, Post EP, Wells KB, Rubenstein LV. Electronic Population-Based Depression Detection and Management Through Universal Screening in the Veterans Health Administration. JAMA Netw Open 2022; 5:e221875. [PMID: 35267029 PMCID: PMC8914576 DOI: 10.1001/jamanetworkopen.2022.1875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In 2016, the US Preventive Services Task Force newly recommended universal screening for depression, with the expectation that screening would be associated with appropriate treatment. Few studies have been able to assess the population-based trajectory from screening to receipt of follow-up and treatment for individuals with depression. OBJECTIVE To examine adherence to guidelines for follow-up and treatment among primary care patients who newly screened positive for depression in the Veterans Health Administration (VA). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used VA electronic data to identify patients who newly screened positive for depression on the 2-item Patient Health Questionnaire at 82 primary care VA clinics in California, Arizona, and New Mexico between October 1, 2015, and September 30, 2019. Data analysis was performed from December 2020 to August 2021. MAIN OUTCOMES AND MEASURES Receipt of guideline-concordant care for screen-positive patients who were determined by clinicians as having depression was assessed. Timely follow-up (within 84 days of screening) was defined as receiving 3 or more mental health specialty visits, 3 or more psychotherapy visits, or 3 or more primary care visits with a depression diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Completing at least minimal treatment (within 12 months) was defined as having 60 days or more of antidepressant prescriptions filled, 4 or more mental health specialty visits, or 3 or more psychotherapy visits. RESULTS The final cohort included 607 730 veterans (mean [SD] age, 59.4 [18.2] years; 546 516 men [89.9%]; 339 811 non-Hispanic White [55.9%]); 8%, or 82 998 of 997 185 person-years, newly screened positive for depression. Clinicians identified fewer than half with depression (15 155 patients), of whom 32% (5034 of 15 650 person-years) met treatment guidelines for timely follow-up and 77% (12 026 of 15 650 person-years) completed at least minimal treatment. Younger age (odds ratio, 0.990; 95% CI, 0.986-0.993; P < .001), Black race (odds ratio, 1.19; 95% CI, CI 1.05-1.34; P = .01), and having comorbid psychiatric diagnoses were significantly associated with timely follow-up. Individual quality metric components (eg, medication or psychotherapy) were associated differently with overall quality results among patient groups, except for age. CONCLUSIONS AND RELEVANCE In this cohort study, most patients met the guidelines for completing at least minimal treatment, but only a minority received timely follow-up after screening positive and being identified as having depression. More research is needed to understand whether the discrepancy between patients who screened positive and patients identified as having depression reflects a gap in recognition of needed care.
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Affiliation(s)
- Lucinda B. Leung
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Karen Chu
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Danielle Rose
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Susan Stockdale
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Edward P. Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - Kenneth B. Wells
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Lisa V. Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California
- RAND Corporation, Santa Monica, California
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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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14
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Springgate BF, Sugarman O, Wells KB, Palinkas LA, Meyers D, Wennerstrom A, Johnson A, Haywood C, Sarpong D, Culbertson R. Community Partnered Participatory Research in Southeast Louisiana Communities Threatened by Climate Change: The C-LEARN EXPERIENCE. Am J Bioeth 2021; 21:46-48. [PMID: 34554077 DOI: 10.1080/15265161.2021.1965248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Kenneth B Wells
- University of California, Los Angeles Semel Neuropsychiatric Institute
| | | | - Diana Meyers
- St. Anna Episcopal Church and Anna's Place NOLA, New Orleans, Louisiana
| | | | - Arthur Johnson
- Lower Ninth Ward Center for Sustainable Engagement and Development, New Orleans, Louisiana
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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Palinkas LA, Springgate BF, Sugarman OK, Hancock J, Wennerstrom A, Haywood C, Meyers D, Johnson A, Polk M, Pesson CL, Seay JE, Stallard CN, Wells KB. A Rapid Assessment of Disaster Preparedness Needs and Resources during the COVID-19 Pandemic. Int J Environ Res Public Health 2021; 18:ijerph18020425. [PMID: 33430355 PMCID: PMC7825778 DOI: 10.3390/ijerph18020425] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/25/2022]
Abstract
Background: This year has seen the emergence of two major crises, a significant increase in the frequency and severity of hurricanes and the COVID-19 pandemic. However, little is known as to how each of these two events have impacted the other. A rapid qualitative assessment was conducted to determine the impact of the pandemic on preparedness and response to natural disasters and the impact of past experiences with natural disasters in responding to the pandemic. Methods: Semi-structured interviews were conducted with 26 representatives of 24 different community-based programs in southern Louisiana. Data were analyzed using procedures embedded in the Rapid Assessment Procedure-Informed Community Ethnography methodology, using techniques of immersion and crystallization and focused thematic analysis. Results: The pandemic has impacted the form and function of disaster preparedness, making it harder to plan for evacuations in the event of a hurricane. Specific concerns included being able to see people in person, providing food and other resources to residents who shelter in place, finding volunteers to assist in food distribution and other forms of disaster response, competing for funds to support disaster-related activities, developing new support infrastructures, and focusing on equity in disaster preparedness. However, several strengths based on disaster preparedness experience and capabilities were identified, including providing a framework for how to respond and adapt to COVID and integration of COVID response with their normal disaster preparedness activities. Conclusions: Although prior experience has enabled community-based organizations to respond to the pandemic, the pandemic is also creating new challenges to preparing for and responding to natural disasters.
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Affiliation(s)
- Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089-0411, USA
- Correspondence: ; Tel.: +1-858-922-7265; Fax: +1-213-740-0789
| | - Benjamin F. Springgate
- LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA; (B.F.S.); (O.K.S.); (A.W.); (C.L.P.); (J.E.S.); (C.N.S.)
| | - Olivia K. Sugarman
- LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA; (B.F.S.); (O.K.S.); (A.W.); (C.L.P.); (J.E.S.); (C.N.S.)
| | - Jill Hancock
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA;
| | - Ashley Wennerstrom
- LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA; (B.F.S.); (O.K.S.); (A.W.); (C.L.P.); (J.E.S.); (C.N.S.)
| | - Catherine Haywood
- Louisiana Community Health Outreach Network, New Orleans, LA 70119, USA;
| | - Diana Meyers
- St. Anna’s Episcopal Church, New Orleans, LA 70116, USA;
| | - Arthur Johnson
- Lower Ninth Ward Center for Sustainable Engagement and Development, New Orleans, LA 70117, USA;
| | - Mara Polk
- National Alliance on Metal Illness-New Orleans, New Orleans, LA 70115, USA;
| | - Carter L. Pesson
- LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA; (B.F.S.); (O.K.S.); (A.W.); (C.L.P.); (J.E.S.); (C.N.S.)
| | - Jessica E. Seay
- LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA; (B.F.S.); (O.K.S.); (A.W.); (C.L.P.); (J.E.S.); (C.N.S.)
| | - Caroline N. Stallard
- LSU Health Sciences Center—New Orleans, School of Medicine and School of Public Health, New Orleans, LA 70112, USA; (B.F.S.); (O.K.S.); (A.W.); (C.L.P.); (J.E.S.); (C.N.S.)
| | - Kenneth B. 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 90095, USA;
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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. Acad 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Phillippi SW, Beiter K, Thomas CL, Sugarman OK, Wennerstrom A, Wells KB, Trapido E. Medicaid Utilization Before and After a Natural Disaster in the 2016 Baton Rouge-Area Flood. Am J Public Health 2020; 109:S316-S321. [PMID: 31505136 DOI: 10.2105/ajph.2019.305193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To understand changes in behavioral health services utilization and expenditures before and after natural disaster with an adult Medicaid population affected by the Baton Rouge, Louisiana-area flood (August 2016).Methods. We examined de-identified behavioral health claims data for Medicaid-insured adults in the affected region for 10 months before and after flooding (October 2015-June 2017). This constituted 273 233 provider claims for 22 196 individuals. Claims data included patient gender, behavioral health diagnoses, treatment dates, and costs. We made adjustments for Medicaid expansion by using monthly enrollment data.Results. Overall, most male patient behavioral health care visits were for substance use disorders (33.6%) and most female patient behavioral health care visits were for depression-related disorders (30%). Both diagnostic categories increased after the flood by 66% and 44%, respectively. Expansion accounted for a 4% increase in claims. Postflood claims reflected 8% to 10% higher costs.Conclusions. Greater amounts of behavioral health care services were sought in all 10 months of the postflood study period. We observed gender differences in use of services and diagnoses. Behavioral health care services following natural disasters must be extended longer than traditionally expected, with consideration for specific population needs.
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Affiliation(s)
- Stephen W Phillippi
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Kaylin Beiter
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Casey L Thomas
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Olivia K Sugarman
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Ashley Wennerstrom
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Kenneth B Wells
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
| | - Edward Trapido
- Stephen W. Phillippi, Kaylin Beiter, Casey L. Thomas, Olivia K. Sugarman, and Ashley Wennerstrom are with the Department of Behavioral and Community Sciences, School of Public Health, Louisiana State University Health Sciences Center New Orleans. Olivia K. Sugarman and Ashley Wennerstrom are also with the Center for Healthcare Value and Equity, School of Medicine, Louisiana State University Health Sciences Center New Orleans. Kenneth B. Wells is with the Department of Psychiatry and Biobehavioral Services, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles. Edward Trapido is with the Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center New Orleans
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Powell BJ, Haley AD, Patel SV, Amaya-Jackson L, Glienke B, Blythe M, Lengnick-Hall R, McCrary S, Beidas RS, Lewis CC, Aarons GA, Wells KB, Saldana L, McKay MM, Weinberger M. Improving the implementation and sustainment of evidence-based practices in community mental health organizations: a study protocol for a matched-pair cluster randomized pilot study of the Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS). Implement Sci Commun 2020; 1. [PMID: 32391524 PMCID: PMC7207049 DOI: 10.1186/s43058-020-00009-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Implementing and sustaining evidence-based programs with fidelity may require multiple implementation strategies tailored to address multi-level, context-specific barriers and facilitators. Ideally, selecting and tailoring implementation strategies should be guided by theory, evidence, and input from relevant stakeholders; however, methods to guide the selection and tailoring of strategies are not well-developed. There is a need for more rigorous methods for assessing and prioritizing implementation determinants (barriers and facilitators) and linking implementation strategies to determinants. The Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS) is an intervention designed to increase the effectiveness of evidence-based practice implementation and sustainment. COAST-IS will enable organizational leaders and clinicians to use Intervention Mapping to select and tailor implementation strategies to address their site-specific needs. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change. Methods COAST-IS will be piloted with community mental health organizations that are working to address the needs of children and youth who experience trauma-related emotional or behavioral difficulties by engaging in a learning collaborative to implement an evidence-based psychosocial intervention (trauma-focused cognitive behavioral therapy). Organizations will be matched and then randomized to participate in the learning collaborative only (control) or to receive additional support through COAST-IS. The primary aims of this study are to (1) assess the acceptability, appropriateness, feasibility, and perceived utility of COAST-IS; (2) evaluate the organizational stakeholders' fidelity to the core elements of COAST-IS; and (3) demonstrate the feasibility of testing COAST-IS in a larger effectiveness trial. Discussion COAST-IS is a systematic method that integrates theory, evidence, and stakeholder perspectives to improve the effectiveness and precision of implementation strategies. If effective, COAST-IS has the potential to improve the implementation and sustainment of a wide range of evidence-based practices in mental health and other sectors. Trial registration This study was registered in ClinicalTrials.gov (NCT03799432) on January 10, 2019 (last updated August 5, 2019).
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Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amber D Haley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheila V Patel
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Amaya-Jackson
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,National Center for Child Traumatic Stress, Durham, NC, USA.,North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Beverly Glienke
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Mellicent Blythe
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Lengnick-Hall
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Stacey McCrary
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Cara C Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gregory A Aarons
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Kenneth B Wells
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,The Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Mary M McKay
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Arevian AC, Bone D, Malandrakis N, Martinez VR, Wells KB, Miklowitz DJ, Narayanan S. Clinical state tracking in serious mental illness through computational analysis of speech. PLoS One 2020; 15:e0225695. [PMID: 31940347 PMCID: PMC6961853 DOI: 10.1371/journal.pone.0225695] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 11/11/2019] [Indexed: 11/19/2022] Open
Abstract
Individuals with serious mental illness experience changes in their clinical states over time that are difficult to assess and that result in increased disease burden and care utilization. It is not known if features derived from speech can serve as a transdiagnostic marker of these clinical states. This study evaluates the feasibility of collecting speech samples from people with serious mental illness and explores the potential utility for tracking changes in clinical state over time. Patients (n = 47) were recruited from a community-based mental health clinic with diagnoses of bipolar disorder, major depressive disorder, schizophrenia or schizoaffective disorder. Patients used an interactive voice response system for at least 4 months to provide speech samples. Clinic providers (n = 13) reviewed responses and provided global assessment ratings. We computed features of speech and used machine learning to create models of outcome measures trained using either population data or an individual's own data over time. The system was feasible to use, recording 1101 phone calls and 117 hours of speech. Most (92%) of the patients agreed that it was easy to use. The individually-trained models demonstrated the highest correlation with provider ratings (rho = 0.78, p<0.001). Population-level models demonstrated statistically significant correlations with provider global assessment ratings (rho = 0.44, p<0.001), future provider ratings (rho = 0.33, p<0.05), BASIS-24 summary score, depression sub score, and self-harm sub score (rho = 0.25,0.25, and 0.28 respectively; p<0.05), and the SF-12 mental health sub score (rho = 0.25, p<0.05), but not with other BASIS-24 or SF-12 sub scores. This study brings together longitudinal collection of objective behavioral markers along with a transdiagnostic, personalized approach for tracking of mental health clinical state in a community-based clinical setting.
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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 of America
| | - Daniel Bone
- Signal Analysis and Interpretation Lab, University of Southern California, Los Angeles, CA, United States of America
| | - Nikolaos Malandrakis
- Signal Analysis and Interpretation Lab, University of Southern California, Los Angeles, CA, United States of America
| | - Victor R. Martinez
- Signal Analysis and Interpretation Lab, University of Southern California, Los Angeles, CA, United States of America
| | - Kenneth B. Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America
- RAND Corporation, Santa Monica, CA, United States of America
| | - David J. Miklowitz
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Shrikanth Narayanan
- Signal Analysis and Interpretation Lab, University of Southern California, Los Angeles, CA, United States of America
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Koushkaki SR, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Focus (Am Psychiatr Publ) 2020; 18:60-70. [PMID: 32015729 PMCID: PMC6996071 DOI: 10.1176/appi.focus.18102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Current Psychiatry Reports (2020) 21: 35).
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Abstract
There is a growing recognition that emotional problems are important to physical health outcomes. In response, primary care clinics have introduced self-report checklists to identify patients with emotional disorders such as depression or anxiety. Yet psychodynamic theory posits that certain emotional problems may be unconscious and unspoken, and thus not discernible on self-report checklists, and studies show that checklists do not identify every patient who needs treatment. New clinical tools are needed to identify subtle and complex presentations. We aimed to develop an innovative mixed-methods approach characterizing different types of verbal expression of feelings, drawing on psychodynamic theory and empirical research. We outline the development of the mixed-methods approach, including our theoretical framework and use of semi-structured interview data from Partners in Care (PIC), a randomized controlled trial of quality improvement for depression. We then illustrate the approach with one case: an older female PIC participant who screened positive for depression on all study self-reports. The approach delineates three qualitatively different categories of words-specific feeling words, vague feeling words, and physical words-that were quantified to define a measurable pattern for our participant. Clinicians could be trained to identify these categories of words in the context of a discussion of feelings to better detect and understand subtle emotional problems in patients who have difficulty talking openly about their feelings. Next steps include furthering face and construct validity and test-retest reliability, examining the prevalence of these patterns in a larger sample, and assessing correlates of patterns.
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Affiliation(s)
- Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kenneth B Wells
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Denise Fan
- National Clinician Scholars Program, David Geffen School of Medicine, University of California, Los Angeles
| | - Norma Mtume
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Elizabeth Bromley
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Leung LB, Rubenstein LV, Yoon J, Post EP, Jaske E, Wells KB, Trivedi RB. Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access. Health Aff (Millwood) 2019; 38:1281-1288. [DOI: 10.1377/hlthaff.2019.00270] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lucinda B. Leung
- Lucinda B. Leung is a core investigator in the Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, and an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the University of California Los Angeles (UCLA) David Geffen School of Medicine
| | - Lisa V. Rubenstein
- Lisa V. Rubenstein is a professor emerita of medicine in the Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, and the Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Jean Yoon
- Jean Yoon is a health economist at the Health Economics Resource Center, VA Palo Alto Healthcare System, in Menlo Park, California, and the University of California San Francisco
| | - Edward P. Post
- Edward P. Post is the national Primary Care–Mental Health Integration medical director in the Veterans Health Administration based out of the VA Ann Arbor Healthcare System and a professor of medicine in the Division of General Medicine, University of Michigan, in Ann Arbor
| | - Erin Jaske
- Erin Jaske is a data analyst in the Primary Care Analytics Team, VA Puget Sound Healthcare System, in Seattle, Washington
| | - Kenneth B. Wells
- Kenneth B. Wells is the director of the UCLA Center for Health Services and Society; a professor of psychiatry in the Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior; and an associate investigator at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
| | - Ranak B. Trivedi
- Ranak B. Trivedi is a core investigator at the Center for Innovation to Implementation, VA Palo Alto Healthcare System, and an assistant professor of psychiatry in the Department of Public Mental Health and Population Sciences, Stanford University, in Menlo Park, California
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Rahmanian Koushkaki S, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Curr Psychiatry Rep 2019; 21:35. [PMID: 30927093 PMCID: PMC6440941 DOI: 10.1007/s11920-019-1017-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
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Affiliation(s)
- Enrico G Castillo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA.
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA.
| | - Roya Ijadi-Maghsoodi
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Division of Population Behavioral Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, 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, USA
| | - Sonya Shadravan
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Elizabeth Moore
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Michael O Mensah
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Mary Docherty
- Harkness Fellow in Healthcare Policy and Practice, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Maria Gabriela Aguilera Nunez
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nicolás Barcelo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nichole Goodsmith
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Laura E Halpin
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Isabella Morton
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph Mango
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Alanna E Montero
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Sara Rahmanian Koushkaki
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Department of Anthropology, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Bowen Chung
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
- Healthy African American Families II, Los Angeles, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Sonya Gabrielian
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, 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, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Jared M Greenberg
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, 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, USA
| | - Ippolytos Kalofonos
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA
- UCLA International Institute, Los Angeles, CA, USA
| | - Sheryl H Kataoka
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Jeanne Miranda
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Harold A Pincus
- Rand Corporation, Santa Monica, CA, USA
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, NewYork-Presbyterian Hospital, Irving Institute for Clinical and Translational Research, New York, NY, USA
| | - Bonnie T Zima
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
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29
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Castillo EG, Chung B, Bromley E, Kataoka SH, Braslow JT, Essock SM, Young AS, Greenberg JM, Miranda J, Dixon LB, Wells KB. Community, Public Policy, and Recovery from Mental Illness: Emerging Research and Initiatives. Harv Rev Psychiatry 2019; 26:70-81. [PMID: 29381527 PMCID: PMC5843494 DOI: 10.1097/hrp.0000000000000178] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This commentary examines the roles that communities and public policies play in the definition and processes of recovery for adults with mental illness. Policy, clinical, and consumer definitions of recovery are reviewed, which highlight the importance of communities and policies for recovery. This commentary then presents a framework for the relationships between community-level factors, policies, and downstream mental health outcomes, focusing on macroeconomic, housing, and health care policies; adverse exposures such as crime victimization; and neighborhood characteristics such as social capital. Initiatives that address community contexts to improve mental health outcomes are currently under way. Common characteristics of such initiatives and select examples are discussed. This commentary concludes with a discussion of providers', consumers', and other stakeholders' roles in shaping policy reform and community change to facilitate recovery.
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Affiliation(s)
- Enrico G Castillo
- From the Center for Health Services and Society (Drs. Chung, Bromley, Kataoka, Young, Miranda, and Wells), Center for Social Medicine and Humanities (Drs. Braslow and Castillo), Division of Child and Adolescent Psychiatry (Dr. Kataoka), Department of Psychiatry and Biobehavioral Sciences (Dr. Greenberg), David Geffen School of Medicine, and School of Public Health (Drs. Miranda and Wells), University of California, Los Angeles; Los Angeles County Department of Mental Health (Dr. Castillo); RAND Corporation (Drs. Chung and Wells); Los Angeles Biomedical Research Institute (Dr. Chung); Healthy African American Families II (Dr. Chung); Health Services Research & Development Center of Innovation (Dr. Young), Desert Pacific MIRECC Health Services Unit (Drs. Bromley and Greenberg), VA Greater Los Angeles Healthcare System; Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University College of Physicians and Surgeons (Drs. Essock and Dixon); New York State Psychiatric Institute (Drs. Essock and Dixon)
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Chung B, Ong M, Ettner SL, Jones F, Gilmore J, McCreary M, Ngo VK, Sherbourne C, Tang L, Dixon E, Koegel P, Miranda J, Wells KB. 12-Month Cost Outcomes of Community Engagement Versus Technical Assistance for Depression Quality Improvement: A Partnered, Cluster Randomized, Comparative-Effectiveness Trial. Ethn Dis 2018; 28:349-356. [PMID: 30202187 DOI: 10.18865/ed.28.s2.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To compare community engagement and planning (CEP) for coalition support to implement depression quality improvement (QI) to resources for services (RS) effects on service-use costs over a 12-month period. Design Matched health and community programs (N=93) were cluster-randomized within communities to CEP or RS. Setting Two Los Angeles communities. Participants Adults (N=1,013) with depressive symptoms (Patient Health Questionnaire (PHQ-8) ≥10); 85% African American and Latino. Interventions CEP and RS to support programs in depression QI. Main Outcome Measures Intervention training and service-use costs over 12 months. Results CEP planning and training costs were almost 3 times higher than RS, largely due to greater CEP provider training participation vs RS, with no significant differences in 12-month service-use costs. Conclusions Compared with RS, CEP had higher planning and training costs with similar service-use costs.
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Affiliation(s)
- Bowen Chung
- Department of Psychiatry, Harbor-UCLA Medical Center/Los Angeles Biomedical Research Institute, Los Angeles, CA.,Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.,RAND Corporation, Los Angeles, CA
| | - Michael Ong
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.,Greater Los Angeles VA Health care System, Los Angeles, CA
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | | | - Michael McCreary
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Lingqi Tang
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Jeanne Miranda
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kenneth B Wells
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.,RAND Corporation, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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31
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Izquierdo A, Ong M, Pulido E, Wells KB, Berkman M, Linski B, Sauer V, Miranda J. Community Partners in Care: 6- and 12-month Outcomes of Community Engagement versus Technical Assistance to Implement Depression Collaborative Care among Depressed Older Adults. Ethn Dis 2018; 28:339-348. [PMID: 30202186 DOI: 10.18865/ed.28.s2.339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Community Partners in Care, a community-partnered, cluster-randomized trial with depressed clients from 95 Los Angeles health and community programs, examined the added value of a community coalition approach (Community Engagement and Planning [CEP]) versus individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care in underserved communities. This exploratory subanalysis examines 6- and 12-month outcomes among CPIC participants aged >50 years. Design Community-partnered, cluster-randomized trial conducted between April 2010 and March 2012. Setting Hollywood-Metropolitan (HM) and South Los Angeles (SLA) Service Planning Areas (SPAs), Los Angeles, California. Participants 394 participants aged >50 years with depressive symptoms (8-item Patient Health Questionnaire score ≥ 10). Intervention A community-partnered multi-sector coalition approach (Community Engagement and Planning [CEP]) vs individual program technical assistance (Resources for Services [RS]) to implement depression collaborative care. Main Outcome Measures Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), community-prioritized outcomes including mental wellness, homelessness risk and physical activity, and services utilization. Results At 6 months, CEP was more effective than RS at improving MHRQL and mental wellness among participants aged >50 years; no differences were found in the effects of CEP vs RS on other outcomes. No significant outcome differences between CEP and RS were found at 12 months. Conclusions A multisector community coalition approach may offer additional benefits over individual program technical assistance to improve outcomes among depressed adults aged >50 years living in underserved communities.
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Affiliation(s)
- Adriana Izquierdo
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.,Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Michael Ong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Esmeralda Pulido
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA.,LA Care Health Plan, Los Angeles, CA
| | - Kenneth B Wells
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | | | - Barbara Linski
- St. Barnabas Hollywood Senior Multipurpose Center, Los Angeles, CA
| | | | - Jeanne Miranda
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
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32
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Khodyakov D, Sharif MZ, Jones F, Heller SM, Pulido E, Wells KB, Bromley E. Whole Person Care in Under-resourced Communities: Stakeholder Priorities at Long-Term Follow-Up in Community Partners in Care. Ethn Dis 2018; 28:371-380. [PMID: 30202190 DOI: 10.18865/ed.28.s2.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Depressed individuals may require help from different agencies to address health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, explore whether service providers understand client priorities, and describe how providers address them. Methods Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depression quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them. Results Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program representatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strategies used to address client needs. Conclusion Depressed clients have multiple health and social needs, and program representatives in under-resourced communities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will address clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care.
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Affiliation(s)
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - S Megan Heller
- Center for Health Services and Society, University of California, Los Angeles, CA
| | | | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Abstract
Background Given national concern over rising mortality from opioid use disorders (OUD) and challenges to increasing OUD treatment access, a coalition approach may hold promise to improve access and outcomes for diverse populations. We present considerations of a community-partnered working group on adapting the Community Partners in Care (CPIC) study and coalition approach to OUD. Method During January 2016 through January 2017, academic, provider, consumer and policy stakeholders reviewed options to adapt CPIC's Resources for Services (RS) for individual program technical assistance and Community Engagement and Planning (CEP) for coalition support to OUD treatments, integrating stakeholder input into design options with estimated sample sizes. Findings The working group recommended Community Reinforcement and Family Treatment (CRAFT) as a stakeholder-support intervention to facilitate uptake and adherence to Medications for Addiction Treatment (MAT). Recommended implementation interventions for MAT/CRAFT were expert technical assistance supplemented by organizational readiness, and CEP for coalition support with a Learning Collaborative. Power estimation suggests that to compare implementation intervention effects on abstinence would require a somewhat larger enrolled sample and 3-4 times the screening sample as CPIC, and for mortality, at least 5-10 times the enrolled sample as CPIC. Discussion Stakeholders viewed the CPIC design and interventions as feasible and acceptable as community-wide approaches for addressing the opioid epidemic, but comparing impacts on mortality would require large, multi-site trials.
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Affiliation(s)
- Kenneth B. Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health, RAND Health Program, Greater Los Angeles Veteran Affairs Health Care System, Los Angeles CA
| | | | - Brian Hurley
- Los Angeles Country Department of Mental Health, Los Angeles, CA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
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Wells KB, Jones L, Zima B, Eisen C. Editorial: Developments in Community Partnered Participatory Research for Behavioral Health. Ethn Dis 2018; 28:287-290. [PMID: 30202179 PMCID: PMC6128341 DOI: 10.18865/ed.28.s2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Ethn Dis. 2018;28(Suppl 2): 287-290; doi:10.18865/ed.28.S2.287.
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Affiliation(s)
- Kenneth B. Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA and RAND Health Program; Los Angeles CA
| | - Loretta Jones
- Healthy African American Families Phase II and Charles R Drew University of Medicine and Science; Los Angeles CA
| | - Bonnie Zima
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute; Los Angeles, CA
| | - Carol Eisen
- Semel Institute for Neuroscience and Human Behavior, Los Angeles Country Department of Mental Health, Los Angeles, CA
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Bromley E, Figueroa C, Castillo EG, Kadkhoda F, Chung B, Miranda J, Menon K, Whittington Y, Jones F, Wells KB, Kataoka SH. Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders' Views of its Promise and Challenge. Ethn Dis 2018; 28:397-406. [PMID: 30202193 DOI: 10.18865/ed.28.s2.397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To understand potential for multi-sector partnerships among community-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity. Design Key stakeholder interviewing during HNI planning and early implementation to elicit perceptions of multi-sector partnerships and innovations required for partnerships to achieve system transformation and health equity. Setting In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations. Participants Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers. Results Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priorities of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and questions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable partnerships including innovations that would increase transparency and normalize information exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability. Conclusions Leaders described improving procedural justice in public agencies' relationships with communities as key to effective partnering for health equity.
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Affiliation(s)
- Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Chantal Figueroa
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Enrico G Castillo
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Farbod Kadkhoda
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Bowen Chung
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; Los Angeles Biomedical Research Institute; Healthy African American Families II, Los Angeles, CA
| | - Jeanne Miranda
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Kumar Menon
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health, Los Angeles, CA
| | - Sheryl H Kataoka
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; UCLA Division of Child and Adolescent Psychiatry, Los Angeles, CA
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Belin TR, Jones A, Tang L, Chung B, Stockdale SE, Jones F, Wright A, Sherbourne CD, Perlman J, Pulido E, Ong MK, Gilmore J, Miranda J, Dixon E, Jones L, Wells KB. Maintaining Internal Validity in Community Partnered Participatory Research: Experience from the Community Partners in Care Study. Ethn Dis 2018; 28:357-364. [PMID: 30202188 DOI: 10.18865/ed.28.s2.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective With internal validity being a central goal of designed experiments, we seek to elucidate how community partnered participatory research (CPPR) impacts the internal validity of public health comparative-effectiveness research. Methods Community Partners in Care (CPIC), a study comparing a community-coalition intervention to direct technical assistance for disseminating depression care to vulnerable populations, is used to illustrate design choices developed with attention to core CPPR principles. The study-design process is reviewed retrospectively and evaluated based on the resulting covariate balance across intervention arms and on broader peer-review assessments. Contributions of the CPIC Council and the study's design committee are highlighted. Results CPPR principles contributed to building consensus around the use of randomization, creating a sampling frame, specifying geographic boundaries delimiting the scope of the investigation, grouping similar programs into pairs or other small blocks of units, collaboratively choosing random-number-generator seeds to determine randomized intervention assignments, and addressing logistical constraints in field operations. Study protocols yielded samples that were well-balanced on background characteristics across intervention arms. CPIC has been recognized for scientific merit, has drawn attention from policymakers, and has fueled ongoing research collaborations. Conclusions Creative and collaborative fulfillment of CPPR principles reinforced the internal validity of CPIC, strengthening the study's scientific rigor by engaging complementary areas of knowledge and expertise among members of the investigative team.
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Affiliation(s)
- Thomas R Belin
- UCLA Department of Biostatistics, Center for Health Sciences, Los Angeles, CA.,UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | - Andrea Jones
- Healthy African American Families II, Los Angeles, CA
| | - Lingqi Tang
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | - Bowen Chung
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA.,Harbor-UCLA Medical Center, Torrance, CA
| | - Susan E Stockdale
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,Greater Los Angeles VA Medical Center, Sepulveda, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Aziza Wright
- Healthy African American Families II, Los Angeles, CA
| | | | | | | | - Michael K Ong
- Greater Los Angeles VA Medical Center, Sepulveda, CA.,UCLA Department of Medicine, Los Angeles, CA
| | | | - Jeanne Miranda
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | | | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA
| | - Kenneth B Wells
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA.,RAND Corporation, Santa Monica, CA.,UCLA Department of Health Policy and Management, Center for Health Sciences, Los Angeles, CA
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Arevian AC, Springgate B, Jones F, Starks SL, Chung B, Wennerstrom A, Jones L, Kataoka SH, Griffith K, Sugarman OK, Williams P, Haywood C, Kirkland A, Meyers D, Pasternak R, Simmasalam R, Tang L, Castillo EG, Mahajan A, Stevens M, Wells KB. The Community and Patient Partnered Research Network (CPPRN): Application of Patient-Centered Outcomes Research to Promote Behavioral Health Equity. Ethn Dis 2018; 28:295-302. [PMID: 30202181 DOI: 10.18865/ed.28.s2.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective We describe the rationale, development, and progress on the Community and Patient Partnered Research Network (CPPRN). The CPPRN builds on more than a decade of partnered work and is designed to promote health equity by developing partnered research on behavioral health and social risk factors in Los Angeles and New Orleans. Setting A community-academic partnership across Los Angeles County and New Orleans. Methods Review of rationale, history, structure, activities and progress in applying community partnered participatory research (CPPR) to CPPRN. Findings Patient and community stakeholders participated in all phases of development, including local and national activities. Key developments include partnered planning efforts, progress on aggregating a large, de-identified dataset across county agencies, and development of an information technology-supported screening approach for behavioral and social determinants in health care, social, and community-based settings. Conclusion The CPPRN represents a promising approach for research data networks, balancing the potential benefit of information technology and data analytic approaches while addressing potential risks and priorities of relevant stakeholders.
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Affiliation(s)
- Armen C Arevian
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Sarah L Starks
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services; Harbor-UCLA Medical Center; UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Loretta Jones
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Sheryl H Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Krystal Griffith
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Olivia K Sugarman
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Pluscedia Williams
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | | | | | | | - Ryan Pasternak
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Rubinee Simmasalam
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Lingqi Tang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Enrico G Castillo
- UCLA David Geffen School of Medicine; Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Max Stevens
- Los Angeles County Chief Executive Office, Los Angeles, CA
| | - Kenneth B Wells
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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Kataoka SH, Ijadi-Maghsoodi R, Figueroa C, Castillo EG, Bromley E, Patel H, Wells KB. Stakeholder Perspectives on the Social Determinants of Mental Health in Community Coalitions. Ethn Dis 2018; 28:389-396. [PMID: 30202192 PMCID: PMC6128346 DOI: 10.18865/ed.28.s2.389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Although evidence supports the potential for community coalitions to positively address social determinants of mental health, little is known about the views of stakeholders involved in such efforts. This study sought to understand county leaders' perspectives about social determinants related to the Health Neighborhood Initiative (HNI), a new county effort to support community coalitions. Design Descriptive, qualitative study, 2014. Setting Community coalitions, located in a large urban city, across eight service planning areas, that serve under-resourced, ethnic minority populations. Procedures We conducted key informant interviews with 49 health care and community leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders' views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories. Results County leaders described multiple social determinants of mental health that were relevant to the HNI community coalitions: housing and safety, community violence, and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to effectively improve mental health. Conclusions Community coalitions have an opportunity to address multiple social determinants of health to meet social and mental health needs of low-resourced communities. Future research should examine how community coalitions, like those in the HNI, can actively engage with community members to identify needs and then deliver evidence-based care.
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Affiliation(s)
- Sheryl H. Kataoka
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Roya Ijadi-Maghsoodi
- Division of Population Behavioral Health, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, VA Greater Los Angeles Health care System, Los Angeles, CA
| | - Chantal Figueroa
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Enrico G. Castillo
- David Geffen School of Medicine, University of California, Los Angeles; Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Elizabeth Bromley
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Heather Patel
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Kenneth B. Wells
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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Arevian AC, O'Hora J, Jones F, Mango J, Jones L, Williams PG, Booker-Vaughns J, Jones A, Pulido E, Banner-Jackson D, Wells KB. Participatory Technology Development to Enhance Community Resilience. Ethn Dis 2018; 28:493-502. [PMID: 30202203 DOI: 10.18865/ed.28.s2.493] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the feasibility of a novel, partnered technology development process to co-create mobile health applications (apps) addressing community health priorities, using psychoeducation of cognitive behavioral therapy (CBT) principles for enhancing resilience as an example. Design Stakeholder engagement, workgroups, pilot feasibility study using mixed methods during October 2013 through January 2016 over three phases: 1) defining the vision of the project and increasing technical capacity, 2) co-development and pilot testing of the app, and 3) planning for sustainability. Setting An academic-community partnership in South Los Angeles, California. Participants Eight stakeholders; 30 pilot participants from the community. Main Outcome Measures Qualitative analysis of audio-recordings of the app development process and stakeholder interviews, surveys of stakeholders' perception of the development process, app use data, and feedback from pilot participants. Results The participatory technology development process resulted in creation and pilot-testing of a resiliency-focused text messaging app. Of the 1,107 messages sent, 23 out of 30 (77%) app users responded to explore interactive content. Stakeholders reported increased perceived competency in creating mobile apps and that the process fostered a culture of co-leadership. There was also sustained engagement in mobile app development by stakeholders beyond the initial project period. Conclusions This is the first study, to our knowledge, to demonstrate the feasibility of participatory technology development, an approach involving direct participation in the development, tailoring and maintenance of a mobile app by a broad set of stakeholders with high representation from racial/ethnic minorities from an under-resourced community. Participatory technology development is a promising approach for creating sustainable, relevant and engaging health technologies across different technological, clinical and community settings.
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Affiliation(s)
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Joseph Mango
- UCLA Center for Health Services and Society, Semel Institute, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA
| | | | | | - Andrea Jones
- Healthy African American Families II, Los Angeles, CA
| | | | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, Los Angeles, CA
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Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018; 28:325-338. [PMID: 30202185 DOI: 10.18865/ed.28.s2.325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Significance Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. Objective To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. Design Secondary analyses of a cluster-randomized trial. Setting 93 health care and community-based programs in two neighborhoods. Participants Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. Intervention CEP or RS for implementing depression quality improvement programs. Outcomes and Analyses Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). Results Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. Conclusions CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
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Figueroa C, Castillo EG, Norquist G, Wells KB, Griffith K, Kadkhoda F, Jones F, Shorter P, Bromley E. A Window of Opportunity: Visions and Strategies for Behavioral Health Policy Innovation. Ethn Dis 2018; 28:407-416. [PMID: 30202194 DOI: 10.18865/ed.28.s2.407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The New York City's Thrive (ThriveNYC) and the Los Angeles County Health Neighborhood Initiative (HNI) are two local policies focused on addressing the social determinants of behavioral health as a preventive strategy for improving health service delivery. On January 29, 2016, leaders from both initiatives came together with a range of federal agencies in health care, public health, and policy research at the RAND Corporation in Arlington, Virginia. The goal of this advisory meeting was to share lessons learned, consider research and evaluation strategies, and create a dialogue between stakeholders and federal funders - all with the purpose to build momentum for policy innovation in behavioral health equity. Methods This article analyzes ethnographic notes taken during the meeting and in-depth interviews of 14 meeting participants through Kingdon's multiple streams theory of policy change. Results Results demonstrated that stakeholders shared a vision for behavioral health policy innovation focused on community engagement and social determinants of health. In addition, Kingdon's model highlighted that the problem, policy and politics streams needed to form a window of opportunity for policy change were coupled, enabling the possibility for behavioral health policy innovation. Conclusions The advisory meeting suggested that local policy makers, academics, and community members, together with federal agents, are working to implement behavioral health policy innovation.
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Affiliation(s)
| | - Enrico G Castillo
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Grayson Norquist
- Emory University Department of Psychiatry and Behavioral Sciences Chief of Psychiatry Service, Grady Health System, Atlanta, GA
| | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health, Los Angeles, CA
| | - Krystal Griffith
- Center for Health Services and Society, University of California, Los Angeles, CA
| | - Farbod Kadkhoda
- Center for Health Services and Society, University of California, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Priscilla Shorter
- IDEAS Center, The Child Study Center of NYU at NYU Langone Medical Center, Department of Child and Adolescent Psychiatry, NYC, NY
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Springgate BF, Arevian AC, Wennerstrom A, Johnson AJ, Eisenman DP, Sugarman OK, Haywood CG, Trapido EJ, Sherbourne CD, Everett A, McCreary M, Meyers D, Kataoka S, Tang L, Sato J, Wells KB. Community Resilience Learning Collaborative and Research Network (C-LEARN): Study Protocol with Participatory Planning for a Randomized, Comparative Effectiveness Trial. Int J Environ Res Public Health 2018; 15:E1683. [PMID: 30720791 PMCID: PMC6121437 DOI: 10.3390/ijerph15081683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/04/2018] [Indexed: 11/16/2022]
Abstract
This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.
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Affiliation(s)
- Benjamin F Springgate
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | - Armen C Arevian
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | | | - Arthur J Johnson
- Center for Sustainable Engagement and Development, New Orleans, LA 70117, USA.
| | - David P Eisenman
- David Geffen School of Medicine at UCLA and UCLA Center for Public Health and Disasters, Los Angeles, CA 90095, USA.
| | - Olivia K Sugarman
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | | | - Edward J Trapido
- LSU Health Sciences Center, New Orleans School of Public Health, New Orleans, LA 70112, USA.
| | | | - Ashley Everett
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
| | - Michael McCreary
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Diana Meyers
- St. Anna's Episcopal Church, New Orleans, LA 70116, USA.
| | - Sheryl Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Lingqi Tang
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
| | - Jennifer Sato
- LSU Health Sciences Center, New Orleans School of Medicine, New Orleans, LA 70112, USA.
| | - Kenneth B Wells
- UCLA Semel Institute for Neuroscience and Human Behavior, Research Center for Health Services and Society, Los Angeles, CA 90024, USA.
- The RAND Corporation, Santa Monica, CA 90401, USA.
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Keegan R, Grover LT, Patron D, Sugarman OK, Griffith K, Sonnier S, Springgate BF, Jumonville LC, Gardner S, Massey W, Miranda J, Chung B, Wells KB, Phillippi S, Trapido E, Ramirez A, Meyers D, Haywood C, Landry C, Wennerstrom A. Case Study of Resilient Baton Rouge: Applying Depression Collaborative Care and Community Planning to Disaster Recovery. IJERPH 2018; 15:E1208. [PMID: 29890659 PMCID: PMC6025623 DOI: 10.3390/ijerph15061208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Addressing behavioral health impacts of major disasters is a priority of increasing national attention, but there are limited examples of implementation strategies to guide new disaster responses. We provide a case study of an effort being applied in response to the 2016 Great Flood in Baton Rouge. METHODS Resilient Baton Rouge was designed to support recovery after major flooding by building local capacity to implement an expanded model of depression collaborative care for adults, coupled with identifying and responding to local priorities and assets for recovery. For a descriptive, initial evaluation, we coupled analysis of documents and process notes with descriptive surveys of participants in initial training and orientation, including preliminary comparisons among licensed and non-licensed participants to identify training priorities. RESULTS We expanded local behavioral health service delivery capacity through subgrants to four agencies, provision of training tailored to licensed and non-licensed providers and development of advisory councils and partnerships with grassroots and government agencies. We also undertook initial efforts to enhance national collaboration around post-disaster resilience. CONCLUSION Our partnered processes and lessons learned may be applicable to other communities that aim to promote resilience, as well as planning for and responding to post-disaster behavioral health needs.
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Affiliation(s)
- Robin Keegan
- Resilient Baton Rouge, 100 North Street, Suite 900, Baton Rouge, LA 70802, USA.
| | - Leslie T Grover
- Resilient Baton Rouge, 100 North Street, Suite 900, Baton Rouge, LA 70802, USA.
| | - David Patron
- Semel Institute for Neuroscience and Human Behavior, UCLA David Geffin School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - Olivia K Sugarman
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA.
| | - Krystal Griffith
- Semel Institute for Neuroscience and Human Behavior, UCLA David Geffin School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - Suzy Sonnier
- Executive Director, Baton Rouge Health District.
| | - Benjamin F Springgate
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA.
| | | | - Sarah Gardner
- Baton Rouge Area Foundation, 100 North Street, Suite 900, Baton Rouge, LA 70802, USA.
| | - Willie Massey
- Resilient Baton Rouge, 100 North Street, Suite 900, Baton Rouge, LA 70802, USA.
| | - Jeanne Miranda
- Semel Institute for Neuroscience and Human Behavior, UCLA David Geffin School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - Bowen Chung
- Semel Institute for Neuroscience and Human Behavior, UCLA David Geffin School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - Kenneth B Wells
- Semel Institute for Neuroscience and Human Behavior, UCLA David Geffin School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - Stephen Phillippi
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA.
| | - Ed Trapido
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA.
| | - Alexa Ramirez
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA.
| | - Diana Meyers
- St. Anna's Episcopal Church, 1313 Esplanade Ave, New Orleans, LA 70116, USA.
| | - Catherine Haywood
- Louisiana Community Health Outreach Network, 1226 N. Broad, New Orleans, LA 70119, USA.
| | - Craig Landry
- UCLA Center for Health Services and Society, Los Angeles, CA 90095, USA.
| | - Ashley Wennerstrom
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave. SL-16 New Orleans, LA 70112, USA.
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Leung LB, Yoon J, Escarce JJ, Post EP, Wells KB, Sugar CA, Yano EM, Rubenstein LV. Primary Care-Mental Health Integration in the VA: Shifting Mental Health Services for Common Mental Illnesses to Primary Care. Psychiatr Serv 2018; 69:403-409. [PMID: 29241440 DOI: 10.1176/appi.ps.201700190] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primary care-mental health integration (PC-MHI) aims to increase access to general mental health specialty (MHS) care for primary care patients thereby decreasing referrals to non-primary care-based MHS services. It remains unclear whether new patterns of usage of MHS services reflect good mental health care. This study examined the relationship between primary care clinic engagement in PC-MHI and use of different MHS services. METHODS This was a retrospective longitudinal cohort study of 66,638 primary care patients with mental illnesses in 29 Southern California Veterans Affairs clinics (2008-2013). Regression models used clinic PC-MHI engagement (proportion of all primary care clinic patients who received PC-MHI services) to predict relative rates of general MHS visits and more specialized MHS visits (for example, visits for serious mental illness services), after adjustment for year and clinic fixed effects, other clinic interventions, and patient characteristics. RESULTS Patients were commonly diagnosed as having depression (35%), anxiety (36%), and posttraumatic stress disorder (22%). For every 1 percentage point increase in a clinic's PC-MHI engagement rate, patients at the clinic had 1.2% fewer general MHS visits per year (p<.001) but no difference in more specialized MHS visits. The reduction in MHS visits occurred among patients with depression (-1.1%, p=.01) but not among patients with psychosis; however, the difference between the subsets was not statistically significant. CONCLUSIONS Primary care clinics with greater engagement in PC-MHI showed reduced general MHS use rates, particularly for patients with depression, without accompanying reductions in use of more specialized MHS services.
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Affiliation(s)
- Lucinda B Leung
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
| | - Jean Yoon
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
| | - José J Escarce
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
| | - Edward P Post
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
| | - Kenneth B Wells
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
| | - Catherine A Sugar
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
| | - Elizabeth M Yano
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
| | - Lisa V Rubenstein
- Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor
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Jones AL, Cochran SD, Leibowitz A, Wells KB, Kominski G, Mays VM. Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010-2015. Healthcare (Basel) 2018; 6:healthcare6020029. [PMID: 29565323 PMCID: PMC6023347 DOI: 10.3390/healthcare6020029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/10/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022] Open
Abstract
Background. Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Methods. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015. Results. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Conclusion. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
| | - Susan D Cochran
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), CA 90095, USA.
- Department of Statistics, University of California, Los Angeles, CA 90095, USA.
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
| | - Arleen Leibowitz
- UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA.
| | - Kenneth B Wells
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.
- UCLA Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, USA.
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
| | - Gerald Kominski
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
- UCLA Center for Health Policy Research, Los Angeles, CA 90024, USA.
| | - Vickie M Mays
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
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Feller SC, Castillo EG, Greenberg JM, Abascal P, Van Horn R, Wells KB. Emotional Well-Being and Public Health: Proposal for a Model National Initiative. Public Health Rep 2018; 133:136-141. [PMID: 29448872 PMCID: PMC5871140 DOI: 10.1177/0033354918754540] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In 2011, the National Prevention, Health Promotion, and Public Health Council named mental and emotional well-being as 1 of 7 priority areas for the National Prevention Strategy. In this article, we discuss emotional well-being as a scientific concept and its relevance to public health. We review evidence that supports the association between emotional well-being and health. We propose a national emotional well-being initiative and describe its 6 components: systematic measurement of emotional well-being, identification of the drivers of emotional well-being, formation of partnerships with diverse stakeholders, implementation and dissemination of evidence-based interventions to promote emotional well-being and its drivers, development of public health messaging, and identification of and strategies to address disparities in emotional well-being and its drivers. Finally, we discuss ways in which a national emotional well-being initiative would complement current public health efforts and the potential challenges to such an initiative.
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Affiliation(s)
- Sophie C. Feller
- Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Enrico G. Castillo
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Jared M. Greenberg
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Pilar Abascal
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Richard Van Horn
- Mental Health Services Oversight and Accountability Commission, Sacramento, CA, USA
| | - Kenneth B. Wells
- Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- RAND Corporation, Los Angeles, CA, USA
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Castillo EG, Shaner R, Tang L, Chung B, Jones F, Whittington Y, Miranda J, Wells KB. Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support. Psychiatr Serv 2018; 69:195-203. [PMID: 29032700 PMCID: PMC5794612 DOI: 10.1176/appi.ps.201600514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. METHODS This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. RESULTS Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. CONCLUSIONS Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.
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Affiliation(s)
- Enrico G Castillo
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Roderick Shaner
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Lingqi Tang
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Bowen Chung
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Felica Jones
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Yolanda Whittington
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Jeanne Miranda
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Kenneth B Wells
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
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Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018. [PMID: 30202185 DOI: 10.18865/ed.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
SIGNIFICANCE Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. OBJECTIVE To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. DESIGN Secondary analyses of a cluster-randomized trial. SETTING 93 health care and community-based programs in two neighborhoods. PARTICIPANTS Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. INTERVENTION CEP or RS for implementing depression quality improvement programs. OUTCOMES AND ANALYSES Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). RESULTS Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. CONCLUSIONS CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
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49
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Bromley E, Eisenman DP, Magana A, Williams M, Kim B, McCreary M, Chandra A, Wells KB. How Do Communities Use a Participatory Public Health Approach to Build Resilience? The Los Angeles County Community Disaster Resilience Project. Int J Environ Res Public Health 2017; 14:ijerph14101267. [PMID: 29065491 PMCID: PMC5664768 DOI: 10.3390/ijerph14101267] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022]
Abstract
Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions’ strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods.
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Affiliation(s)
- Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
- West Los Angeles VA Healthcare Center, Los Angeles, CA 90073, USA.
- RAND Corporation, Santa Monica, CA 90401, USA.
| | - David P Eisenman
- Division of General Internal Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA 90095, USA.
- UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA.
| | - Aizita Magana
- Los Angeles County Department of Public Health, 313 N Figueroa St, Los Angeles, CA 90012, USA.
| | | | - Biblia Kim
- School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA.
| | - Michael McCreary
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA.
- West Los Angeles VA Healthcare Center, Los Angeles, CA 90073, USA.
- UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA.
- RAND Corporation, Santa Monica, CA 90401, USA.
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50
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Brown CH, Curran G, Palinkas LA, Aarons GA, Wells KB, Jones L, Collins LM, Duan N, Mittman BS, Wallace A, Tabak RG, Ducharme L, Chambers DA, Neta G, Wiley T, Landsverk J, Cheung K, Cruden G. An Overview of Research and Evaluation Designs for Dissemination and Implementation. Annu Rev Public Health 2017; 38:1-22. [PMID: 28384085 PMCID: PMC5384265 DOI: 10.1146/annurev-publhealth-031816-044215] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs. This article is one product of a design workgroup that was formed in 2013 by the National Institutes of Health to address dissemination and implementation research, and whose members represented diverse methodologic backgrounds, content focus areas, and health sectors. These experts integrated their collective knowledge on dissemination and implementation designs with searches of published evaluations strategies. This article emphasizes randomized and nonrandomized designs for the traditional translational research continuum or pipeline, which builds on existing efficacy and effectiveness trials to examine how one or more evidence-based clinical/prevention interventions are adopted, scaled up, and sustained in community or service delivery systems. We also mention other designs, including hybrid designs that combine effectiveness and implementation research, quality improvement designs for local knowledge, and designs that use simulation modeling.
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Affiliation(s)
- C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611;
| | - Geoffrey Curran
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205;
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, School of Social Work, University of Southern California, Los Angeles, California 90089;
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California 92093;
| | - Kenneth B Wells
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California 90024;
| | - Loretta Jones
- Healthy African American Families, Los Angeles, California 90008;
| | - Linda M Collins
- The Methodology Center and Department of Human Development & Family Studies, Pennsylvania State University, University Park, Pennsylvania 16802;
| | - Naihua Duan
- Department of Psychiatry, Columbia University Medical Center, Columbia University, New York, NY 10027;
| | - Brian S Mittman
- VA Center for Implementation Practice and Research Support, Virginia Greater Los Angeles Healthcare System, North Hills, California 91343;
| | - Andrea Wallace
- College of Nursing, The University of Iowa, Iowa City, Iowa 52242;
| | - Rachel G Tabak
- Prevention Research Center, George Warren Brown School, Washington University, St. Louis, Missouri 63105;
| | - Lori Ducharme
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland 20814;
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland 20850; ,
| | - Gila Neta
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland 20850; ,
| | - Tisha Wiley
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland 20814;
| | | | - Ken Cheung
- Mailman School of Public Health, Columbia University, New York, NY 10032;
| | - Gracelyn Cruden
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611;
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina 27514;
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