1
|
Steiner JL, Belisle N, Cahill JD, Garcia-Vassallo G, Johnson A, Lukens C, Oliva ME, Pedersen K, Shetler D, Wassmer K, Wilkins KM. Adopting a Novel Approach to Prevent and Address Patient Mistreatment of Staff in a Community Mental Health Center. Psychiatr Serv 2024; 75:492-495. [PMID: 38291887 DOI: 10.1176/appi.ps.20230234] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Verbal mistreatment of staff by patients is common in health care settings. Experiencing or witnessing mistreatment can have harmful psychological impacts, affecting well-being and clinical practice. As part of an effort to become an antiracist organization, an academic community mental health center based in Connecticut developed an initiative to address verbal mistreatment. Training in the Expect, Recognize, Address, Support, Establish (ERASE) framework was provided to 140 staff members. This training and subsequent actions to enhance the culture of safety were perceived as helpful by staff. Further development of the initiative is proceeding as the center's primary performance improvement program.
Collapse
Affiliation(s)
- Jeanne L Steiner
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Nicole Belisle
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - John D Cahill
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Gabriela Garcia-Vassallo
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Avon Johnson
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Carrie Lukens
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Maria E Oliva
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Kyle Pedersen
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Dan Shetler
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Karen Wassmer
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| | - Kirsten M Wilkins
- Department of Psychiatry, Yale School of Medicine, New Haven (Steiner, Belisle, Cahill, Garcia-Vassallo, Johnson, Lukens, Oliva, Pedersen, Wilkins); Connecticut Mental Health Center, New Haven (Steiner, Belisle, Cahill, Johnson, Oliva, Pedersen, Shetler, Wassmer); U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven (Garcia-Vassallo, Lukens, Wilkins)
| |
Collapse
|
2
|
Li L, Cooper HR, Parmentier BL, Williamson M, Crouch M, Muzquiz-Drummond S, Babin A. Integrating Board-Certified Psychiatric Pharmacists in a Certified Community Behavioral Health Clinic. Psychiatr Serv 2024:appips20230521. [PMID: 38595116 DOI: 10.1176/appi.ps.20230521] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Demand for mental health services has dramatically increased in recent years, raising concerns about the availability of service providers to meet these increased needs. One approach to expanding access to care is the use of highly qualified board-certified psychiatric pharmacists (BCPPs). However, the implementation of programs for integrating BCPPs has not been well characterized in community mental health settings. This column describes the development and implementation of a comprehensive practice model to incorporate BCPPs in a certified community behavioral health clinic. The authors report the results from the first 14 months of BCPP integration (based on 3,221 direct patient care interventions), offer recommendations, and highlight lessons learned.
Collapse
Affiliation(s)
- Luming Li
- Harris Center for Mental Health and IDD, Houston (all authors); School of Medicine, Baylor University, Houston (Muzquiz-Drummond)
| | - Heather Rozea Cooper
- Harris Center for Mental Health and IDD, Houston (all authors); School of Medicine, Baylor University, Houston (Muzquiz-Drummond)
| | - Brittany L Parmentier
- Harris Center for Mental Health and IDD, Houston (all authors); School of Medicine, Baylor University, Houston (Muzquiz-Drummond)
| | - Mark Williamson
- Harris Center for Mental Health and IDD, Houston (all authors); School of Medicine, Baylor University, Houston (Muzquiz-Drummond)
| | - Mitchell Crouch
- Harris Center for Mental Health and IDD, Houston (all authors); School of Medicine, Baylor University, Houston (Muzquiz-Drummond)
| | - Sylvia Muzquiz-Drummond
- Harris Center for Mental Health and IDD, Houston (all authors); School of Medicine, Baylor University, Houston (Muzquiz-Drummond)
| | - Angela Babin
- Harris Center for Mental Health and IDD, Houston (all authors); School of Medicine, Baylor University, Houston (Muzquiz-Drummond)
| |
Collapse
|
3
|
Levin CE, Tauscher J, Meller S, Brian RM, Buck BE, Ben-Zeev D. Cost of Implementing mHealth in Community Mental Health Settings: External Versus Internal Facilitation. Psychiatr Serv 2024; 75:357-362. [PMID: 37880968 DOI: 10.1176/appi.ps.20230140] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE This study aimed to compare the costs of two implementation models for the mobile health (mHealth) intervention FOCUS in community mental health settings. The external facilitation (EF) approach uses a hub-and-spoke model, in which a central specialist provides support to clinicians and clients at multiple agencies. With the internal facilitation (IF) approach, frontline clinical staff at each center are trained to serve as their organization's local specialists. METHODS Financial and economic cost data were collected in the context of a hybrid type 3 effectiveness-implementation trial by using a mixed-methods, top-down expenditure analysis with microcosting approaches. The analysis compared the incremental costs of both models and the costs of successfully engaging clients (N=210) at 20 centers. Costs were characterized as start-up or recurrent (personnel, supplies, contracted services, and indirect costs). RESULTS The average annual financial cost per site was $23,517 for EF and $19,118 for IF. EF yielded more FOCUS users at each center, such that the average monthly financial costs were lower for EF ($167 per client [N=129]) than for IF ($177 per client [N=81]). When using a real-world scenario based on economic costs and a lower organizational indirect rate, the average monthly cost per client was $73 for EF and $59 for IF. Both models reflected substantial cost reductions (about 50%) relative to a previous deployment of FOCUS in a clinical trial. CONCLUSIONS Compared with IF, EF yielded more clients who received mHealth at community mental health centers and had comparable or lower costs.
Collapse
Affiliation(s)
- Carol E Levin
- Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller)
| | - Justin Tauscher
- Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller)
| | - Suzanne Meller
- Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller)
| | - Rachel M Brian
- Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller)
| | - Benjamin E Buck
- Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller)
| | - Dror Ben-Zeev
- Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller)
| |
Collapse
|
4
|
Cully JA, Hundt NE, Fletcher T, Sansgiry S, Zeno D, Kauth MR, Kunik ME, Sorocco K. Brief Cognitive-Behavioral Therapy for Depression in Community Clinics: A Hybrid Effectiveness-Implementation Trial. Psychiatr Serv 2024; 75:237-245. [PMID: 37674395 DOI: 10.1176/appi.ps.20220582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
OBJECTIVE The authors examined whether brief cognitive-behavioral therapy (bCBT) for depression, delivered by mental health providers in community-based outpatient clinics (CBOCs) of the Veterans Health Administration, improved depression outcomes and was feasible and acceptable in clinical settings. METHODS The authors used a type-2 hybrid effectiveness-implementation, patient-randomized trial to compare bCBT with enhanced usual care. Participants (N=189) with moderate symptoms of depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) were enrolled from CBOCs in the southern United States. bCBT (N=109) consisted of three to six sessions, delivered by mental health providers (N=17) as part of routine clinic practices. Providers received comprehensive training and support to facilitate bCBT delivery. Recipients of enhanced usual care (N=80) were given educational materials and encouraged to discuss treatment options with their primary care provider. The primary effectiveness outcome was PHQ-9-assessed depression symptoms posttreatment (4 months after baseline) and at 8- and 12-month follow-ups. Implementation outcomes focused on bCBT dose received, provider fidelity, and satisfaction with bCBT training and support. RESULTS bCBT improved depression symptoms (Cohen's d=0.55, p<0.01) relative to enhanced usual care posttreatment, and the improvement was maintained at 8- and 12-month follow-ups (p=0.004). bCBT participants received a mean±SD of 3.7±2.7 sessions (range 0-9), and 64% completed treatment (≥3 sessions). Providers delivered bCBT with fidelity and reported that bCBT training and support were feasible and effective. CONCLUSIONS bCBT had a modest treatment footprint of approximately four sessions, was acceptable to participants and providers, was feasible for delivery in CBOCs, and produced meaningful sustained improvements in depression.
Collapse
Affiliation(s)
- Jeffrey A Cully
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| | - Natalie E Hundt
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| | - Terri Fletcher
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| | - Shubhada Sansgiry
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| | - Darrell Zeno
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| | - Michael R Kauth
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| | - Mark E Kunik
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| | - Kristen Sorocco
- U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, and Baylor College of Medicine, Houston (Cully, Hundt, Fletcher, Sansgiry, Zeno, Kauth, Kunik); VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), virtual (Zeno); Oklahoma City VA Health Care System and University of Oklahoma College of Medicine, Oklahoma City (Sorocco)
| |
Collapse
|
5
|
Nawaz S, Moon KJ, Hasenstab KA, Bryant I, Singh P, Montesano VL, Knudsen K, Wastler HM, Blouin A, Breitborde NJK, Seiber EE. Costs of Coordinated Specialty Care for First-Episode Psychosis: A Microcosting Analysis. Psychiatr Serv 2024; 75:295-298. [PMID: 37731346 DOI: 10.1176/appi.ps.20230241] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
In this study, the authors measured and described the costs of coordinated specialty care (CSC) for first-episode psychosis in Ohio. A microcosting tool was used to estimate personnel and nonpersonnel costs of service delivery at seven CSC programs. Average annual cost per participant (N=511 participants) was estimated as $17,810 (95% CI=$9,141-$26,479). On average, 61% (95% CI=53%-69%) of annual program costs were nonbillable. Key cost drivers included facility costs, administrative tasks, and social services. Novel financing models may redress reimbursement gaps incurred by CSC programs.
Collapse
Affiliation(s)
- Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Ian Bryant
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Parvati Singh
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Vicki L Montesano
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Kraig Knudsen
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Heather M Wastler
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Alexandra Blouin
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Nicholas J K Breitborde
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies (Nawaz, Moon, Hasenstab, Bryant, Seiber) and Division of Epidemiology (Singh), College of Public Health, Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Montesano, Knudsen); Department of Psychiatry and Behavioral Health (Wastler, Blouin, Breitborde), College of Medicine, Ohio State University, Columbus
| |
Collapse
|
6
|
Grove LR, Emerson KR, Merola LS, Andries S, Cohen DA. Attitudes Toward COVID-19 Vaccination Among Behavioral Health Service Clients. Psychiatr Serv 2023; 74:1281-1284. [PMID: 37461817 DOI: 10.1176/appi.ps.20230019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE The authors examined attitudes toward and uptake of COVID-19 vaccination among individuals with serious mental illness or substance use disorder. METHODS Clients of a community mental health center in Texas (N=50) participated in semistructured, in-person interviews regarding their COVID-19 vaccination decision. Thematic analysis was used to analyze interview data. RESULTS Most participants (68%) reported receipt of at least one COVID-19 vaccine dose. Participants were motivated to get vaccinated mostly by a desire to protect themselves or others. Convenience of vaccination location and access to free vaccination facilitated vaccine uptake. However, concerns about the COVID-19 vaccine were common among both vaccinated and unvaccinated participants and could be reinforced or overcome by social network influences. CONCLUSIONS Fear, uncertainty, and conflicting vaccine information were common themes in the COVID-19 vaccination decisions of behavioral health service clients. Improving access to information from trusted sources, including health care providers, could help to overcome vaccine concerns in this population.
Collapse
Affiliation(s)
- Lexie R Grove
- Department of Population Health (Grove) and Department of Psychiatry and Behavioral Sciences (Emerson, Merola, Andries, Cohen), Dell Medical School, The University of Texas at Austin, Austin; Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, The University of Texas at Austin, Austin (Cohen)
| | - Kaleigh R Emerson
- Department of Population Health (Grove) and Department of Psychiatry and Behavioral Sciences (Emerson, Merola, Andries, Cohen), Dell Medical School, The University of Texas at Austin, Austin; Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, The University of Texas at Austin, Austin (Cohen)
| | - Laura Stevens Merola
- Department of Population Health (Grove) and Department of Psychiatry and Behavioral Sciences (Emerson, Merola, Andries, Cohen), Dell Medical School, The University of Texas at Austin, Austin; Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, The University of Texas at Austin, Austin (Cohen)
| | - Spencer Andries
- Department of Population Health (Grove) and Department of Psychiatry and Behavioral Sciences (Emerson, Merola, Andries, Cohen), Dell Medical School, The University of Texas at Austin, Austin; Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, The University of Texas at Austin, Austin (Cohen)
| | - Deborah Ann Cohen
- Department of Population Health (Grove) and Department of Psychiatry and Behavioral Sciences (Emerson, Merola, Andries, Cohen), Dell Medical School, The University of Texas at Austin, Austin; Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, The University of Texas at Austin, Austin (Cohen)
| |
Collapse
|
7
|
Shen A, Graden L, Harper A. Debt Inequity Among Clients of a Community Mental Health Center. Psychiatr Serv 2023; 74:1208-1211. [PMID: 36916063 DOI: 10.1176/appi.ps.202100565] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Debt is an overlooked social determinant of health that reinforces systems of discrimination. This study examined the impact of debt among individuals with serious mental illness. Individuals with serious mental illness who identified as Black, Indigenous, or other people of color carried a disproportionate amount of debt, often from attempting to meet basic needs. Increased levels of debt were associated with symptoms of depression. Addressing debt inequity is essential to both financial justice and mental health recovery.
Collapse
Affiliation(s)
- Alice Shen
- Department of Psychiatry (Shen), Yale College (Graden), and Program for Recovery and Community Health (Harper), Yale University, New Haven
| | - Luisa Graden
- Department of Psychiatry (Shen), Yale College (Graden), and Program for Recovery and Community Health (Harper), Yale University, New Haven
| | - Annie Harper
- Department of Psychiatry (Shen), Yale College (Graden), and Program for Recovery and Community Health (Harper), Yale University, New Haven
| |
Collapse
|
8
|
Brown JD, Stewart KA, Miller RL, Dehus E, Rose T, DeWitt K, Chapman R, Wishon A, Breslau J, Dey J, Jacobus-Kantor L. Impacts of the Certified Community Behavioral Health Clinic Demonstration on Emergency Department Visits and Hospitalizations. Psychiatr Serv 2023; 74:911-920. [PMID: 36916061 DOI: 10.1176/appi.ps.20220410] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The Certified Community Behavioral Health Clinic (CCBHC) demonstration is designed to increase access to comprehensive ambulatory care and crisis services, which may reduce emergency department (ED) visits and hospitalizations. This study examined whether the demonstration had an impact on ED visits and hospitalizations in Missouri, Oklahoma, and Pennsylvania. METHODS This difference-in-differences analysis used Medicaid claims data from 2015 to 2019 to examine service use during a 12-month baseline period and the first 24 months of the demonstration for beneficiaries who received care from CCBHCs and beneficiaries who received care from other behavioral health clinics in the same state, representing care as usual. Propensity score methods were used to develop treatment and comparison groups with similar characteristics. RESULTS In Pennsylvania and Oklahoma, beneficiaries who received care from CCBHCs had a statistically significant reduction in the average number of behavioral health ED visits, relative to the comparison group (13% and 11% reductions, respectively); no impact on ED visits in Missouri was observed. The demonstration was associated with a statistically significant reduction in all-cause hospitalizations in Oklahoma, when the analysis used a 2-year rather than a 1-year baseline period, and also in Pennsylvania, when hospitalizations were truncated at the 98th percentile to exclude beneficiaries with outlier hospitalization rates. CONCLUSIONS The CCBHC demonstration reduced behavioral health ED visits in two states, and the study also revealed some evidence of reductions in hospitalizations.
Collapse
Affiliation(s)
- Jonathan D Brown
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Kate A Stewart
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Rachel L Miller
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Eric Dehus
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Tyler Rose
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Kathryn DeWitt
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Richard Chapman
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Allison Wishon
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Joshua Breslau
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Judith Dey
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| | - Laura Jacobus-Kantor
- Mathematica, Washington, D.C. (Brown, Stewart, Miller, Dehus, Rose, Wishon); Verana Health, San Francisco (DeWitt, Chapman); RAND Corporation, Pittsburgh (Breslau); Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. (Dey, Jacobus-Kantor)
| |
Collapse
|
9
|
Breitborde NJK, Parris CJ, Stearns WH, Nawaz S, Seiber E, Hamilton S, Hefner J, Hogan TH, Singh P, Knudsen K, Martt N, Srihari VH, Cahill J, Jani A, Anagbonu F, Baughman C, Carpenter KM, Dunivant CN, Dunlap N, Guirgis H, Lazarus S, Moe A, Nguyen C, Wastler H, Montesano V. Promoting the Success and Sustainability of Coordinated Specialty Care Teams in Ohio. Psychiatr Serv 2023; 74:766-769. [PMID: 36415991 DOI: 10.1176/appi.ps.20220126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
Recent COVID-19-related federal legislation has resulted in time-limited increases in Mental Health Block Grant (MHBG) set-aside dollars for coordinated specialty care (CSC) throughout the United States. The state of Ohio has opted to apply these funds to establish a learning health network of Ohio CSC teams, promote efforts to expand access to CSC, and quantify the operating costs and rates of reimbursement from private and public payers for these CSC teams. These efforts may provide other states with a model through which they can apply increased MHBG funds to support the success of their own CSC programs.
Collapse
Affiliation(s)
- Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Craig J Parris
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Walter H Stearns
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Saira Nawaz
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Eric Seiber
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Sarah Hamilton
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Jennifer Hefner
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Tory H Hogan
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Parvati Singh
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Kraig Knudsen
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Nicholas Martt
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Vinod H Srihari
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - John Cahill
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Anant Jani
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Francis Anagbonu
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Catherine Baughman
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Kristen M Carpenter
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Crystal N Dunivant
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Nicholas Dunlap
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Hossam Guirgis
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Sophie Lazarus
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Aubrey Moe
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Christopher Nguyen
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Heather Wastler
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| | - Vicki Montesano
- Department of Psychiatry and Behavioral Health (Breitborde, Parris, Stearns, Hamilton, Baughman, Carpenter, Guirgis, Lazarus, Moe, Nguyen, Wastler), Department of Psychology (Breitborde, Carpenter, Lazarus, Moe), and College of Public Health (Nawaz, Seiber, Hefner, Hogan, Singh, Anagbonu), Ohio State University, Columbus; Ohio Department of Mental Health and Addiction Services, Columbus (Knudsen, Martt, Montesano); Department of Psychiatry, Yale University, New Haven (Srihari, Cahill); Somerville College, University of Oxford, Oxford (Jani); Department of Psychiatry, Northeast Ohio Medical University, Rootstown (Dunivant, Dunlap)
| |
Collapse
|
10
|
Smith TE, Bury D, Hendrick D, Morse G, Drake RE. Barriers to Client Engagement and Strategies to Improve Participation in Mental Health and Supported Employment Services. Psychiatr Serv 2023; 74:38-43. [PMID: 36065584 DOI: 10.1176/appi.ps.202200023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE A few clients in every mental health center present challenging behaviors, have difficulty engaging in services, and create stress within the treatment team. The authors provided consultations on clients with these characteristics over 4 years in the Social Security Administration's Supported Employment Demonstration (SED). METHODS Four experienced community mental health leaders provided consultations on 105 of nearly 2,000 clients receiving team-based behavioral health and employment services in the SED. Using document analysis, consultants coded their notes and identified themes that described barriers to client engagement and strategies teams used to overcome them. RESULTS Clients who were difficult to engage experienced complex and interacting behavioral health, medical, and social conditions, which made it hard for therapists to develop therapeutic relationships and help clients find employment. Faced with engagement barriers, staff were often discouraged and felt hopeless about achieving success. To address these barriers, consultants and teams developed several strategies: using supervisors and teammates for support, providing persistent outreach, pursuing referrals and consultations to help with complex conditions, and developing realistic goals. CONCLUSIONS Supervisors, team leaders, and consultants in community mental health settings should help staff develop realistic strategies to manage the small number of clients whose behaviors present the greatest challenges. Effective strategies involve providing team-based outreach and support, fostering staff morale, obtaining specialist consultations regarding complex conditions, and calibrating realistic goals.
Collapse
Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Debra Bury
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Delia Hendrick
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Gary Morse
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Robert E Drake
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| |
Collapse
|
11
|
Mascayano F, Alvarado R, Andrews HF, Baumgartner JN, Burrone MS, Cintra J, Conover S, Dahl CM, Fader KM, Gorroochurn P, Galea S, Jorquera MJ, Lovisi GM, Mitkiewicz de Souza F, Pratt C, Restrepo-Toro ME, Rojas G, Rodrigues Sarução K, Rosenheck R, Schilling S, Shriver T, Stastny P, Tapia E, Cavalcanti MT, Valencia E, Yang LH, Restrepo Henao A, Martínez-Alés G, Romero Pardo V, Gomez Alemany T, Susser E. A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial. Psychiatr Serv 2022; 73:1225-1231. [PMID: 35678081 DOI: 10.1176/appi.ps.202000843] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.
Collapse
Affiliation(s)
- Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Ruben Alvarado
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Howard F Andrews
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Joy N Baumgartner
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Maria Soledad Burrone
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Jacqueline Cintra
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Sarah Conover
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Catarina M Dahl
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Kim M Fader
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Prakash Gorroochurn
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Maria J Jorquera
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Giovanni M Lovisi
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Flavia Mitkiewicz de Souza
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Charissa Pratt
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Maria E Restrepo-Toro
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Graciela Rojas
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Keli Rodrigues Sarução
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Robert Rosenheck
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Sara Schilling
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Tom Shriver
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Peter Stastny
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Eric Tapia
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Maria Tavares Cavalcanti
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Eliecer Valencia
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Lawrence H Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Alexandra Restrepo Henao
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Victor Romero Pardo
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Teresa Gomez Alemany
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany)
| |
Collapse
|
12
|
Lewis CC, Marti CN, Scott K, Walker MR, Boyd M, Puspitasari A, Mendel P, Kroenke K. Standardized Versus Tailored Implementation of Measurement-Based Care for Depression in Community Mental Health Clinics. Psychiatr Serv 2022; 73:1094-1101. [PMID: 35538748 PMCID: PMC9529853 DOI: 10.1176/appi.ps.202100284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/30/2022]
Abstract
Objective Measurement-based care (MBC) is an evidence-based practice that is rarely integrated into psychotherapy. The authors sought to determine whether tailored MBC implementation can improve clinician fidelity and depression outcomes compared with standardized implementation. Methods This cluster-randomized trial enrolled 12 community behavioral health clinics to receive 5 months of implementation support. Clinics randomized to the standardized implementation received electronic health record data captured with the nine-item Patient Health Questionnaire (PHQ-9), a needs assessment, clinical training, guidelines, and group consultation in MBC fidelity. Tailored implementation support included these strategies, but the training content was tailored to clinics’ barriers to MBC, and group consultation centered on overcoming these barriers. Clinicians (N=83, tailored; N=71, standardized) delivering individual psychotherapy to 4,025 adults participated. Adult patients (N=87, tailored; N=141, standardized) contributed data for depression outcome analyses. Results The odds of PHQ-9 completion were lower in the tailored group at baseline (odds ratio [OR]=0.28, 95% CI=0.08–0.96) but greater at 5 months (OR=3.39, 95% CI=1.00–11.48). The two implementation groups did not differ in full MBC fidelity. PHQ-9 scores decreased significantly from baseline (mean±SD=17.6±4.4) to 12 weeks (mean=12.6±5.9) (p<0.001), but neither implementation group nor MBC fidelity significantly predicted PHQ-9 scores at week 12. Conclusions Tailored MBC implementation outperformed standardized implementation with respect to PHQ-9 completion, but discussion of PHQ-9 scores in clinician-patient sessions remained suboptimal. MBC fidelity did not predict week-12 depression severity. MBC can critically inform collaborative adjustments to session or treatment plans, but more strategic system-level implementation support or longer implementation periods may be needed.
Collapse
Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - C Nathan Marti
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Kelli Scott
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Madison R Walker
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Meredith Boyd
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Ajeng Puspitasari
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Peter Mendel
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| | - Kurt Kroenke
- Kaiser Permanente Washington Health Research Institute, Seattle (Lewis); Abacist Analytics, Austin, Texas (Marti); Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island (Scott); School of Public Health, University of North Carolina, Chapel Hill (Walker); Department of Psychology, University of California, Los Angeles, Los Angeles (Boyd); Mayo Clinic, Rochester, Minnesota (Puspitasari); RAND Corporation, Santa Monica, California (Mendel); Department of Medicine, Indiana University, Bloomington (Kroenke)
| |
Collapse
|
13
|
Abstract
OBJECTIVE This study examined differences between certified community behavioral health clinics (CCBHCs) and community mental health centers (CMHCs) in the services offered and populations served. METHODS Data from the 2020 National Mental Health Services Survey were used to quantify the proportion of CCBHCs (N=336) and CMHCs (N=1,953) that offered services and served populations described in the CCBHC certification criteria. RESULTS A higher proportion of CCBHCs than CMHCs offered crisis services, peer support, substance use disorder treatment, treatment for co-occurring disorders, antipsychotics, assertive community treatment, general medical health screening, tobacco cessation services, psychiatric rehabilitation services, and other outpatient services. A higher proportion of CCBHCs than CMHCs served veterans and transition-age youths. CONCLUSIONS CCBHCs differed from CMHCs in the services provided and populations served. Differences between CCBHCs and CMHCs in some service categories were more pronounced in demonstration than in nondemonstration states. However, it was unclear whether these differences existed before the introduction of the CCBHC model.
Collapse
|
14
|
Mangurian C, Thomas MD, Mitsuishi F, Goldman LE, Niu G, Handley MA, Riano NS, Hwong A, Essock S, Dilley J, Newcomer JW, Schillinger D. Lessons Learned From a New Reverse-Integration Model to Improve Primary Care Screening in Community Mental Health Settings. Psychiatr Serv 2022; 73:942-945. [PMID: 35138129 PMCID: PMC9357142 DOI: 10.1176/appi.ps.202100177] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors sought to describe a reverse-integration intervention aimed at improving preventive health screening in a community mental health clinic. The intervention, CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness), integrated primary care services into a large urban community mental health setting. It was implemented in 2015 and included a patient-centered team, population-based care, emphasis on screening, and evidence-based treatment. CRANIUM's strengths included provider acceptability, a patient-centered approach, sustained patient engagement, and economic feasibility. Challenges included underutilized staff, registry maintenance, and unanticipated screening barriers. The CRANIUM reverse-integration model can be feasibly implemented and was acceptable to providers.
Collapse
Affiliation(s)
- Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Marilyn D Thomas
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Fumi Mitsuishi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - L Elizabeth Goldman
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Grace Niu
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Margaret A Handley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Nicholas S Riano
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Alison Hwong
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Susan Essock
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - John W Newcomer
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Dean Schillinger
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| |
Collapse
|
15
|
Lee JI, Kim E, Kim HJ, Lee DH. Factors influencing the successful connection of deliberate self-injury patients to community-based mental health centers. Asian J Psychiatr 2022; 72:103088. [PMID: 35358763 DOI: 10.1016/j.ajp.2022.103088] [Citation(s) in RCA: 3] [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] [Received: 05/30/2021] [Revised: 12/17/2021] [Accepted: 03/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The emergency department (ED) is a good place to start preventing actions for suicide attempters. As a preventive factor, early intervention, follow-up management, and connection with community-based mental health care are important. We aimed to determine which factors were important for a successful connection to community-based mental health care services. METHODS This study was conducted at two tertiary teaching hospitals from January 2018 to December 2020. There were 1016 deliberate self-harm patients who received the four weeks of follow-up intervention. RESULTS There were 166 patients in the connected group and 850 patients in the non-connected group. In the logistic regression analysis for the successful connection to community-based mental health care, married patients had an odds ratio (OR) 1.627 (95% CI 0.960-2.758), 1.314 OR (95% CI 0.619-2.790) of separated patients and 5.317 OR (CI 1.864-15.168) of widowed patients compared to single patients. And face-to-face follow-up management had 2.630 OR (95% CI 1.815-3.811) to the successful connection rate to community-based mental healthcare compared to the patients in non-face-to-face management. CONCLUSION When deliberately self-injured patients who visited the ED received short-term follow-up intervention after emergency treatment, face-to-face follow-up intervention had a higher connection rate to community-based mental healthcare centers than non-face-to-face follow-up intervention. In the future, for deliberate self-harm patients who visit the ED, the ED staff should manage deliberate self-harm through early detection and face-to-face follow-up intervention, and other methods that can compensate for face-to-face follow-up intervention.
Collapse
Affiliation(s)
- Jung Il Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, South Korea
| | - Eun Kim
- Department of Emergency Medicine, Ewha Womans University, Seoul, South Korea
| | - Hye Jin Kim
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Seoul, South Korea.
| |
Collapse
|
16
|
Tanzer JR, Redding CA, Mikhalyuk I, Bennett B, Lamoureux B, Achin D, Bassett S, Martin R, Stein LAR. Implementing Coordinated Specialty Care in CMHC Youth and Young Adults with Severe Mental Illness: Preliminary Outcome Assessment. Community Ment Health J 2021; 57:1348-1359. [PMID: 33438137 DOI: 10.1007/s10597-020-00763-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
This study assessed impact of Coordinated Specialty Care (CSC), expanded to include both first episode psychosis (FEP) and severe mental health disorders (e.g., depression, bipolar disorder, trauma) in youths attending Community Mental Health Centers (CMHCs). Eligible youth and young adults (ages 16-26 years, N = 201) were recruited from two CMHCs and assessed every 6 months. Paired sample t-tests were performed comparing pre- and post-treatment observations. Statistically significant decreases from pre to post were found in sad and anxious feelings and in days hospitalized for psychiatric emergency and increases were found in subjective health ratings and employment status. This preliminary assessment supports the effectiveness of expanded inclusion criteria for participation in the CSC model.
Collapse
Affiliation(s)
- Joshua Ray Tanzer
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA.
| | - Colleen A Redding
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Irena Mikhalyuk
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | | | | | - Denise Achin
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, USA
| | - Shayna Bassett
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | | | - L A R Stein
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, USA
- Brown University School of Public Health, Providence, USA
- RI Training School, Cranston, USA
| |
Collapse
|
17
|
Abstract
Evidence-based practices (EBPs) are frequently proposed as an approach to close the quality chasm in behavioral health treatment, and many U.S. municipalities are investing in EBPs as a primary way to improve the quality of care delivered to individuals most in need. In this Open Forum, the authors argue that EBPs often cannot be successfully implemented because basic organizational needs are not met in the current fiscal environment. The authors summarize research that supports why EBPs, along with other approaches to improve quality, are likely to fail until there is adequate financing. They also propose a policy and research agenda to ameliorate and address the fiscal challenges inherent in community mental health and substance use services.
Collapse
Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (all authors); Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (all authors); Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (all authors); Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| |
Collapse
|
18
|
Abstract
OBJECTIVE Person-centered care is a key quality indicator and central to promoting integrated and recovery-oriented services. Person-centered care planning (PCCP) is a manualized intervention promoting the collaborative cocreation of a recovery-oriented care service plan on the basis of an individual's most valued life goals. This cluster randomized controlled trial tested the effect of PCCP training on person-centered care delivery in community mental health clinics. METHODS Fourteen clinic sites were randomly assigned to receive either PCCP training (N=7; experimental condition) or service planning as usual (N=7; control condition). Data were collected from online surveys, and service plans were completed by 60 provider teams. The Person-Centered Care Planning Assessment Measure was administered via chart review at baseline, 12 months, and 18 months, and surveys were used to measure supervision, implementation leadership, and program type. The main effect was examined with linear mixed-effects regression models, with observations over time. RESULTS Analyses controlling for service user and program characteristics revealed that at 12 months, the group assigned to PCCP training showed significant improvements in delivering person-centered care compared with the control group (b=1.10, SE=0.50, p=0.03). At 18 months, this effect was even more pronounced (b=1.47, SE=0.50, p=0.01), representing a medium-to-large effect size of d=0.71 (95% confidence interval=0.23-1.20). CONCLUSIONS These findings indicate that training providers in PCCP increases provider competency in delivering person-centered care. Using an objective measure of person-centered care, the authors show that a comprehensive training strategy can target both the philosophical shift and the technical skills needed to promote client recovery.
Collapse
Affiliation(s)
- Victoria Stanhope
- Silver School of Social Work, New York University, New York City (Stanhope); School of Social Work, University of Minnesota, Minneapolis (Choy-Brown); School of Social Work, Boise State University, Boise, Idaho (Williams); School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus)
| | - Mimi Choy-Brown
- Silver School of Social Work, New York University, New York City (Stanhope); School of Social Work, University of Minnesota, Minneapolis (Choy-Brown); School of Social Work, Boise State University, Boise, Idaho (Williams); School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus)
| | - Nathaniel Williams
- Silver School of Social Work, New York University, New York City (Stanhope); School of Social Work, University of Minnesota, Minneapolis (Choy-Brown); School of Social Work, Boise State University, Boise, Idaho (Williams); School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus)
| | - Steven C Marcus
- Silver School of Social Work, New York University, New York City (Stanhope); School of Social Work, University of Minnesota, Minneapolis (Choy-Brown); School of Social Work, Boise State University, Boise, Idaho (Williams); School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus)
| |
Collapse
|
19
|
Lim C, Hernandez M, Gaona L, Barrio C. Recruitment of Asian Americans with Schizophrenia Spectrum Disorder for Research Participation: Barriers, Strategies, and Outcomes. Community Ment Health J 2021; 57:490-501. [PMID: 32588227 DOI: 10.1007/s10597-020-00670-z] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Abstract
Difficulty reaching Asian Americans with schizophrenia spectrum disorder has prompted mental health researchers to exclude this subpopulation from the sampling frame or enroll a comparatively smaller sample compared to other races and ethnicities with similar diagnoses. Understanding potential influences on research participation may facilitate efforts to increase the representation of this vulnerable yet underrepresented population in research. We detailed our experiences recruiting Asian Americans with schizophrenia spectrum disorder for participation in an observational study that evaluated their clinical outcomes. We applied the matching model of recruitment by identifying recruitment barriers encountered by or arising from the target group and researchers at the macro (community mental health center and academic institution), mediator (gatekeepers and research team), and micro (participant and interviewer) levels and then implementing a multilevel approach to overcoming identified obstacles. Our yearlong recruitment efforts yielded a diverse community sample (n = 75) recruited from six urban community mental health centers. Barriers to involving Asian Americans with schizophrenia spectrum disorder in research are complex and associated with being a member of a heterogeneous racial and ethnic minority group and having a serious psychiatric condition. Engaging Asian Americans with schizophrenia spectrum disorder in research is feasible if researchers devote time and resources to address barriers confronting the target group and challenges researchers encounter.
Collapse
Affiliation(s)
- Caroline Lim
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Blk AS3 Level 4, 3 Arts Link, Singapore, 117570, Singapore.
| | - Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA
| | - Lizbeth Gaona
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA.,College of Behavioral and Social Sciences, Calfornia Baptist University, Riverside, USA
| | - Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
| |
Collapse
|
20
|
Walker ER, Moore E, Tapscott S, Alperin M, Cummings JR, Druss BG. Developing Regional Mental Health Priorities: Mixed-Methods Needs Assessment of Eight States in the Southeastern United States. Psychiatr Serv 2021; 72:358-361. [PMID: 33234050 DOI: 10.1176/appi.ps.202000141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
State mental health agencies (SMHAs), which provide a variety of services to meet their residents' mental health needs, typically work within their own state, with little opportunity for cross-state collaboration and information exchange. This column describes a mixed-methods needs assessment conducted by the Southeast Mental Health Technology Transfer Center (MHTTC) to identify regional mental health priorities in eight states of the southeastern United States. The six priority areas identified were mental health workforce, school-based mental health, suicide prevention, peer workforce, criminal justice and mental health, and supported housing. These regional priorities inform the Southeast MHTTC's activities and can be used to promote collaborative exchange and problem solving among SMHAs.
Collapse
Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Emily Moore
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Stephanie Tapscott
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Melissa Alperin
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Janet R Cummings
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Benjamin G Druss
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| |
Collapse
|
21
|
Abstract
OBJECTIVE Since the first recovery college (RC) opened in England in 2009, many more have begun operating around the world. The body of knowledge regarding the effects of RCs is growing, suggesting their benefit to recovery, well-being, goal achievement, knowledge, self-management, social support, reduced stigma, and service use. The objective of this review was to establish the state of knowledge about RCs from current empirical literature and to document the methods used to evaluate them. METHODS In consultation with an international expert panel, two independent evaluators performed a literature review with no date limits on publications in the Medline and Scopus electronic databases. RESULTS A total of 460 articles were found, and 31 publications were retained. RC attendance was associated with high satisfaction among students, attainment of recovery goals, changes in service providers' practice, and reductions in service use and cost. CONCLUSIONS To our knowledge, this is the first literature review of peer-reviewed publications about original studies evaluating the impacts of RCs, including studies pertaining to students, health service providers' practices, education and management practitioners, and citizens. Quantitative studies with a high level of evidence were underrepresented and should be considered as a future evaluation design. Furthermore, outcomes such as empowerment and reduced stigma should be assessed with standardized tools. The impact of RCs on attendees, family, friends, and caregivers and on the everyday practice of health service providers who attend RCs for continuing education or as tutors should also be assessed.
Collapse
Affiliation(s)
- Joanie Thériault
- Department of Occupational Therapy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada (Thériault, Lord, Briand); Department of Psychiatry, Douglass Hospital Research Centre, McGill University, Montreal (Piat); Psychology and Psychological Therapies, Sussex Partnership National Health Service Foundation Trust, Hove, United Kingdom (Meddings)
| | - Marie-Michèle Lord
- Department of Occupational Therapy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada (Thériault, Lord, Briand); Department of Psychiatry, Douglass Hospital Research Centre, McGill University, Montreal (Piat); Psychology and Psychological Therapies, Sussex Partnership National Health Service Foundation Trust, Hove, United Kingdom (Meddings)
| | - Catherine Briand
- Department of Occupational Therapy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada (Thériault, Lord, Briand); Department of Psychiatry, Douglass Hospital Research Centre, McGill University, Montreal (Piat); Psychology and Psychological Therapies, Sussex Partnership National Health Service Foundation Trust, Hove, United Kingdom (Meddings)
| | - Myra Piat
- Department of Occupational Therapy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada (Thériault, Lord, Briand); Department of Psychiatry, Douglass Hospital Research Centre, McGill University, Montreal (Piat); Psychology and Psychological Therapies, Sussex Partnership National Health Service Foundation Trust, Hove, United Kingdom (Meddings)
| | - Sara Meddings
- Department of Occupational Therapy, University of Québec at Trois-Rivières, Trois-Rivières, Québec, Canada (Thériault, Lord, Briand); Department of Psychiatry, Douglass Hospital Research Centre, McGill University, Montreal (Piat); Psychology and Psychological Therapies, Sussex Partnership National Health Service Foundation Trust, Hove, United Kingdom (Meddings)
| |
Collapse
|
22
|
Abstract
OBJECTIVE This study evaluated the impact of two behavioral health home (BHH) approaches, provider-supported care and self-directed care, on health care utilization and cost outcomes among adult Medicaid recipients with serious mental illness. METHODS Eleven community mental health provider sites were randomly assigned to one of the BHH approaches, which each site implemented over a 2-year period. In both approaches, staff were trained in wellness coaching to support patients' progress toward general health and wellness goals. Provider-supported sites employed a full-time on-site registered nurse, who provided consultation to patients and wellness coaches. Each approach had a consistently enrolled treatment group (combined N=859) with a matched comparison cohort that was identified for analysis. Approaches were compared with each other and with baseline, and differences between each approach and its comparison cohort were examined by using analysis of covariance to determine impact on total health care cost, prescription costs, and use and cost of general medical and behavioral health services. RESULTS Relative to its comparison cohort, each approach achieved significant reductions in total cost (15% for provider-supported care and 26% for self-directed care) and increases in use of outpatient general medical services (43% for provider-supported care and 29% for self-directed care). Compared with self-directed care, provider-supported care resulted in approximately 28% lower use of general medical inpatient services and 26% lower related costs. CONCLUSIONS BHH approaches in community mental health settings can produce health care savings and decrease use of inpatient health care.
Collapse
Affiliation(s)
- James Highland
- BerryDunn, Portland, Maine (Highland), Phoenix (Ji), and Honolulu (Kukla); UPMC Center for High-Value Health Care (Nikolajski, Kogan) and Community Care Behavioral Health Organization (Schuster), UPMC Insurance Services Division, Pittsburgh
| | - Cara Nikolajski
- BerryDunn, Portland, Maine (Highland), Phoenix (Ji), and Honolulu (Kukla); UPMC Center for High-Value Health Care (Nikolajski, Kogan) and Community Care Behavioral Health Organization (Schuster), UPMC Insurance Services Division, Pittsburgh
| | - Jane Kogan
- BerryDunn, Portland, Maine (Highland), Phoenix (Ji), and Honolulu (Kukla); UPMC Center for High-Value Health Care (Nikolajski, Kogan) and Community Care Behavioral Health Organization (Schuster), UPMC Insurance Services Division, Pittsburgh
| | - Yang Ji
- BerryDunn, Portland, Maine (Highland), Phoenix (Ji), and Honolulu (Kukla); UPMC Center for High-Value Health Care (Nikolajski, Kogan) and Community Care Behavioral Health Organization (Schuster), UPMC Insurance Services Division, Pittsburgh
| | - Matt Kukla
- BerryDunn, Portland, Maine (Highland), Phoenix (Ji), and Honolulu (Kukla); UPMC Center for High-Value Health Care (Nikolajski, Kogan) and Community Care Behavioral Health Organization (Schuster), UPMC Insurance Services Division, Pittsburgh
| | - James Schuster
- BerryDunn, Portland, Maine (Highland), Phoenix (Ji), and Honolulu (Kukla); UPMC Center for High-Value Health Care (Nikolajski, Kogan) and Community Care Behavioral Health Organization (Schuster), UPMC Insurance Services Division, Pittsburgh
| |
Collapse
|
23
|
Abstract
Diffusion theory has deeply influenced implementation science and, specifically, language and thinking around practitioners and organizations that do not adopt evidence-based practices. In this Open Forum, the authors address the use of the term "laggard" to characterize this late or nonadopting group and argue for new nomenclature and modernized attitudes and approaches toward this group.
Collapse
Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| |
Collapse
|
24
|
Abstract
OBJECTIVE This study examined the availability of primary care and wellness services in community mental health centers (CMHCs) and outpatient mental health facilities (OMHFs). METHODS This study used data from the 2016 National Mental Health Services Survey to examine the proportion of facilities that reported offering integrated primary care and wellness services (smoking and tobacco cessation counseling, diet and exercise counseling, and chronic disease and illness management). The study used logistic regression to model the odds that a facility offered integrated primary care as a function of facility characteristics. RESULTS Across states, 23% of CMHCs and 19% of OMHFs offered integrated primary care. The odds of offering integrated primary care were significantly higher among facilities that reported more quality improvement practices, prohibited smoking, or offered wellness services. Less than one third offered smoking and tobacco cessation counseling or other wellness services. CONCLUSIONS Integrated primary care remains uncommon in CMHCs and OMHFs and is more likely among facilities with certain characteristics.
Collapse
|
25
|
Park CHK, Lee JW, Lee SY, Moon JJ, Jeon DW, Shim SH, Cho SJ, Kim SG, Lee J, Paik JW, Kim MH, Kim S, Park JH, You S, Jeon HJ, Rhee SJ, Ahn YM. The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior: Study rationale, methodology, and baseline sample characteristics of a long-term, large-scale, multi-center, prospective, naturalistic, observational cohort study. Compr Psychiatry 2019; 88:29-38. [PMID: 30468986 DOI: 10.1016/j.comppsych.2018.11.003] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study is a prospective, naturalistic, observational cohort study, aiming to identify predictors of suicide attempt and suicide characteristics in the Korean suicidal population. The findings intend to contribute to a thorough understanding of suicidal phenomena and development of suicide prevention guidelines. The present cross-section study examines the study rationale, methodology, and baseline characteristics of the participants. METHODS Participants were enrolled via the hospital and community gateways, establishing the hospital-based cohort (HC) and community-based cohort (CC), respectively. Baseline assessment was conducted on sociodemographic, clinical, diagnostic, and psychopathological aspects. The Columbia-Suicide Severity Rating Scale was used to investigate suicidality. RESULTS A total of 800 suicidal people aged 15 years or older were enrolled from 8 university hospitals and 8 community mental health welfare centers (CMHWCs), among whom 480 (60%) were suicidal ideators and 320 (40%) were attempters. The ideators comprised 207 CC and 273 HC participants, whereas the attempters, 34 CC and 286 HC participants. Despite their lower severity in some measures, including suicidal ideation, compared with their HC counterparts, the CC participants within each group of ideators or attempters presented clinically significant psychopathology. Moreover, alcohol use problems and past suicide attempt were more likely to be found in CC participants. Only 11.1% to 21.6% of the participants in each of the four groups (defined by the cohorts and the ideators/attempters) were on any type of psychiatric treatment. CONCLUSIONS Suicidal visitors to CMHWCs need to be as closely monitored as suicidal patients in university hospitals, especially considering their association with problem drinking and past suicide attempt. A cautious assumption is that the high suicide rate in Korea might be partly attributable to the low proportion of patients receiving psychiatric services.
Collapse
Affiliation(s)
- C Hyung Keun Park
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jae Won Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, 895 Muwangno, Iksan, Jeollabuk-do 54538, Republic of Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea
| | - Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soon Chun Hyang University Cheonan Hospital, Soon Chun Hyang University, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, 21 Namdongdea-ro 774 gil, Namdong-gu, Incheon 21565, Republic of Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeonggi-do 14584, Republic of Korea.
| | - Jeewon Lee
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeonggi-do 14584, Republic of Korea
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, Republic of Korea.
| | - Seokho Kim
- Department of Sociology, College of Social Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University College of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon 16419, Republic of Korea
| | - Sungeun You
- Department of Psychology, College of Social Sciences, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do 28644, Republic of Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| |
Collapse
|
26
|
Abstract
Stakeholder engagement is an important component of pragmatic trials seeking to improve mental health care in real-world settings. Models of stakeholder engagement outline the benefits of involving a diverse array of partners in all phases of research. This column describes a stakeholder engagement plan for a comparative-effectiveness pragmatic trial of a care navigator program to increase linkage between emergency departments and outpatient treatment at community mental health centers. Benefits of stakeholder engagement include meaningful input on program design and implementation, insights into balancing the need for flexibility among clinical sites while implementing the program with fidelity, and early discussions about program sustainability and dissemination.
Collapse
Affiliation(s)
- Elizabeth Reisinger Walker
- Dr. Walker and Ms. Zahn are with the Department of Behavioral Sciences and Health Education and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Rachel Zahn
- Dr. Walker and Ms. Zahn are with the Department of Behavioral Sciences and Health Education and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Benjamin G Druss
- Dr. Walker and Ms. Zahn are with the Department of Behavioral Sciences and Health Education and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| |
Collapse
|
27
|
Koksvik JM, Linaker OM, Gråwe RW, Bjørngaard JH, Lara-Cabrera ML. The effects of a pretreatment educational group programme on mental health treatment outcomes: a randomized controlled trial. BMC Health Serv Res 2018; 18:665. [PMID: 30157839 PMCID: PMC6114285 DOI: 10.1186/s12913-018-3466-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Received: 03/23/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022] Open
Abstract
Background Patients dropping out of mental health treatment is considered a widespread and significant obstacle to providing effective treatment, thus reducing the probability of patients achieving the desired improvement. Here, relative to ordinary treatment, we investigate the effects of providing an educational group programme before mental health treatment on mental health symptomatology and the risk of patients dropping out or prematurely discontinuing treatment. Methods A randomized controlled trial in which adults referred to a community mental health center were randomized to either a Control Group (n = 46) or a pretreatment educational programme followed by treatment as usual (Intervention Group, n = 45). The primary outcome was self-reported mental health symptomatology assessed with BASIS-32. Data were analyzed by multilevel linear regression and Cox’s regression. Results We recruited 93 patients during a 26-month period. Assessments were performed before (0 month, baseline) and after the intervention (1 month, before treatment initiation), and after 4 and 12 months. The net difference in BASIS-32 score between 0 and 1-month was − 0.27 (95% confidence interval CI] -0.45 to − 0.09) in favor of the intervention group. Although both groups had a significant and continuous decline in psychopathology during the treatment (from 1 month and throughout the 4- and 12-month follow-up assessments), the group difference detected before treatment (between 0 and 1 month) persisted throughout the study. Premature treatment discontinuation was partially prevented. The dropout risk was 74% lower in the Intervention Group than in the Control Group (hazard ratio 0.26, 95% CI = 0.07–0.93). Conclusions A brief educational intervention provided before mental health treatment seems to have an immediate and long-lasting effect on psychopathology, supplementary to traditional treatment. Such an intervention might also have a promising effect on reducing treatment dropout. Trial registration NCT00967265, clinicaltrials.gov. Registered August 27, 2009, retrospectively registered.
Collapse
Affiliation(s)
- John Morten Koksvik
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Pb 8905 MTFS, 7491, Trondheim, Norway. .,Tiller Community Mental Health Center, Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway.
| | - Olav Morten Linaker
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Pb 8905 MTFS, 7491, Trondheim, Norway.,Department of Research and Development, Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Rolf Wilhelm Gråwe
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Pb 8905 MTFS, 7491, Trondheim, Norway.,Department of Research and Development, Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Forensic Department and Research Center Brøset, St. Olavs University Hospital, Trondheim, Norway
| | - Mariela Loreto Lara-Cabrera
- Tiller Community Mental Health Center, Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway.,Department of Research and Development, Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
28
|
Bartels SJ, Aschbrenner KA, Pratt SI, Naslund JA, Scherer EA, Zubkoff L, Cohen MJ, Williams GE, Wolfe RS, Jue K, Brunette MF. Implementation of a Lifestyle Intervention for People With Serious Mental Illness in State-Funded Mental Health Centers. Psychiatr Serv 2018; 69:664-670. [PMID: 29606077 DOI: 10.1176/appi.ps.201700368] [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 The purpose of this study was to evaluate health outcomes of a state-supported implementation in community mental health settings of an evidence-based lifestyle intervention for overweight and obese adults with serious mental illness. METHODS Weight and fitness outcomes were evaluated for 122 overweight or obese adults with serious mental illness in four community mental health centers (CMHCs) that were participating in a phased statewide implementation of the In SHAPE lifestyle intervention. Six- and 12-month outcomes were compared between two CMHCs that implemented In SHAPE in the first 12 months and two CMHCs with similar characteristics that implemented In SHAPE in a subsequent phase in the statewide implementation 12 months later. RESULTS Participants in the two In SHAPE sites (N=63 participants) lost significantly more weight (p=.003) and showed greater improvement in fitness (p=.011) compared with participants at the two usual care control sites (N=59 participants). At six months, nearly half (49%) of In SHAPE participants and at 12 months more than half (60%) of In SHAPE participants showed clinically significant cardiovascular risk reduction defined as ≥5% weight loss or improved fitness (>50 m [164 feet] increase on the six-minute walk test). The difference between the In SHAPE and control groups was not statistically significant. CONCLUSIONS This natural experiment demonstrated promising public health benefits of a practical implementation of health promotion programming for overweight and obese adults with serious mental illness and offers a potential model for reducing risk of early mortality among individuals served by state-funded mental health centers nationwide.
Collapse
Affiliation(s)
- Stephen J Bartels
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Kelly A Aschbrenner
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Sarah I Pratt
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - John A Naslund
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Emily A Scherer
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Lisa Zubkoff
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Michael J Cohen
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Gail E Williams
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Rosemarie S Wolfe
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Kenneth Jue
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| | - Mary F Brunette
- Dr. Bartels, Dr. Aschbrenner, Dr. Pratt, Dr. Zubkoff, Ms. Williams, Ms. Wolfe, and Dr. Brunette are with the Department of Psychiatry, and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Bartels is also with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, where Dr. Scherer is affiliated. Dr. Zubkoff is also with the Engineering Resource Center, White River Junction Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr. Naslund is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston. Mr. Cohen is with MJC Health Solutions LLC, Amherst, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire
| |
Collapse
|
29
|
Brunette MF, Pratt SI, Bartels SJ, Scherer EA, Sigmon SC, Ferron JC, Santos M, Williams GE, Kosydar S, Wolfe RS, Lotz D, Capuchino K. Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries With Mental Illness. Psychiatr Serv 2018; 69:274-280. [PMID: 29137560 DOI: 10.1176/appi.ps.201700245] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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 Medicaid beneficiaries with severe mental illnesses are a financially disadvantaged group with high rates of smoking and poor cessation outcomes. This study examined whether abstinence-contingent monetary incentives improved outcomes when added to cessation treatments at community mental health centers: prescriber visit for pharmacotherapy only (PV only), prescriber visit and facilitated quitline (PV+Q), and prescriber visit and telephone cognitive-behavioral therapy (PV+CBT). METHODS During 2012-2015, a total of 1,468 adult, daily smoking Medicaid beneficiaries with mental illnesses received Web-based motivational tobacco education. Eligible participants who wanted cessation treatment (N=661) were randomly assigned to treatment with or without abstinence-contingent incentives for four weeks after a quit attempt and assessed for biologically verified abstinence at three, six, nine, and 12 months. To examine intervention effect on abstinence over time, logistic generalized linear models estimated with generalized estimating equations were used, with missing observations imputed as smoking. RESULTS Participants included smokers with schizophrenia disorders (N=148), bipolar disorder (N=150), major depressive disorder (N=158), and anxiety and other disorders (N=205). There was no significant effect of intervention (PV only, PV+Q, and PV+CBT). However, participants who received monetary incentives were more likely to be abstinent from smoking over time (adjusted odds ratio [AOR]=1.77, p=.009). Post hoc comparisons indicated greater abstinence at 12 months in PV+Q with incentives than in PV+Q without incentives (14% versus 4% abstinent, AOR=3.94, p=.014). Treatment participation and cessation outcomes did not differ significantly between diagnostic groups. CONCLUSIONS Abstinence-contingent incentives improved cessation outcomes among financially disadvantaged smokers with mental illness receiving tobacco treatment at community mental health centers.
Collapse
Affiliation(s)
- Mary F Brunette
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Sarah I Pratt
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Stephen J Bartels
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Emily A Scherer
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Stacey C Sigmon
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Joelle C Ferron
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Meghan Santos
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Gail E Williams
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Samuel Kosydar
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Rosemarie S Wolfe
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Doris Lotz
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| | - Kelley Capuchino
- Dr. Brunette, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry, and Dr. Scherer is with the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Dr. Brunette, Dr. Pratt, and Dr. Bartels are also with the Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, where Dr. Ferron, Ms. Santos, Ms. Williams, Mr. Kosydar, and Ms. Wolfe are affiliated. Dr. Sigmon is with the Department of Psychiatry, University of Vermont College of Medicine, Burlington. Dr. Lotz and Ms. Capuchino are with the New Hampshire Department of Health and Human Services, Concord
| |
Collapse
|
30
|
Mangurian C, Niu G, Schillinger D, Newcomer JW, Gilmer T. Understanding the Cost of a New Integrated Care Model to Serve CMHC Patients Who Have Serious Mental Illness. Psychiatr Serv 2017; 68:990-993. [PMID: 28859579 PMCID: PMC7755073 DOI: 10.1176/appi.ps.201700199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/07/2023]
Abstract
People with serious mental illness, such as schizophrenia and bipolar disorder, experience premature mortality, often from cardiovascular disease (CVD). Unfortunately, people with serious mental illness typically are not screened or treated for CVD risk factors despite national guideline recommendations. Access to primary preventive care in community mental health settings has the potential to reduce early mortality rates in this population. The authors review best practices for developing an integrated care model for people with serious mental illness by considering economic feasibility and sustainability from the perspective of a community mental health clinic (CMHC). A process-mapping approach was used to gather information on clinic costs (staff roles, responsibilities, time, and salary) of serving 544 patients at one CMHC. The estimated annual cost of the model was measurable and modest, at $74 per person, suggesting that this model may be financially feasible.
Collapse
Affiliation(s)
- Christina Mangurian
- Dr. Mangurian and Dr. Niu are with the Department of Psychiatry, Weill Institute for Neurosciences, and Dr. Schillinger is with the Division of General Internal Medicine, all at the University of California, San Francisco. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Gilmer is with the Department of Family Medicine and Public Health, University of California, San Diego
| | - Grace Niu
- Dr. Mangurian and Dr. Niu are with the Department of Psychiatry, Weill Institute for Neurosciences, and Dr. Schillinger is with the Division of General Internal Medicine, all at the University of California, San Francisco. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Gilmer is with the Department of Family Medicine and Public Health, University of California, San Diego
| | - Dean Schillinger
- Dr. Mangurian and Dr. Niu are with the Department of Psychiatry, Weill Institute for Neurosciences, and Dr. Schillinger is with the Division of General Internal Medicine, all at the University of California, San Francisco. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Gilmer is with the Department of Family Medicine and Public Health, University of California, San Diego
| | - John W Newcomer
- Dr. Mangurian and Dr. Niu are with the Department of Psychiatry, Weill Institute for Neurosciences, and Dr. Schillinger is with the Division of General Internal Medicine, all at the University of California, San Francisco. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Gilmer is with the Department of Family Medicine and Public Health, University of California, San Diego
| | - Todd Gilmer
- Dr. Mangurian and Dr. Niu are with the Department of Psychiatry, Weill Institute for Neurosciences, and Dr. Schillinger is with the Division of General Internal Medicine, all at the University of California, San Francisco. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Gilmer is with the Department of Family Medicine and Public Health, University of California, San Diego
| |
Collapse
|
31
|
Martinez W, Galván J, Saavedra N, Berenzon S. Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis. Psychiatr Serv 2017; 68:497-502. [PMID: 27974004 PMCID: PMC5411288 DOI: 10.1176/appi.ps.201600141] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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 Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired. METHODS A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access. RESULTS Primary care staff reported a number of significant barriers to implementing mental health services in primary care clinics, an already fragile and underfunded system. Barriers included the following broad thematic categories: service issues, language and cultural issues, care recipient characteristics, and issues with lack of knowledge. CONCLUSIONS Results indicate that the implementation of mental health services in primary care clinics in Mexico will be difficult. However, the information in this study can help inform the integration of mental health into community-based primary care in Mexico through the development of adequate evaluative tools to assess the feasibility and progress of integrating these services.
Collapse
Affiliation(s)
- William Martinez
- Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City
| | - Jorge Galván
- Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City
| | - Nayelhi Saavedra
- Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City
| | - Shoshana Berenzon
- Dr. Martinez is with the School of Public Health, University of California, Berkeley (e-mail: ). The other authors are with the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City
| |
Collapse
|
32
|
MacDonald-Wilson KL, Hutchison SL, Karpov I, Wittman P, Deegan PE. A Successful Implementation Strategy to Support Adoption of Decision Making in Mental Health Services. Community Ment Health J 2017; 53:251-256. [PMID: 27262699 DOI: 10.1007/s10597-016-0027-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 09/24/2015] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
Abstract
Individual involvement in treatment decisions with providers, often through the use of decision support aids, improves quality of care. This study investigates an implementation strategy to bring decision support to community mental health centers (CMHC). Fifty-two CMHCs implemented a decision support toolkit supported by a 12-month learning collaborative using the Breakthrough Series model. Participation in learning collaborative activities was high, indicating feasibility of the implementation model. Progress by staff in meeting process aims around utilization of components of the toolkit improved significantly over time (p < .0001). Survey responses by individuals in service corroborate successful implementation. Community-based providers were able to successfully implement decision support in mental health services as evidenced by improved process outcomes and sustained practices over 1 year through the structure of the learning collaborative model.
Collapse
Affiliation(s)
- Kim L MacDonald-Wilson
- UPMC Insurance Services Division, Community Care Behavioral Health, Pittsburgh, PA, USA.
| | - Shari L Hutchison
- UPMC Insurance Services Division, Community Care Behavioral Health, Pittsburgh, PA, USA
| | - Irina Karpov
- UPMC Insurance Services Division, Community Care Behavioral Health, Pittsburgh, PA, USA
| | - Paul Wittman
- UPMC Insurance Services Division, Community Care Behavioral Health, Pittsburgh, PA, USA
| | | |
Collapse
|
33
|
Abstract
OBJECTIVE Young adulthood represents a critical time to address elevated obesity rates and the risk of early mortality, particularly among people with serious mental illness. Few studies have assessed the benefits of lifestyle interventions targeting weight loss among these young adults. This study examined the impact of the 12-month In SHAPE lifestyle intervention on weight loss and fitness among overweight and obese young adults with serious mental illness (ages 21-30) compared with participants over age 30. METHODS Data were combined from three trials of the 12-month In SHAPE program delivered through community mental health centers. In SHAPE includes weekly fitness trainer meetings, a gym membership, and nutrition education. Primary outcomes were weight loss and change in fitness at 12 months. RESULTS Participants (N=194) had a schizophrenia spectrum disorder (53%) or a mood disorder (47%). The overall sample achieved significant weight loss and improved fitness; differences between young adults (N=29) and participants over age 30 (N=165) were not significant. An important finding was that 42% of young adults achieved clinically significant reductions in cardiovascular risk, defined as ≥5% weight loss or improved fitness (>50-m increase on the 6-Minute Walk Test), compared with 54% of adults over age 30 (a nonsignificant difference between age groups). CONCLUSIONS Among persons enrolled in a lifestyle intervention, overweight and obese young adults experienced benefits comparable with those of adults over age 30. Young adults with serious mental illness face high risk of gaining weight, but a meaningful proportion of these individuals can achieve clinically significant cardiovascular risk reduction, thus highlighting the need to promote lifestyle intervention participation in this group.
Collapse
Affiliation(s)
- John A Naslund
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kelly A Aschbrenner
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Emily A Scherer
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sarah I Pratt
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Stephen J Bartels
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| |
Collapse
|
34
|
Steiner JL, Anez-Nava L, Baranoski M, Cole R, Davidson L, Delphin-Rittmon M, Dike C, DiLeo PJ, Duman RS, Kirk T, Krystal J, Malison RT, Rohrbaugh RM, Sernyak MJ, Srihari V, Styron T, Tebes JK, Woods S, Zonana H, Jacobs SC. The Connecticut Mental Health Center: Celebrating 50 Years of a Successful Partnership Between the State and Yale University. Psychiatr Serv 2016; 67:1286-1289. [PMID: 27691379 DOI: 10.1176/appi.ps.201600373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-owned and state-operated joint venture between the state and Yale University built and sustained with federal, state, and university funds. Collaboration across these entities has produced a wide array of clinical, educational, and research initiatives, a few of which are described in this column. The missions of clinical care, research, and education remain the foundation for an organization that serves 5,000 individuals each year who are poor and who experience serious mental illnesses and substance use disorders.
Collapse
Affiliation(s)
- Jeanne L Steiner
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Luis Anez-Nava
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Madelon Baranoski
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Robert Cole
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Larry Davidson
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Miriam Delphin-Rittmon
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Charles Dike
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Paul J DiLeo
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Ronald S Duman
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Thomas Kirk
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - John Krystal
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Robert T Malison
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Robert M Rohrbaugh
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Michael J Sernyak
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Vinod Srihari
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Thomas Styron
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Jacob K Tebes
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Scott Woods
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Howard Zonana
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Selby C Jacobs
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| |
Collapse
|
35
|
Min SY. [The Psychosocial Adaptation Process of Psychiatric Nurses Working in Community Mental Health Centers]. J Korean Acad Nurs 2016; 45:868-78. [PMID: 26805499 DOI: 10.4040/jkan.2015.45.6.868] [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: 05/18/2015] [Revised: 06/10/2015] [Accepted: 09/04/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to verify psychosocial issues faced by psychiatric and community mental health nurse practitioners (PCMHNP) working in community mental health centers, and to identify the adaptation processes used to resolve the issues. METHODS Data were collected through in-depth interviews between December 2013 and August 2014. Participants were 11 PCMHNP working in community mental health centers. Analysis was done using the grounded theory methodology. The first question was "How did you start working at a community mental health center; what were the difficulties you faced during your employment and how did you resolve them?" RESULTS The core category was 'regulating within relationships.' The adaptation process was categorized into three sequential stages: 'nesting,' 'hanging around the nest,' and 'settling into the nest.' Various action/interaction strategies were employed in these stages. The adaptation results from using these strategies were 'psychiatric nursing within life' and 'a long way to go.' CONCLUSION The results of this study are significant as they aid in understanding the psychosocial adaptation processes of PCMHNP working in community mental health centers, and indicate areas to be addressed in the future in order for PCMHNP to fulfill their professional role in the local community.
Collapse
Affiliation(s)
- So Young Min
- Department of Nursing, Semyung University, Jecheon, Korea.
| |
Collapse
|
36
|
Moljord IEO, Lara-Cabrera ML, Perestelo-Pérez L, Rivero-Santana A, Eriksen L, Linaker OM. Psychometric properties of the Patient Activation Measure-13 among out-patients waiting for mental health treatment: A validation study in Norway. Patient Educ Couns 2015; 98:1410-7. [PMID: 26146239 DOI: 10.1016/j.pec.2015.06.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/20/2015] [Accepted: 06/13/2015] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined. METHODS A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51). RESULTS The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p<0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85). CONCLUSION PAM has appropriate and acceptable psychometric properties in mental health settings. PRACTICE IMPLICATIONS Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health.
Collapse
Affiliation(s)
- Inger Elise O Moljord
- Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Nidaros Community Mental Health Center, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway.
| | - Mariela L Lara-Cabrera
- Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Tiller Community Mental Health Center, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway.
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Amado Rivero-Santana
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain; Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain; Canarian Foundation of Health Research (FUNCANIS), Tenerife, Spain
| | - Lasse Eriksen
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway
| | - Olav M Linaker
- Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience, Trondheim, Norway
| |
Collapse
|