1
|
Klodnick VV, Johnson RP, Sapiro B, Fagan MA, Cohen DA. How Young Adults with Serious Mental Health Diagnoses Navigate Poverty Post-emancipation: The Complex Roles of Community Mental Health Services & Informal Social Support. Community Ment Health J 2024; 60:635-648. [PMID: 37789173 DOI: 10.1007/s10597-023-01188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023]
Abstract
Serious mental health diagnoses are prevalent among youth who "age out" of foster care by reaching the maximum age for child welfare service eligibility. Post-emancipation, little is known about how youth engage in community mental health services, or leverage informal social networks, to navigate independence. Twenty emancipating youth completed three interviews over 16 months. All emancipated into poverty; most lived alone and initially connected to adult community mental health teams. Four service use and informal support profiles emerged from analysis: (1) Navigators (n = 2) actively used mental health services and provided limited informal support; Treaders (n = 9) passively used mental health services and heavily exchanged informal support; Survivors (n = 5) used mental health services when in crisis and heavily provided informal support; and Strugglers (n = 4) avoided mental health services and took resources from informal connections. Findings have implications for both child and adult mental health and social service providers.
Collapse
Affiliation(s)
- Vanessa V Klodnick
- Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, The University of Texas at Austin, Austin, USA.
- Thresholds Youth & Young Adult Services, Chicago, IL, USA.
| | - Rebecca P Johnson
- Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, The University of Texas at Austin, Austin, USA
- Thresholds Youth & Young Adult Services, Chicago, IL, USA
| | - Beth Sapiro
- Department of Social Work and Child Advocacy, College of Humanities and Social Sciences, Montclair State University, Montclair, NJ, USA
| | - Marc A Fagan
- Thresholds Youth & Young Adult Services, Chicago, IL, USA
| | - Deborah A Cohen
- Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, The University of Texas at Austin, Austin, USA
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, USA
| |
Collapse
|
2
|
Nogueira-Leite D, Marques-Cruz M, Cruz-Correia R. Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey. BMC Med Inform Decis Mak 2024; 24:99. [PMID: 38637866 PMCID: PMC11025147 DOI: 10.1186/s12911-024-02488-1] [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] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment. OBJECTIVE This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers. METHODS A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence. RESULTS Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect. CONCLUSIONS These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health. TRIAL REGISTRATION RR2-10.2196/41040.
Collapse
Affiliation(s)
- Diogo Nogueira-Leite
- Health Data Science Ph.D. Program, Faculty of Medicine of the University of Porto, Porto, Portugal.
- Department of Community Medicine, Health Information and Decision-Making, Faculty of Medicine of the University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal.
- Nova School of Business and Economics Health Economics & Management Knowledge Center, New University of Lisbon, Lisbon, Portugal.
| | - Manuel Marques-Cruz
- Health Data Science Ph.D. Program, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Community Medicine, Health Information and Decision-Making, Faculty of Medicine of the University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal
- Nova School of Business and Economics Health Economics & Management Knowledge Center, New University of Lisbon, Lisbon, Portugal
| | - Ricardo Cruz-Correia
- Department of Community Medicine, Health Information and Decision-Making, Faculty of Medicine of the University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal
- Center for Health Technology and Services Research, Porto, Portugal
| |
Collapse
|
3
|
Hoover SA. Investing in School Mental Health: Strategies to Wisely Spend Federal and State Funding. Psychiatr Serv 2024:appips20230553. [PMID: 38566559 DOI: 10.1176/appi.ps.20230553] [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: 04/04/2024]
Abstract
In the context of the current youth mental health crisis, it is prudent to reconsider how resources are allocated to facilitate the delivery of effective and comprehensive supports and services to children and adolescents. Schools are the main delivery sites for youth mental health services. Many districts have adopted comprehensive school mental health systems (CSMHS) to provide a multitiered approach comprising mental health promotion, prevention, and intervention to students via partnerships between school and community health and behavioral health providers. COVID-19 relief funding and other new federal and state investments in school mental health have led to expansions of school mental health programming in most states. An impending federal funding cliff necessitates an examination of how to wisely invest now to achieve the greatest positive future impact on youth mental health. To capitalize on opportunities to sustain effective school mental health and maximize return on investment, states may consider four strategies: leverage cross-sector partnerships to advance school mental health policies and funding, strengthen and expand Medicaid coverage of CSMHS, establish and enhance data systems, and create state technical assistance and professional development support for CSMHS implementation through local education agencies.
Collapse
Affiliation(s)
- Sharon A Hoover
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore
| |
Collapse
|
4
|
Frank RG, Paris J. The Strongest Predictor of CCBHC Presence: Population Density. Psychiatr Serv 2024; 75:398. [PMID: 38557133 DOI: 10.1176/appi.ps.20240054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
|
5
|
Ingoglia C, Farley David R. Broad Reach of Certified Community Behavioral Health Centers. Psychiatr Serv 2024; 75:397-398. [PMID: 38557131 DOI: 10.1176/appi.ps.20240018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
|
6
|
Hirschtritt ME, Staglin B, Buttlaire S, Ahearn K, Oglesby S, Dixon LB, Shern D, Ewing T, Niendam TA. Reimbursement for a Broader Array of Services in Coordinated Specialty Care for Early Psychosis. Psychiatr Serv 2024:appips20230551. [PMID: 38532691 DOI: 10.1176/appi.ps.20230551] [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: 03/28/2024]
Abstract
Despite the growing evidence supporting the benefits of coordinated specialty care (CSC) for early psychosis, access to this multimodal, evidence-based program in the United States has been hindered by a lack of funding for core CSC services and activities. The recent approval of team-based reimbursement codes by the Centers for Medicare and Medicaid Services has the potential to fund substantially more CSC services for clients with insurance coverage that accepts the new team-based billing codes. This streamlined and more inclusive billing strategy may reduce administrative burden and support the financial viability of CSC programs.
Collapse
Affiliation(s)
- Matthew E Hirschtritt
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Brandon Staglin
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Stuart Buttlaire
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Kerry Ahearn
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Sarada Oglesby
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Lisa B Dixon
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - David Shern
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Toby Ewing
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Tara A Niendam
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| |
Collapse
|
7
|
Kern LJ, Comartin EB, Nelson V, Kubiak SP. Jail-Based For-Profit Mental Health Providers and Treatment Engagement After Release. Psychiatr Serv 2024:appips20230396. [PMID: 38477837 DOI: 10.1176/appi.ps.20230396] [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: 03/14/2024]
Abstract
OBJECTIVE This study compared mental health treatment engagement among people with serious mental illness after release from jails that had either a for-profit (N=3 jails) or a nonprofit mental health provider (N=7 jails). METHODS Across the 10 jails, data were collected in 2019 for 1,238 individuals with serious mental illness. Data included demographic characteristics (age, race-ethnicity, gender, geography, and jail type) and behavioral health variables (previous mental health treatment, psychotropic medication use, substance use, and receipt of jail-based mental health services). Logistic regression was used to predict treatment engagement during the year after release, stratified by type of jail-based mental health provider, in analyses controlled for demographic and behavioral health variables. RESULTS Almost half (46%, N=573) of the individuals had stayed in jails with a for-profit mental health provider; the other half (54%, N=665) had stayed in jails with a nonprofit provider. In the year after release, 37% (N=458) of all individuals engaged in mental health treatment, and 63% (N=780) did not. Those who had stayed in a jail with a for-profit provider were significantly less likely to engage in mental health treatment during the year after release (AOR=0.59, 95% CI=0.42-0.83, p<0.01), compared with those in jails having a nonprofit provider. CONCLUSIONS Staying in a jail with a for-profit mental health provider was associated with reduced postrelease engagement with community service providers. Less engagement with services during a pivotal time after release may increase behavioral health crises that erode individuals' well-being and may raise downstream costs due to further criminal legal involvement and emergency care use.
Collapse
Affiliation(s)
- Lester J Kern
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago (Kern); Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Comartin, Nelson, Kubiak)
| | - Erin B Comartin
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago (Kern); Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Comartin, Nelson, Kubiak)
| | - Victoria Nelson
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago (Kern); Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Comartin, Nelson, Kubiak)
| | - Sheryl P Kubiak
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago (Kern); Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit (Comartin, Nelson, Kubiak)
| |
Collapse
|
8
|
Friesen P, Wusinich C, Lynch K, Russell D. "A Light at the End of the Tunnel": Experiences With Peer Specialists in the Open Dialogue Model. Psychiatr Serv 2024; 75:283-286. [PMID: 37752824 DOI: 10.1176/appi.ps.20230126] [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: 09/28/2023]
Abstract
OBJECTIVE The authors examined participants' experiences with peer specialists in Parachute NYC, a community mental health program of support teams trained in Open Dialogue and intentional peer support. METHODS Qualitative interviews were conducted with eight enrollees and 10 network members (enrollees' family members). All excerpts coded as pertaining to peers were thematically analyzed. RESULTS Experiences with peer specialists were mostly positive. Participants especially valued peers' relatability and tendency to instill hope and engender empathy among enrollees and network members; peers' ability to foster community connections was also highly regarded. Generally, enrollees benefited from having peers and other health care professionals on a Parachute team because of their different forms of expertise. Concerns about peer specialists in dialogic care were reported by some network members, who questioned peers' degree of shared experiences, professionalism, and contributions to team unity. CONCLUSIONS Despite generally positive findings, the optimal role for peers within the Open Dialogue model needs further exploration.
Collapse
Affiliation(s)
- Phoebe Friesen
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
| | - Christina Wusinich
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
| | - Katherine Lynch
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
| | - David Russell
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
| |
Collapse
|
9
|
Kozelka EE, Acquilano SC, Al-Abdulmunem M, Guarino S, Elwyn G, Drake RE, Carpenter-Song E. Digital Mental Health and Its Discontents: Assumptions About Technology That Create Barriers to Equitable Access. Psychiatr Serv 2024; 75:299-302. [PMID: 38050440 DOI: 10.1176/appi.ps.20230238] [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: 12/06/2023]
Abstract
Despite the potential of digital mental health interventions to aid recovery for people with serious mental illness, access to these digital tools remains a key barrier. In this column, the authors discuss three key assumptions that shape the integration of digital mental health tools into community health settings: clinical context, digital literacy, and financial burden. Clinical contexts have shifted with the increased use of telehealth, altering intervention environments; access to a mobile device is not the same as digital literacy; and digital mental health care is not necessarily affordable. Context-centered study design through ethnography will facilitate transfer of digital resources to real-world settings.
Collapse
Affiliation(s)
- Ellen E Kozelka
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Stephanie C Acquilano
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Monirah Al-Abdulmunem
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Sue Guarino
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Glyn Elwyn
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Robert E Drake
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Elizabeth Carpenter-Song
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| |
Collapse
|
10
|
Blajeski S, Smith MJ, Harrington M, Johnson J, Ross B, Weaver A, Razzano LA, Pashka N, Brown A, Prestipino J, Nelson K, Lieberman T, Jordan N, Oulvey EA, Mueser KT, McGurk SR, Bell MD, Smith JD. A Mixed-Methods Implementation Evaluation of Virtual Reality Job Interview Training in IPS Supported Employment. Psychiatr Serv 2024; 75:228-236. [PMID: 37644829 PMCID: PMC10902191 DOI: 10.1176/appi.ps.20230023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Employment rates among individuals with serious mental illness may be improved by engagement in the individual placement and support (IPS) model of supported employment. Results from a recent randomized controlled trial (RCT) indicate that virtual reality job interview training (VR-JIT) improves employment rates among individuals with serious mental illness who have been actively engaged in IPS for at least 90 days. This study reports on an initial implementation evaluation of VR-JIT during the RCT in a community mental health agency. METHODS A sequential, complementary mixed-methods design included use of qualitative data to improve understanding of quantitative findings. Thirteen IPS staff trained to lead VR-JIT implementation completed VR-JIT acceptability, appropriateness, and feasibility surveys. Participants randomly assigned to IPS with VR-JIT completed acceptability (N=42) and usability (N=28) surveys after implementation. The authors also conducted five focus groups with IPS staff (N=11) and VR-JIT recipients (N=13) and semistructured interviews with IPS staff (N=9) and VR-JIT recipients (N=4), followed by an integrated analysis process. RESULTS Quantitative results suggest that IPS staff found VR-JIT to be highly acceptable, appropriate for integration with IPS, and feasible for delivery. VR-JIT was highly acceptable to recipients. Qualitative results add important context to the quantitative findings, including benefits of VR-JIT for IPS staff as well as adaptations for delivering technology-based interventions to individuals with serious mental illness. CONCLUSIONS These qualitative and quantitative findings are consistent with each other and were influenced by VR-JIT's adaptability and perceived benefits. Tailoring VR-JIT instruction and delivery to individuals with serious mental illness may help optimize VR-JIT implementation within IPS.
Collapse
Affiliation(s)
- Shannon Blajeski
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Matthew J Smith
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Meghan Harrington
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Jeffery Johnson
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Brittany Ross
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Addie Weaver
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Lisa A Razzano
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Nicole Pashka
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Adrienne Brown
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - John Prestipino
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Karley Nelson
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Tovah Lieberman
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Neil Jordan
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Eugene A Oulvey
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Kim T Mueser
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Susan R McGurk
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Morris D Bell
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Justin D Smith
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| |
Collapse
|
11
|
Abstract
Certified community behavioral health centers (CCBHCs) were established under section 223 of the Protecting Access to Medicare Act of 2014. CCBHCs had the goal of expanding access to care for people with behavioral health needs "regardless of ability to pay and place of residence." The authors used descriptive tables and a heat map to compare the geographic distribution of CCBHCs with county-level rates of mental illness, poverty, and population density. Regression models were employed to determine which county-level characteristics are most strongly associated with the establishment of a CCBHC. The authors found that population density is a stronger predictor of CCBHC presence than are rates of poverty or serious mental illness. Holding all other local characteristics constant, the authors observed that going from the population density typical of the most rural counties to that of the most urban counties was associated with an approximately 28-percentage-point increase (from 7% to 35%) in the likelihood of being served by a CCBHC. Expanding CCBHC services to areas with lower population densities likely requires an approach that is different from the current method of allocation of grant funds by the Substance Abuse and Mental Health Services Administration (SAMHSA). Two features of the program might be modified. The first would build on flexibilities incorporated into the most recent round of SAMHSA grantmaking, which explicitly aim to build infrastructure and capacity to develop a CCBHC. A second modification might seek to identify which certification requirements are essential to supporting CCBHC quality and access and eliminate nonessential requirements.
Collapse
Affiliation(s)
- Richard G Frank
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Brookings Institution, Washington, D.C. (Frank, Paris)
| | - Julia Paris
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Brookings Institution, Washington, D.C. (Frank, Paris)
| |
Collapse
|
12
|
Tomovic M, Balfour ME, Cho T, Prathap N, Harootunian G, Mehreen R, Ostrovsky A, Goldman ML. Patient Flow and Reutilization of Crisis Services Within 30 Days in a Comprehensive Crisis System. Psychiatr Serv 2024:appips20230232. [PMID: 38410037 DOI: 10.1176/appi.ps.20230232] [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: 02/28/2024]
Abstract
OBJECTIVE Crisis services are undergoing an unprecedented expansion in the United States, but research is lacking on crisis system design. This study describes how individuals flow through a well-established crisis system and examines factors associated with reutilization of such services. METHODS This cross-sectional study used Medicaid claims to construct episodes describing the flow of individuals through mobile crisis, specialized crisis facility, emergency department, and inpatient services. Claims data were merged with electronic health record (EHR) data for the subset of individuals receiving care at a crisis response center. A generalized estimating equation was used to calculate adjusted odds ratios for demographic, clinical, and operational factors associated with reutilization of services within 30 days of an episode's end point. RESULTS Of 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset (N=9,202 episodes) with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status. CONCLUSIONS Crisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.
Collapse
Affiliation(s)
- Milos Tomovic
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Margaret E Balfour
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Ted Cho
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Nishanth Prathap
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Gevork Harootunian
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Raihana Mehreen
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Andrey Ostrovsky
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Matthew L Goldman
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| |
Collapse
|
13
|
Last BS, Crable EL, Khazanov GK, Scheinfeld LP, McGinty EE, Purtle J. Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review. Psychiatr Serv 2024:appips20230258. [PMID: 38369883 DOI: 10.1176/appi.ps.20230258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Federal loan repayment programs (LRPs) are one strategy to address the shortage of behavioral health providers. This scoping review aimed to identify and characterize the federal LRPs' impact on the U.S. behavioral health workforce. METHODS A scoping review was conducted in accordance with JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. The authors searched the Ovid MEDLINE, Web of Science, APA PsycInfo, EconLit, PAIS Index, and Embase databases, and gray literature was also reviewed. Two coders screened each article's abstract and full text and extracted study data. Findings were narratively synthesized and conceptually organized. RESULTS The full-text screening identified 17 articles that met eligibility criteria. Of these, eight were peer-reviewed studies, and all but one evaluated the National Health Service Corps (NHSC) LRP. Findings were conceptually organized into five categories: descriptive studies of NHSC behavioral health needs and the NHSC workforce (k=4); providers' perceptions of, and experiences with, the NHSC (k=2); associations between NHSC funding and the number of NHSC behavioral health providers (k=4); NHSC behavioral health workforce productivity and capacity (k=3); and federal LRP recruitment and retention (k=4). CONCLUSIONS The literature on federal LRPs and their impact on the behavioral health workforce is relatively limited. Although federal LRPs are an important and effective tool to address the behavioral health workforce shortage, additional federal policy strategies are needed to attract and retain behavioral health providers and to diversify the behavioral health workforce.
Collapse
Affiliation(s)
- Briana S Last
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Erika L Crable
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Gabriela Kattan Khazanov
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Laurel P Scheinfeld
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Emma E McGinty
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Jonathan Purtle
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| |
Collapse
|
14
|
Tsai J, Kinney RL, Elbogen EB, Gluff J. Systematic Review of Financial Interventions for Adults Experiencing Behavioral Health Conditions. Psychiatr Serv 2024:appips20230271. [PMID: 38321921 DOI: 10.1176/appi.ps.20230271] [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: 02/08/2024]
Abstract
OBJECTIVE The authors reviewed the literature on finance-based interventions used to improve clinical and psychosocial outcomes among adults experiencing mental disorders, substance use disorders, or both. METHODS A systematic review of the peer-reviewed literature, published from 1900 to 2022, was conducted. Only studies with participants with a mental disorder or a substance use disorder, a structured finance-based intervention or program, a quantitative dependent variable in a behavioral health outcomes domain, and a defined research design were included. Studies were rated with a quality assessment tool, and overall evidence (levels I-VII) for the outcomes was rated. RESULTS In total, 544 articles were identified, screened for eligibility, and reduced to 55 articles. These articles were rated by two independent raters, and 18 articles were ultimately included. Of these 18 articles, four reported findings of randomized controlled trials (RCTs), one conducted a secondary analysis of an RCT, and the remaining articles were observational studies. The most studied intervention was representative payeeship, which reduced substance use and enhanced money management, showing the strongest evidence for improving outcomes among adults with behavioral health conditions. Weaker evidence suggested that financial education and assistance interventions could improve health care utilization and other psychosocial outcomes among individuals with mental or substance use disorders. CONCLUSIONS Level II-V evidence indicates that finance-based interventions can improve outcomes among adults experiencing behavioral health conditions. Further research is needed to assess the impact of interventions beyond representative payee programs on objectively measured outcomes.
Collapse
Affiliation(s)
- Jack Tsai
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
| | - Rebecca L Kinney
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
| | - Eric B Elbogen
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
| | - Jeffrey Gluff
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
| |
Collapse
|
15
|
Covell NH, Patel SR, Margolies PJ, Hinds MT, Lopez LO, Dixon LB. Support From Intermediary Organizations for Evidence-Based Practices in Behavioral Health Care. Psychiatr Serv 2024; 75:191-193. [PMID: 37731345 DOI: 10.1176/appi.ps.20230139] [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
Intermediary and purveyor organizations play a key role in disseminating and implementing evidence-based behavioral health best practices (EBPs). The authors provide a case example to describe how state-funded intermediaries can enhance the implementation and sustainment of EBP. Benefits of using state-funded intermediaries include the ability to collaborate with state entities to address barriers to and then incentivize best practices, access to resources to develop a robust infrastructure to support EBP training and implementation, and enhanced capacity to support organizations beyond individual EBPs (e.g., developing an internal quality-improvement process, supporting cross-cutting competencies, and helping organizations to identify synergies across EBP and to prioritize what to implement first).
Collapse
Affiliation(s)
- Nancy H Covell
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Sapana R Patel
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Paul J Margolies
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Melissa T Hinds
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Luis O Lopez
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| | - Lisa B Dixon
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Covell, Patel, Margolies, Dixon); Center for Practice Innovations, New York State Psychiatric Institute, New York City (all authors)
| |
Collapse
|
16
|
Tugnawat D, Singh A, Anand A, Bondre A, Chandke D, Dhurve P, Joshi U, Khan A, Muke S, Negi B, Nikhare K, Rathore D, Ramaswamy R, Haney JR, Sen Y, Sharma K, Shrivastava R, Verma N, Vishwakarma R, Vishwakarma D, Vorapanya V, Patel V, Bhan A, Naslund JA. ESSENCE: An Implementation Research Program to Scale Up Depression Care in Rural Communities. Psychiatr Serv 2024; 75:167-177. [PMID: 37904491 DOI: 10.1176/appi.ps.202100223] [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: 11/01/2023]
Abstract
BACKGROUND Task sharing may involve training nonspecialist health workers (NSHWs) to deliver brief mental health interventions. This approach is promising for reducing the global mental health treatment gap. However, capacity is limited for training large cadres of frontline workers in low- and middle-income countries, hindering uptake of these interventions at scale. METHODS The ESSENCE (enabling translation of science to service to enhance depression care) project in Madhya Pradesh, India, aims to address these challenges through two sequential randomized controlled trials. First, a training trial will evaluate the effectiveness and cost-effectiveness of digital training, compared with conventional face-to-face training, in achieving clinical competency of NSHWs in delivering an intervention for depression. This initial trial will be followed by an implementation trial aimed at evaluating the effectiveness of a remote enhanced implementation support, compared with routine implementation support, in addressing barriers to delivery of depression care in primary care facilities. RESULTS This project involved developing and pilot testing a scalable smartphone-based program for training NSHWs to deliver a brief psychological intervention for depression screening. This initial research guided a randomized trial of a digital training approach with NSHWs to evaluate the effectiveness of this approach. This trial will be followed by a cluster-randomized trial to evaluate the effectiveness of remote implementation support in ensuring efficient delivery of depression care in primary care facilities. NEXT STEPS Findings from these trials may inform sustainable training and implementation support models to integrate depression care into primary care for scale-up in resource-constrained settings.
Collapse
Affiliation(s)
- Deepak Tugnawat
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Abhishek Singh
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Aditya Anand
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ameya Bondre
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dinesh Chandke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Pooja Dhurve
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Udita Joshi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Azaz Khan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Shital Muke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Babita Negi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kalyani Nikhare
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dharmendra Rathore
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Rohit Ramaswamy
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Juliana Restivo Haney
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Yogendra Sen
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kamlesh Sharma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ritu Shrivastava
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Narendra Verma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ram Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Deepali Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vorapat Vorapanya
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vikram Patel
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Anant Bhan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - John A Naslund
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| |
Collapse
|
17
|
Ghose SS, George P, Goldman HH, Ren W, Zhu X, Dixon LB, Rosenblatt A. Community- and Program-Level Predictors of Funding Streams Used by Coordinated Specialty Care Programs. Psychiatr Serv 2024; 75:155-160. [PMID: 37528699 DOI: 10.1176/appi.ps.20220112] [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: 08/03/2023]
Abstract
OBJECTIVE Although coordinated specialty care (CSC) is an effective service model to address first-episode psychosis, CSC is not widely accessible in the United States, and funding for this service model often remains challenging. The authors examined whether community- or program-level factors predict the use of public and private funding streams in a national sample of 34 CSC programs in 22 U.S. states and territories. METHODS As part of a larger mixed-methods study, CSC program leaders completed a brief questionnaire regarding funding sources. Statistical modeling was used to examine program- and community-level predictors of the use of funding sources. RESULTS Most CSC programs (20 of 34, 59%) reported that Mental Health Block Grant (MHBG) set-aside funds accounted for more than half of their total funding, and 11 of these programs reported that these funds contributed to >75% of their funding. Programs ≤5 years old were more likely to rely on MHBG set-aside funds. Programs in Medicaid expansion states were more likely to rely on Medicaid funding than programs in nonexpansion states. Programs in higher-income service catchment areas used more state funds than did those in lower-income areas, and among programs in lower-income service catchment areas, those that were >4 years old were more likely than those ≤4 years old to rely on state funds other than Medicaid. CONCLUSIONS CSC programs remain largely dependent on MHBG set-aside funding. Some programs have diversified their funding streams, most notably by including more Medicaid and other state funding. A more comprehensive funding approach is needed to reduce reliance on the MHBG set-aside funds.
Collapse
Affiliation(s)
- Sushmita Shoma Ghose
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Preethy George
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Howard H Goldman
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Weijia Ren
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Xiaoshu Zhu
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Lisa B Dixon
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Abram Rosenblatt
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| |
Collapse
|
18
|
Hoagwood KE, Richards-Rachlin S, Baier M, Vilgorin B, Horwitz SM, Narcisse I, Diedrich N, Cleek A. Implementation Feasibility and Hidden Costs of Statewide Scaling of Evidence-Based Therapies for Children and Adolescents. Psychiatr Serv 2024:appips20230183. [PMID: 38268465 DOI: 10.1176/appi.ps.20230183] [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: 01/26/2024]
Abstract
OBJECTIVE State mental health systems are retraining their workforces to deliver services supported by research. Knowledge about evidence-based therapies (EBTs) for child and adolescent disorders is robust, but the feasibility of their statewide scaling has not been examined. The authors reviewed implementation feasibility for 12 commonly used EBTs, defining feasibility for statewide scaling as an EBT having at least one study documenting acceptability, facilitators and barriers, or fidelity; at least one study with a racially and ethnically diverse sample; an entity for training, certification, or licensing; and fiscal data reflecting the costs of implementation. METHODS The authors reviewed materials for 12 EBTs being scaled in New York State and conducted a literature review with search terms relevant to their implementation. Costs and certification information were supplemented by discussions with treatment developers and implementers. RESULTS All 12 EBTs had been examined for implementation feasibility, but only three had been examined for statewide scaling. Eleven had been studied in populations reflecting racial-ethnic diversity, but few had sufficient power for subgroup analyses to demonstrate effectiveness with these samples. All had certifying or licensing entities. The per-clinician costs of implementation ranged from $500 to $3,500, with overall ongoing costs ranging from $100 to $6,000. A fiscal analysis of three EBTs revealed hidden costs ranging from $5,000 to $24,000 per clinician, potentially limiting sustainability. CONCLUSIONS The evidence necessary for embedding EBTs in state systems has notable gaps that may hinder sustainability. Research-funding agencies should prioritize studies that focus on the practical aspects of scaling to assist states as they retrain their workforces.
Collapse
Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Shira Richards-Rachlin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Meaghan Baier
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Boris Vilgorin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Iriane Narcisse
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Nadege Diedrich
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Andrew Cleek
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| |
Collapse
|
19
|
Carlo AD, Basu A, Unützer J, Jordan N. Acceptance of Insurance by Psychiatrists and Other Physicians, 2007-2016. Psychiatr Serv 2024; 75:25-31. [PMID: 37424301 DOI: 10.1176/appi.ps.202100669] [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: 07/11/2023]
Abstract
OBJECTIVE The authors aimed to analyze psychiatrists' and other physicians' acceptance of insurance and the associations between insurance acceptance and specific physician- and practice-level characteristics. METHODS Using the restricted version of the National Ambulatory Medical Care Survey, January 2007-December 2016, the authors analyzed acceptance of private insurance, public insurance, and any insurance among psychiatrists compared with nonpsychiatrist physicians. Because data were considered restricted, all analyses were conducted at federal Research Data Center facilities. RESULTS The unweighted sample included an average of 4,725 physicians per 2-year time grouping between 2007 and 2016, with an average of 7% being psychiatrists. Nonpsychiatrists participated in all insurance networks at higher rates than did psychiatrists, and the acceptance gap was wider for public (Medicare and Medicaid) than private (noncapitated and capitated) insurance. Among psychiatrists, those practicing in metropolitan statistical areas and those in solo practices were significantly less likely than their peers in other locations and treatment settings to accept private, public, or any insurance. These findings were also observed among nonpsychiatrists, although to a lesser extent. CONCLUSIONS In addition to general policy interventions to improve insurance network adequacy for psychiatric care, additional measures or incentives to promote insurance network participation should be considered for psychiatrists in solo practices and those in metropolitan areas.
Collapse
Affiliation(s)
- Andrew D Carlo
- Meadows Mental Health Policy Institute, Dallas (Carlo); Department of Psychiatry and Behavioral Sciences (Carlo, Jordan) and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Jordan), Northwestern University Feinberg School of Medicine, Chicago; Departments of Pharmacy, Health Services, and Economics (Basu) and Department of Psychiatry and Behavioral Sciences (Unützer), University of Washington, Seattle
| | - Anirban Basu
- Meadows Mental Health Policy Institute, Dallas (Carlo); Department of Psychiatry and Behavioral Sciences (Carlo, Jordan) and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Jordan), Northwestern University Feinberg School of Medicine, Chicago; Departments of Pharmacy, Health Services, and Economics (Basu) and Department of Psychiatry and Behavioral Sciences (Unützer), University of Washington, Seattle
| | - Jürgen Unützer
- Meadows Mental Health Policy Institute, Dallas (Carlo); Department of Psychiatry and Behavioral Sciences (Carlo, Jordan) and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Jordan), Northwestern University Feinberg School of Medicine, Chicago; Departments of Pharmacy, Health Services, and Economics (Basu) and Department of Psychiatry and Behavioral Sciences (Unützer), University of Washington, Seattle
| | - Neil Jordan
- Meadows Mental Health Policy Institute, Dallas (Carlo); Department of Psychiatry and Behavioral Sciences (Carlo, Jordan) and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Jordan), Northwestern University Feinberg School of Medicine, Chicago; Departments of Pharmacy, Health Services, and Economics (Basu) and Department of Psychiatry and Behavioral Sciences (Unützer), University of Washington, Seattle
| |
Collapse
|
20
|
Bonfine N, Barrenger SL, Munetz MR. Approaching Jail Diversion and Prevention of Criminal Legal System Involvement Simultaneously. Psychiatr Serv 2023:appips20230218. [PMID: 38050441 DOI: 10.1176/appi.ps.20230218] [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: 12/06/2023]
Abstract
Despite prolific jail diversion initiatives, people with serious mental illness continue to be overrepresented in the criminal legal system. This continued overrepresentation has led to recent calls to address social determinants of health and criminal risk factors rather than to allocate new resources to diverting people from the criminal legal system. This shift toward prevention by addressing social factors that influence health and criminal legal outcomes should occur alongside a continued focus on diversion to understand what works and for whom. An effective, well-funded, and comprehensive community-based mental health services system could serve as the ultimate intercept for preventing criminal legal system involvement.
Collapse
Affiliation(s)
- Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown
| | | | - Mark R Munetz
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown
| |
Collapse
|
21
|
Sohn JH, Cho SJ, Lee HW, Kim H, Lee SY, Park Y, Seo HY, Kim ES, Park JE, Hahm BJ. Effectiveness of a Community-Based Intensive Case Management Model on Reducing Hospitalization for People With Severe Mental Illness in Seoul. Psychiatry Investig 2023; 20:1133-1141. [PMID: 38163652 PMCID: PMC10758329 DOI: 10.30773/pi.2023.0152] [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] [Received: 05/11/2023] [Revised: 07/11/2023] [Accepted: 08/31/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE To overcome the limited effectiveness of standard case management services, the Seoul Intensive Case Management program (S-ICM) for patients with serious mental illnesses was introduced in 2017. This study aimed to evaluate its effectiveness in reducing the length of hospital stay. METHODS Monitoring data from April 2019 to March 2020 were retrieved from the Seoul Mental Health Welfare Center. A total of 759 participants with serious mental illnesses were included. The average length of admission per month was compared between the pre-ICM (previous year) and during-ICM periods. For post-ICM observation subgroup, average length of admission per month was compared between pre-ICM, during-ICM, and post-ICM periods. To determine the relative contributions of risk factors for during-ICM and post-ICM admission, multivariate logistic regression analyses were performed. RESULTS The average admission stay for pre-ICM period was significantly longer than that for during-ICM period (1.47 vs. 0.26 days). Among the predictors for during-ICM admission, pre-ICM psychiatric admission was the most important risk factor, followed by medical aid beneficiary and suicidal behavior. In the subgroup analysis of the post-ICM observation period, the pre-ICM, during-ICM, and post-ICM average admission stays were 1.45, 0.29, and 0.57 days/month, respectively. There was a significant difference in the average length of stay between the pre-ICM and during-ICM periods and between the pre-ICM and post-ICM periods. Post-ICM admission risks included pre-ICM admission, S-ICM duration <3 months, and chronic unstable symptoms. CONCLUSION The results suggest that the S-ICM effectively reduces psychiatric hospitalization duration, at least over a short-term period.
Collapse
Affiliation(s)
- Jee Hoon Sohn
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Public Health and Medical Services, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Hae Woo Lee
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Hyun Kim
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Seung Yeon Lee
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Yoomi Park
- Citizens’ Health Bureau, Seoul Metopolitan Government, Seoul, Republic of Korea
| | - Hwo Yeon Seo
- Institute of Public Health and Medical Services, Seoul National University Hospital, Seoul, Republic of Korea
- Jongno-gu Community Mental Health Welfare Center, Seoul, Republic of Korea
| | - Eun Soo Kim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bong Jin Hahm
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
22
|
Adams DR, Pérez-Flores NJ, Mabrouk F, Minor C. Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study. Psychiatr Serv 2023:appips20230198. [PMID: 38018150 DOI: 10.1176/appi.ps.20230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. METHODS In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. RESULTS Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. CONCLUSIONS Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.
Collapse
Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Nancy Jacquelyn Pérez-Flores
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Fatima Mabrouk
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Carolyn Minor
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| |
Collapse
|
23
|
Bunting SR, Chalmers K, Yohanna D, Lee R. Prescription of Long-Acting Injectable Antipsychotic Medications Among Outpatient Mental Health Care Service Providers. Psychiatr Serv 2023; 74:1146-1153. [PMID: 37042107 DOI: 10.1176/appi.ps.20220586] [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: 04/13/2023]
Abstract
OBJECTIVE Long-acting injectable antipsychotic medications (LAIAPs) are a valuable and underused treatment for patients with chronic mental illnesses such as schizophrenia and bipolar disorder. This study aimed to examine prescription patterns of LAIAPs among outpatient mental health care service providers in the United States. METHODS The authors conducted a secondary analysis of the 2020-2021 National Mental Health Services Survey to assess the percentage of outpatient mental health care service providers (N=9,433) that prescribed LAIAPs to patients. Descriptive statistics were calculated to describe the overall frequency of outpatient facilities prescribing LAIAPs and differences in the specific LAIAPs prescribed. The authors also conducted multivariable analyses to identify facility characteristics associated with likelihood of LAIAP prescribing. RESULTS Across all outpatient mental health care service providers, 30.6% prescribed LAIAPs. Community mental health centers were most likely to prescribe LAIAPs (62.6%), whereas partial hospitalization and day programs were least likely (32.1%). The most used LAIAP was paliperidone palmitate (77.7%), and the least used was olanzapine pamoate (29.6%). Providers with programs specifically for patients with serious mental illness (59.5%) and providers with a dedicated first-episode psychosis program (58.2%) were more likely to prescribe LAIAPs than were providers without such programming. CONCLUSIONS Prescription of LAIAPs is limited at outpatient mental health care service providers in the United States. Expansion of these services and diversification of delivery models are needed to improve LAIAP prescriptions, which are associated with improved patient outcomes across a broad range of measures.
Collapse
Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
| | - Kristen Chalmers
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
| | - Daniel Yohanna
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
| | - Royce Lee
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
| |
Collapse
|
24
|
Lapidos A, Garlick J, Rulli D. Oral Health Recovery: A Peer Support Specialist-Led Health Education Program for People With Serious Mental Illness. Psychiatr Serv 2023; 74:1196-1199. [PMID: 36916059 DOI: 10.1176/appi.ps.20220465] [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
Oral health affects whole health and quality of life. This is especially true for people with serious mental illness, a population with heightened risks for oral disease and needs for oral treatment. Studies have previously shown the effectiveness of peer support specialist (PSS)-led wellness interventions. Oral health educational materials and a health education approach were collaboratively developed by a multidisciplinary team and then implemented at one community mental health center and three PSS-run drop-in centers. PSSs provided health education and linked consumers to dental care. Program evaluation (N=41 respondents) indicated the approach's acceptability, feasibility, and sustainability.
Collapse
Affiliation(s)
- Adrienne Lapidos
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Lapidos, Garlick); Ann Arbor VA Medical Center, Ann Arbor (Garlick); Division of Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor (Rulli)
| | - James Garlick
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Lapidos, Garlick); Ann Arbor VA Medical Center, Ann Arbor (Garlick); Division of Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor (Rulli)
| | - Danielle Rulli
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Lapidos, Garlick); Ann Arbor VA Medical Center, Ann Arbor (Garlick); Division of Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor (Rulli)
| |
Collapse
|
25
|
Castillo BA, Shterenberg R, Bolton JM, Dewa CS, Pullia K, Hensel JM. Virtual Acute Psychiatric Ward: Evaluation of Outcomes and Cost Savings. Psychiatr Serv 2023; 74:1045-1051. [PMID: 37016824 DOI: 10.1176/appi.ps.20220332] [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: 04/06/2023]
Abstract
OBJECTIVE The COVID-19 pandemic motivated rapid expansion of virtual care. In Winnipeg, Canada, the authors launched a virtual psychiatric acute care ward (vWARD) to divert patients from hospitalization through daily remote treatment by a psychiatry team using telephone or videoconferencing. This study examined vWARD patient characteristics, predictors of transfer to a hospital, use of acute care postdischarge, and costs of the vWARD compared with in-person hospitalization. METHODS Data for all vWARD admissions from March 23, 2020, to April 30, 2021, were retrieved from program documents and electronic records. Emergency department visits and hospitalizations in the 6 months before admission and the 30 days after discharge were documented. Logistic regression identified factors associated with transfer to a hospital. Thirty-day acute care use after discharge was modeled with Kaplan-Meier curves. A break-even cost analysis was generated with data for usual hospital-based care. RESULTS The 132 vWARD admissions represented a diverse demographic and clinical population. Overall, 57% involved suicidal behavior, and 29% involved psychosis or mania. Seventeen admissions (13%) were transferred to a hospital. Only presence of psychosis or mania significantly predicted transfer (OR=34.2, 95% CI=3.3-354.6). Eight individuals were hospitalized in the 30 days postdischarge (cumulative survival=0.93). vWARD costs were lower than usual care across several scenarios. CONCLUSIONS A virtual ward is a feasible, effective, and potentially cost-saving intervention to manage acute psychiatric crises in the community and avoid hospitalization. It has benefits for both the health system and the individual who prefers to receive care at home.
Collapse
Affiliation(s)
- Bon A Castillo
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Ravit Shterenberg
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Carolyn S Dewa
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Katrina Pullia
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| | - Jennifer M Hensel
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Castillo, Shterenberg, Bolton, Pullia, Hensel); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis (Dewa)
| |
Collapse
|
26
|
Ma CF, Luo H, Leung SF, Wong GHY, Lam RPK, Bastiampillai T, Chen EYH, Chan SKW. Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study. Lancet Reg Health West Pac 2023; 39:100814. [PMID: 37927999 PMCID: PMC10625018 DOI: 10.1016/j.lanwpc.2023.100814] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 11/07/2023]
Abstract
Background There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years. Methods Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates. Findings A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates. Interpretation ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time. Funding None.
Collapse
Affiliation(s)
- Chak Fai Ma
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rex Pui Kin Lam
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
27
|
Cook JA, Jonikas JA, Burke-Miller JK, Hamilton M, Falconer C, Blessing M, Aranda F, Johns G, Cauffield C. Randomized Controlled Trial of Self-Directed Care for Medically Uninsured Adults With Serious Mental Illness. Psychiatr Serv 2023; 74:1027-1036. [PMID: 36987709 DOI: 10.1176/appi.ps.20220508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Self-directed care (SDC) is a treatment model in which recipients self-manage funds designated for provision of services. The model is designed to cost no more than traditional services while achieving superior participant outcomes. The authors examined the model's impact on outcomes, service costs, and user satisfaction among medically uninsured, low-income individuals with serious mental illness. METHODS Adults in the public mental health system (N=42) were randomly assigned (1:1) to receive SDC or services as usual and were assessed at baseline and 6- and 12-month follow-ups. Outcomes included perceived competence for mental health self-management, met and unmet needs, degree of autonomy support, self-perceived recovery, and employment. Mixed-effects random regression analysis tested for differences in longitudinal changes in outcomes between the two study conditions. Differences in service costs were analyzed with negative binomial regression models. RESULTS Compared with individuals in the control condition, SDC participants reported greater improvement in perceived competence, met and unmet needs, autonomy support, recovery from symptom domination, and employment. No differences were found between the two groups in total per-person service costs or costs for individual services. The most frequent nontraditional purchases were for medical, dental, and vision services (33%) and health and wellness supports (33%). Satisfaction with SDC services was high. CONCLUSIONS Mental health SDC services achieved participant outcomes superior to treatment as usual, with equivalent service use and costs and high user satisfaction. This model may be well suited to the needs of uninsured adults with low income who receive public behavioral health care.
Collapse
Affiliation(s)
- Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Jessica A Jonikas
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Jane K Burke-Miller
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Marie Hamilton
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Carl Falconer
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Michael Blessing
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Frances Aranda
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Gretchen Johns
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| | - Christine Cauffield
- Center on Mental Health Services Research and Policy, University of Illinois Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Aranda, Johns); TaskForce Fore Ending Homelessness, Fort Lauderdale, Florida (Falconer); Office of Substance Abuse and Mental Health, Florida Department of Children and Families, Tallahassee (Blessing); Lutheran Services Florida, LSF Health Systems, Jacksonville (Cauffield)
| |
Collapse
|
28
|
Burns A, Menachemi N, Yeager VA, Vest JR, Mazurenko O. Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities. Psychiatr Serv 2023; 74:929-935. [PMID: 36872894 PMCID: PMC10565906 DOI: 10.1176/appi.ps.20220427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration's (SAMHSA's) best practices guidelines. METHODS Secondary data from SAMHSA's Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities' organizational characteristics associated with adopting BHCC best practices. RESULTS Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). CONCLUSIONS Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.
Collapse
Affiliation(s)
- Ashlyn Burns
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Valerie A Yeager
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Joshua R. Vest
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis
| | - Olena Mazurenko
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| |
Collapse
|
29
|
Jones N, Callejas L, Brown M, Colder Carras M, Croft B, Pagdon S, Sheehan L, Oluwoye O, Zisman-Ilani Y. Barriers to Meaningful Participatory Mental Health Services Research and Priority Next Steps: Findings From a National Survey. Psychiatr Serv 2023; 74:902-910. [PMID: 36935620 PMCID: PMC11022526 DOI: 10.1176/appi.ps.20220514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE A growing consensus has emerged regarding the importance of stakeholder involvement in mental health services research. To identify barriers to and the extent of stakeholder involvement in participatory research, the authors undertook a mixed-methods study of researchers and community members who reported participation in such research. METHODS Eight consultative focus groups were conducted with diverse groups of stakeholders in mental health services research (N=51 unique participants, mostly service users), followed by a survey of service users, family members, community providers, and researchers (N=98) with participatory research experience. Focus groups helped identify facilitators and barriers to meaningful research collaboration, which were operationalized in the national survey. Participants were also asked about high-priority next steps. RESULTS The barrier most strongly endorsed as a large or very large problem in the field was lack of funding for stakeholder-led mental health services research (76%), followed by lack of researcher training in participatory methods (74%) and insufficiently diverse backgrounds among stakeholders (69%). The two most frequently identified high-priority next steps were ensuring training and continuing education for researchers and stakeholders (33%) and authentically centering lived experience and reducing tokenism in research (26%). CONCLUSIONS These findings suggest a need for increased attention to and investment in the development, implementation, and sustainment of participatory methods that prioritize collaboration with direct stakeholders, particularly service users, in U.S. mental health services research. The findings also underscore the presence and potentially important role of researchers who dually identify as service users and actively contribute a broader orientation from the service user-survivor movement.
Collapse
Affiliation(s)
- Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Linda Callejas
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Marie Brown
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Michelle Colder Carras
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Bevin Croft
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Shannon Pagdon
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Lindsay Sheehan
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Oladunni Oluwoye
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| | - Yaara Zisman-Ilani
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones, Pagdon); Child and Family Studies, University of South Florida, Tampa (Callejas); Department of Psychiatry, New York University, New York City (Brown); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Carras); Human Services Research Institute, Cambridge, Massachusetts (Croft); New York State Psychiatric Institute, New York City (Pagdon); Department of Psychology, Illinois Institute of Technology, Chicago (Sheehan); Department of Community and Behavioral Health, School of Medicine, Washington State University, Spokane (Oluwoye); Department of Social and Behavioral Sciences, Temple University, Philadelphia, and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London (Zisman-Ilani)
| |
Collapse
|
30
|
Abstract
OBJECTIVE Utilization of the 988 Suicide and Crisis Lifeline (Lifeline; formerly called the National Suicide Prevention Lifeline) was analyzed in relation to suicide deaths in U.S. states between 2007 and 2020 to identify states with potential unmet need for mental health crisis hotline services. METHODS Annual state call rates were calculated from calls routed to the Lifeline during the 2007-2020 period (N=13.6 million). Annual state suicide mortality rates (standardized) were calculated from suicide deaths reported to the National Vital Statistics System (2007-2020 cumulative deaths=588,122). Call rate ratio (CRR) and mortality rate ratio (MRR) were estimated by state and year. RESULTS Sixteen U.S. states demonstrated a consistently high MRR and a low CRR, suggesting high suicide burden and relatively low Lifeline use. Heterogeneity in state CRRs decreased over time. CONCLUSIONS Prioritizing states with a high MRR and a low CRR for messaging and outreach regarding the availability of the Lifeline can ensure more equitable, need-based access to this critical resource.
Collapse
Affiliation(s)
- Sasikiran Kandula
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Johnathan Higgins
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Alena Goldstein
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Madelyn S Gould
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Mark Olfson
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Katherine M Keyes
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| | - Jeffrey Shaman
- Department of Environmental Health Sciences (Kandula, Shaman), Department of Epidemiology (Gould, Olfson, Keyes), and Department of Psychiatry (Gould, Olfson), Columbia University, New York City; 988 Suicide and Crisis Lifeline, Vibrant Emotional Health, New York City (Higgins, Goldstein)
| |
Collapse
|
31
|
Kerman N, Nisenbaum R, Durbin A, Wang R, Kozloff N, Hwang SW, Stergiopoulos V. A Pragmatic Randomized Controlled Trial of Financial Incentives in Case Management for Homeless Adults With Mental Illness. Psychiatr Serv 2023; 74:823-829. [PMID: 36820517 DOI: 10.1176/appi.ps.20220392] [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: 02/24/2023]
Abstract
OBJECTIVE Financial incentives can facilitate behavior change and service engagement in health care settings, but research on their use with adults experiencing homelessness is limited. This study examined the effectiveness of financial incentives in improving service engagement and health outcomes among homeless adults with mental illness in Toronto. METHODS The authors of this randomized controlled trial recruited 176 participants receiving brief multidisciplinary case management services for homeless adults with mental illness after hospital discharge. In a 1:1 randomization design, 87 participants received a financial incentive of CAN$20 for every week they remained engaged with the service for up to 6 months. The remaining 89 participants received treatment as usual. The primary outcome was service contact rates for up to 6 months of follow-up. Secondary outcomes included self-reported health status, mental health symptoms, substance use, quality of life, housing stability, acute health service use, and working alliance. Negative binomial regression models, analyses of covariance, generalized estimating equations models, and Wilcoxon rank sum tests were used to examine differences between the financial incentive and treatment-as-usual groups across outcomes of interest. RESULTS No significant differences were found between the financial incentive and treatment-as-usual groups in service contact rates or any of the secondary outcomes examined over the 6-month period. CONCLUSIONS In low-barrier, brief case management programs tailored to the needs of adults experiencing homelessness, financial incentives may not affect service engagement or health outcomes. Further research is needed to identify the effect of financial incentives on engagement in other services, including housing-based interventions.
Collapse
Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Rosane Nisenbaum
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Anna Durbin
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Ri Wang
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Stephen W Hwang
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto
| |
Collapse
|
32
|
Saunders R, Liu Y, Delamain H, O'Driscoll C, Naqvi SA, Singh S, Stott J, Wheatley J, Pilling S, Cape J, Buckman JEJ. Examining bi-directional change in sleep and depression symptoms in individuals receiving routine psychological treatment. J Psychiatr Res 2023; 163:1-8. [PMID: 37178582 PMCID: PMC10643991 DOI: 10.1016/j.jpsychires.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Sleep disturbance is a common symptom of depression. There is conflicting evidence whether improvements in sleep might impact depressive symptoms, or whether treating the core depressive symptoms might improve sleep disturbance. This study explored the bi-directional impact of sleep and depressive symptom change among individuals receiving psychological treatment. METHODS Session-by-session change in sleep disturbance and depressive symptom severity scores were explored in patients receiving psychological therapy for depression from Improving Access to Psychological Therapies services in England. Bi-directional change in sleep disturbance and depressive symptoms was modelled using random-intercept cross-lagged panel models with items from the PHQ-9. RESULTS The sample included 17,732 adults that had received three or more treatment sessions. Both depressive symptoms and sleep disturbance scores decreased. Between initial timepoints, higher sleep disturbance was associated with lower depression scores, but after this point positive cross-lagged effects were observed for both the impact of sleep disturbance on later depressive symptoms, and depressive symptoms on later sleep disturbance scores. The magnitude of effects suggested depressive symptoms may have more impact on sleep than the reverse, and this effect was larger in sensitivity analyses. CONCLUSIONS Findings provide evidence that psychological therapy for depression results in improvements in core depressive symptoms and sleep disturbance. There was some evidence that depressive symptoms may have more impact on sleep disturbance scores at the next therapy session, than sleep disturbance does on later depressive symptoms. Targeting the core symptoms of depression initially may optimise outcomes, but further research is needed to elucidate these relationships.
Collapse
Affiliation(s)
- R Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom.
| | - Y Liu
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - H Delamain
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - C O'Driscoll
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - S A Naqvi
- Barking & Dagenham and Havering IAPT Services - North East London NHS Foundation Trust, London, United Kingdom
| | - S Singh
- Waltham Forest Talking Therapies - North East London NHS Foundation Trust, London, United Kingdom
| | - J Stott
- ADAPTlab, Research Department of Clinical Educational and Health Psychology, UCL, London, United Kingdom
| | - J Wheatley
- Talk Changes: City & Hackney IAPT Service - Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - S Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - J Cape
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom
| | - J E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational, and Health Psychology, UCL, London, United Kingdom; iCope -Camden and Islington Psychological Therapies Services - Camden & Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
33
|
Lam EHY, Lai ESK, Lai ECL, Lau E, Siu BWM, Tang DYY, Mok CCM, Lam M. Effect of Community Treatment Orders on Mental Health Service Usage, Emergency Visits, and Violence: a Systematic Review and Meta-Analysis. East Asian Arch Psychiatry 2023; 33:37-43. [PMID: 37400226 DOI: 10.12809/eaap2246] [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] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Community treatment orders (CTOs) enable patients to actively engage in mental health services while being supervised in the community outside the hospital setting. However, the efficacy of CTOs remains controversial in terms of mental health services usage or service contacts, emergency visits, and violence. METHODS The databases PsychINFO, Embase, and Medline were searched on 11 March 2022 by 2 independent reviewers through the Covidence website (www.covidence.org). Randomised or non-randomised case-control studies and pre-post studies were included if they examine the effect of CTOs on service contacts, emergency visits, and violence in individuals with mental illnesses by comparing with control groups or pre-CTO conditions. Conflicts were resolved by consultation of the third independent reviewer. RESULTS Sixteen studies provided sufficient data in the target outcome measures and were included in analysis. Variability in the risk of bias was high among studies. Meta-analyses were conducted separately for case-control studies and pre-post studies. For service contacts, a total of 11 studies with 66,192 patients reported changes in the number of service contacts under CTOs. In 6 case-control studies, a small non-significant increase in service contacts was observed in those under CTOs (Hedge's g = 0.241, z = 1.535, p = 0.13). In 5 pre-post studies, a large and significant increase in service contacts was noted after CTOs (Hedge's g = 0.830, z = 5.056, p < 0.001). For emergency visits, a total of 6 studies with 930 patients reported changes in the number of emergency visits under CTOs. In 2 case-control studies, a small non-significant increase in emergency visits was noted in those under CTOs (Hedge's g = -0.196, z = -1.567, p = 0.117). In 4 pre-post studies, a small significant decrease in emergency visits was noted after CTOs (Hedge's g = 0.553, z = 3.101, p = 0.002). For violence, a total of 2 pre-post studies reported a moderate significant reduction in violence after CTOs (Hedge's g = 0.482, z = 5.173, p < 0.001). CONCLUSION Case-control studies showed inconclusive evidence, but pre-post studies showed significant effects of CTOs in promoting service contacts and reducing emergency visits and violence. Future studies on cost-effectiveness analysis and qualitative analysis for specific populations with various cultures and backgrounds are warranted.
Collapse
Affiliation(s)
- E H Y Lam
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - E S K Lai
- Department of Occupational Therapy, Castle Peak Hospital, Hong Kong SAR, China
| | - E C L Lai
- Department of Child and Adolescent Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - E Lau
- Department of Occupational Therapy, Castle Peak Hospital, Hong Kong SAR, China
| | - B W M Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - D Y Y Tang
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - C C M Mok
- Department of Occupational Therapy, Castle Peak Hospital, Hong Kong SAR, China
| | - M Lam
- Department of General Adult Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| |
Collapse
|
34
|
Saunders R, Moinian D, Stott J, Delamain H, Naqvi SA, Singh S, Wheatley J, Pilling S, Buckman JEJ. Measurement invariance of the PHQ-9 and GAD-7 across males and females seeking treatment for common mental health disorders. BMC Psychiatry 2023; 23:298. [PMID: 37118684 PMCID: PMC10148535 DOI: 10.1186/s12888-023-04804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalised Anxiety Disorder scale (GAD-7) scales are routinely used in research and clinical practice. Whilst measurement invariance of these measures across gender has been demonstrated individually in general population studies and clinical samples, less is known about invariance of the distinct but correlated latent factors ('depression' and 'anxiety'). The current study assessed measurement invariance of these constructs across males and females seeking treatment for common mental health disorders. METHODS Data were provided from eight psychological treatment services in London, England. Data from initial assessments with the services where individual items on the PHQ-9 and GAD-7 were available were included in analyses. Measurement invariance was explored across self-identified genders, with 'male' and 'female' categories available in the dataset. Sensitivity analyses were conducted using propensity score matching on sociodemographic and clinical variables. RESULTS Data were available for 165,872 patients (110,833 females, 55,039 males). There was evidence of measurement invariance between males and females in both the full sample and a propensity score matched sample (n = 46,249 in each group). CONCLUSIONS Measurement invariance of the correlated depression and anxiety factors of PHQ-9 and GAD-7 were indicated in this sample of individuals seeking psychological treatment for CMHDs. These results support the use of these measures in routine clinical practice for both males and females. This is of particular importance for assessing the prevalence of clinically significant levels of symptoms as well as comparing treatment outcomes across genders.
Collapse
Affiliation(s)
- Rob Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK.
| | - Delilah Moinian
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Henry Delamain
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Syed Ali Naqvi
- Barking & Dagenham and Havering IAPT Services, North East London NHS Foundation Trust, London, UK
| | - Satwant Singh
- Waltham Forest Talking Therapies, North East London NHS Foundation Trust, London, UK
| | - Jon Wheatley
- Talk Changes: City & Hackney IAPT Service, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Stephen Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Joshua E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| |
Collapse
|
35
|
Coelho VAA, da Gama CAP, Andrade LIE, Silva MAE, Guimarães DA, de Azevedo Guimarães EA, Modena CM. Community mental health care network: an evaluative approach in a Brazilian state. Int J Ment Health Syst 2023; 17:9. [PMID: 37076934 PMCID: PMC10113974 DOI: 10.1186/s13033-023-00578-7] [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] [Received: 12/21/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like 'Family Health Strategy,' 'Expanded Family Health Center,' and 'Psychosocial Care Centers' but a lack of 'Beds in General Hospitals' destinated to mental health care, 'Unified Electronic Medical Records' and 'Mental Health Training Activities for Professionals.' In the process dimension, adequate implementation of actions such as 'Multidisciplinary and Joint Care,' 'Assistance to Common Mental Disorders by Primary Health Care,' 'Management of Psychiatric Crises in Psychosocial Care Centers,' 'Offer of Health Promotion Actions,' and 'Discussion of Cases by Mental Health Teams' point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of 'Psychosocial Rehabilitation Actions,' 'Productive Inclusion,' 'User Protagonism,' 'Network Integration,' and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.
Collapse
Affiliation(s)
- Vívian Andrade Araújo Coelho
- Graduate Program in Public Health, René Rachou Institute/Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil.
- Department of Family Medicine, Mental and Collective Health (DEMSC), Medical School, Federal University of Ouro Preto (UFOP), R. Dois - Campus Morro do Cruzeiro, Ouro Preto, MG, 35400-000, Brazil.
| | | | | | - Mariana Arantes E Silva
- Federal University of São João Del Rei, Mid-West Campus (UFSJ/CCO), Divinópolis, Minas Gerais, Brazil
| | - Denise Alves Guimarães
- Federal University of São João Del Rei, Mid-West Campus (UFSJ/CCO), Divinópolis, Minas Gerais, Brazil
| | | | - Celina Maria Modena
- Graduate Program in Public Health, René Rachou Institute/Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
36
|
Taormina SP, Laney-King D, Michalopoulou G. Turning a Crisis Into an Opportunity: Virtual Implementation of an Evidence-Based Treatment. Psychiatr Serv 2023:appips20220476. [PMID: 37042109 DOI: 10.1176/appi.ps.20220476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Shibany Preeya Taormina
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit
| | - Deirdre Laney-King
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit
| | - Georgia Michalopoulou
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit
| |
Collapse
|
37
|
Martinez K, Chlebowski C, Roesch S, Stadnick NA, Villodas M, Brookman-Frazee L. Psychometric Assessment of the Eyberg Child Behavior Inventory in Children with Autism in Community Settings. J Autism Dev Disord 2023; 53:1693-1705. [PMID: 35278165 PMCID: PMC9464797 DOI: 10.1007/s10803-022-05427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
The Eyberg Child Behavior Inventory (ECBI) is a frequently used measure to assess interfering behaviors in children and psychometric properties have recently been examined in children with autism spectrum disorder (ASD). There is a need to confirm the identified factors and examine the factor structure in a racially/ethnically diverse, community-based sample. The current study conducts a psychometric analysis of the ECBI in a sample of children with ASD receiving publicly-funded mental health services. Data were collected from 201 children with ASD ages 5-13 years (60% Hispanic/Latinx) participating in a community effectiveness trial. Confirmatory factor analysis indicated poor model fit using previously identified factors and a new four-factor solution was identified. Clinical and research implications of these findings are discussed.
Collapse
Affiliation(s)
- Kassandra Martinez
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
| | - Miguel Villodas
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| |
Collapse
|
38
|
Abstract
OBJECTIVE Individual placement and support (IPS) is an evidence-based strategy that helps individuals with mental illness obtain and maintain competitive employment. Despite the approach's overall success, almost half of IPS clients do not find work. Impairment in cognitive abilities may hamper employment and limit the benefits from rehabilitation services such as IPS. This randomized controlled trial aimed to assess the effects of adding cognitive remediation therapy (CRT) for IPS clients who had difficulties finding employment. METHODS At 14 mental health centers in Canada, 97 clients who had not found work after 3 months of receiving IPS services were recruited. Consenting clients were randomly assigned to either continue IPS alone or receive CRT added to IPS. The CRT used the Thinking Skills for Work protocol, a 12-week program that included computerized cognitive exercises along with coping strategies for managing cognitive challenges. RESULTS Participants completed on average 10 of 12 individual training sessions in coping strategies and 12 of 24 computerized training sessions. The addition of CRT to IPS resulted in significantly more participants working at the 3-month (odds ratio [OR]=2.83, 95% confidence interval [CI]=1.22-6.60) and 9-month follow-ups (OR=2.91, 95% CI=1.27-6.65). Participants who received CRT worked more hours and earned more in wages than those receiving IPS alone over the 9-month follow-up period. Both groups showed significantly improved cognitive outcomes at the 3-month follow-up, with no time × group interaction. CONCLUSIONS Cognitive remediation, especially skills training in coping and compensatory strategies, improves employment outcomes among individuals who do not show an early benefit of using IPS services.
Collapse
Affiliation(s)
- Amy M N Burns
- Department of Psychiatry, University of British Columbia, Vancouver, Canada (both authors); Department of Psychiatry, Royal Columbian Hospital (Burns), and Fraser Health Early Psychosis Intervention Program (Erickson), New Westminster, British Columbia, Canada
| | - David H Erickson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada (both authors); Department of Psychiatry, Royal Columbian Hospital (Burns), and Fraser Health Early Psychosis Intervention Program (Erickson), New Westminster, British Columbia, Canada
| |
Collapse
|
39
|
Tepper M, Farb E. The Behavioral Health Workforce Crisis and the Need for Complex, Adaptive Change. Psychiatr Serv 2023:appips20220416. [PMID: 36748245 DOI: 10.1176/appi.ps.20220416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Miriam Tepper
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Tepper); Community Health Center, Inc., Hartford, Connecticut, and Yale School of Nursing, Orange, Connecticut (Farb)
| | - Emily Farb
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Tepper); Community Health Center, Inc., Hartford, Connecticut, and Yale School of Nursing, Orange, Connecticut (Farb)
| |
Collapse
|
40
|
Frank RG, Shim RS. Toward Greater Accountability in Mental Health Care. Psychiatr Serv 2023; 74:182-187. [PMID: 35734866 DOI: 10.1176/appi.ps.20220097] [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: 02/03/2023]
Abstract
Lack of accountability contributes to the gap between best practices and potential outcomes. Few mental health providers routinely practice evidence-based care. In fact, within the mental health field, there is significant controversy over the use of evidence-based practices. Lack of accountability affects individuals receiving care at the patient level, provider level, and systems level. The authors identify several impediments to accountability in behavioral health care. These include failure to develop a diverse, well-trained workforce; challenges in measurement; misalignment of payment incentives; and misguided regulations. Accountability arrangements typically consist of several elements: a clear articulation of goals, objectives, or standards; metrics so that progress toward achieving goals can be tracked; and consequences for insurers, providers, and professionals for achieving or failing to achieve objectives. To advance system goals, the full complement of accountability tools should be consistently applied to all sources of behavioral health care and supports. The authors focus on three sets of accountability tools-performance metrics, payment incentives, and regulatory standards-that when implemented thoughtfully can help move the field toward more positive outcomes in behavioral health.
Collapse
Affiliation(s)
- Richard G Frank
- Department of Health Care Policy, Harvard Medical School, Boston, and Brookings Institution, Washington, D.C. (Frank); Department of Psychiatry, University of California, Davis, Sacramento (Shim)
| | - Ruth S Shim
- Department of Health Care Policy, Harvard Medical School, Boston, and Brookings Institution, Washington, D.C. (Frank); Department of Psychiatry, University of California, Davis, Sacramento (Shim)
| |
Collapse
|
41
|
Margolies PJ, Chiang IC, Covell NH, Jewell TC, Broadway-Wilson K, Gregory R, Scannevin G, Dixon LB. Staff Time in the Community: An Enduring Critical Component of Individual Placement and Support in the Digital Age. Psychiatr Serv 2023; 74:197-200. [PMID: 35833252 DOI: 10.1176/appi.ps.202100550] [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: 02/03/2023]
Abstract
OBJECTIVE This study examined the relationship between individual placement and support (IPS) employment specialists' time spent in the community and employment outcomes in the current digital age, featuring increased technology use and online hiring practices. METHODS The authors examined the relationship between employment outcomes and IPS employment specialists' time spent in the community at 78 sites in 2018 and 84 sites in 2019. RESULTS The amount of time staff spent in the community was significantly and positively associated with better employment outcomes. CONCLUSIONS These data support the continued importance of employment specialists' spending time in the community with employers and IPS recipients to achieve optimal outcomes for recipients.
Collapse
Affiliation(s)
- Paul J Margolies
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| | - I-Chin Chiang
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| | - Nancy H Covell
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| | - Thomas C Jewell
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| | - Karen Broadway-Wilson
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| | - Raymond Gregory
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| | - Gary Scannevin
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (all authors); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York (Margolies, Covell, Jewell, Dixon)
| |
Collapse
|
42
|
Asher L, Rapiya B, Repper J, Reddy T, Myers B, Hanlon C, Petersen I, Brooke-Sumner C. Peer-led recovery groups for people with psychosis in South Africa (PRIZE): protocol for a randomised controlled feasibility trial. Pilot Feasibility Stud 2023; 9:19. [PMID: 36726164 PMCID: PMC9890934 DOI: 10.1186/s40814-022-01232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The available care for people with psychosis in South Africa is inadequate to support personal recovery. Group peer support interventions are a promising approach to foster recovery, but little is known about the preferences of service users, or the practical application of this care model, in low- and middle-income countries (LMIC). This study aims to assess the acceptability and feasibility of integrating peer-led recovery groups for people with psychosis and their caregivers in South Africa into existing systems of care, and to determine key parameters in preparation for a definitive trial. METHODS The study is set in Nelson Mandela Bay Metropolitan district of the Eastern Cape Province, South Africa. The design is an individually randomised parallel group feasibility trial comparing recovery groups in addition to treatment as usual (TAU) with TAU alone in a 1:1 allocation ratio. We aim to recruit 100 isiXhosa-speaking people with psychosis and 100 linked caregivers. TAU comprises anti-psychotic medication-focused outpatient care. The intervention arm will comprise seven recovery groups, including service users and caregiver participants. Recovery groups will be delivered in two phases: a 2-month phase facilitated by an auxiliary social worker, then a 3-month peer-led phase. We will use mixed methods to evaluate the process and outcomes of the study. Intervention acceptability and feasibility (primary outcomes) will be assessed at 5 months post-intervention start using qualitative data collected from service users, caregivers, and auxiliary social workers, along with quantitative process indicators. Facilitator competence will be assessed with the GroupACT observational rating tool. Trial procedures will be assessed, including recruitment and retention rates, contamination, and validity of quantitative outcome measures. To explore potential effectiveness, quantitative outcome data (functioning, unmet needs, personal recovery, internalised stigma, health service use, medication adherence, and caregiver burden) will be collected at baseline, 2 months, and 5 months post-intervention start. DISCUSSION This study will contribute to the sparse evidence on the acceptability and feasibility of peer-led and recovery-oriented interventions for people with psychosis in LMIC when integrated into existing care systems. Results from this feasibility trial will inform preparations for a definitive trial and subsequent larger-scale implementation. TRIAL REGISTRATION Pan-African Clinical Trials Register PACTR202202482587686. Registered on 28 February 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=21496 .
Collapse
Affiliation(s)
- Laura Asher
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Bongwekazi Rapiya
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa
| | - Julie Repper
- Implementing Recovery through Organisational Change, Nottingham, UK
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa.,Curtin enAble Institute, Curtin University, Perth, Western Australia, 6151, Australia.,Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa
| |
Collapse
|
43
|
Lam PC, Lewis-Fernández R, Aggarwal NK. The Cultural Formulation Interview: Building the Case for Cultural Competence in Clinical Care. Psychiatr Serv 2023; 74:216-217. [PMID: 36722093 DOI: 10.1176/appi.ps.202100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Peter C Lam
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (all authors); Columbia University Department of Psychiatry, New York City (Lewis-Fernández)
| | - Roberto Lewis-Fernández
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (all authors); Columbia University Department of Psychiatry, New York City (Lewis-Fernández)
| | - Neil Krishan Aggarwal
- New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York City (all authors); Columbia University Department of Psychiatry, New York City (Lewis-Fernández)
| |
Collapse
|
44
|
Oviedo E, Means RF, Lilley-Haughey K, Hua LL. Integration of Substance Use Disorder Treatment Into a Traditional Community Mental Health Treatment System. Psychiatr Serv 2023:appips202100643. [PMID: 36695014 DOI: 10.1176/appi.ps.202100643] [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: 01/26/2023]
Abstract
In response to the opioid crisis, Catholic Charities of Baltimore sought to integrate substance use disorder treatment into their outpatient community mental health clinics. The agency developed a systematic practice improvement strategy that included a competency-based curriculum and supervision plan for psychiatric providers and therapists. Psychiatric providers developed competency with medications used to treat substance use disorders, and therapists developed competency in therapeutic modalities to treat substance use disorders, all of which were gradually integrated into outpatient clinics. This column demonstrates that integration of substance use disorder treatment into outpatient community mental health care is feasible and beneficial.
Collapse
|
45
|
Keepers BC, Easterly CW, Nora Dennis, Domino ME, Bhalla IP. A Survey of Behavioral Health Care Providers on Use and Barriers to Use of Measurement-Based Care. Psychiatr Serv 2023; 74:349-357. [PMID: 36695012 DOI: 10.1176/appi.ps.202100735] [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: 01/26/2023]
Abstract
OBJECTIVE Despite robust evidence for efficacy of measurement-based care (MBC) in behavioral health care, studies suggest that adoption of MBC is limited in practice. A survey from Blue Cross-Blue Shield of North Carolina was sent to behavioral health care providers (BHCPs) about their use of MBC, beliefs about MBC, and perceived barriers to its adoption. METHODS The authors distributed the survey by using professional networks and snowball sampling. Provider and clinical practice characteristics were collected. Numerical indices of barriers to MBC use were created. Ordered logistic regression models were used to identify associations among practice and provider characteristics, barriers to MBC use, and level of MBC use. RESULTS Of the 922 eligible BHCPs who completed the survey, 426 (46%) reported using MBC with at least half of their patients. Providers were more likely to report MBC use if they were part of a large group practice, had MBC training, had more weekly care hours, or practiced in nonmetropolitan settings. Physicians, self-reported generalists, more experienced providers, and those who did not accept insurance were less likely to report MBC use. Low perceived clinical utility was the barrier most strongly associated with less frequent use of MBC. CONCLUSIONS Although evidence exists for efficacy of MBC in behavioral health care, less than half of BHCPs reported using MBC with at least half of their patients, and low perceived clinical utility of MBC was strongly associated with lower MBC use. Implementation strategies that attempt to change negative attitudes toward MBC may effectively target this barrier to use.
Collapse
Affiliation(s)
- Breanna C Keepers
- Department of Psychiatry, New York-Presbyterian Hospital, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York City (Keepers); University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (Easterly); Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill (Easterly); Blue Cross-Blue Shield of North Carolina, Durham (Dennis, Bhalla); Duke University School of Medicine, Durham, North Carolina (Dennis); College of Health Solutions and Center for Health Information and Research, Arizona State University, Tempe (Domino)
| | - Caleb W Easterly
- Department of Psychiatry, New York-Presbyterian Hospital, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York City (Keepers); University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (Easterly); Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill (Easterly); Blue Cross-Blue Shield of North Carolina, Durham (Dennis, Bhalla); Duke University School of Medicine, Durham, North Carolina (Dennis); College of Health Solutions and Center for Health Information and Research, Arizona State University, Tempe (Domino)
| | - Nora Dennis
- Department of Psychiatry, New York-Presbyterian Hospital, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York City (Keepers); University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (Easterly); Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill (Easterly); Blue Cross-Blue Shield of North Carolina, Durham (Dennis, Bhalla); Duke University School of Medicine, Durham, North Carolina (Dennis); College of Health Solutions and Center for Health Information and Research, Arizona State University, Tempe (Domino)
| | - Marisa Elena Domino
- Department of Psychiatry, New York-Presbyterian Hospital, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York City (Keepers); University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (Easterly); Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill (Easterly); Blue Cross-Blue Shield of North Carolina, Durham (Dennis, Bhalla); Duke University School of Medicine, Durham, North Carolina (Dennis); College of Health Solutions and Center for Health Information and Research, Arizona State University, Tempe (Domino)
| | - Ish P Bhalla
- Department of Psychiatry, New York-Presbyterian Hospital, and New York State Psychiatric Institute, Columbia University Irving Medical Center, New York City (Keepers); University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (Easterly); Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill (Easterly); Blue Cross-Blue Shield of North Carolina, Durham (Dennis, Bhalla); Duke University School of Medicine, Durham, North Carolina (Dennis); College of Health Solutions and Center for Health Information and Research, Arizona State University, Tempe (Domino)
| |
Collapse
|
46
|
Karcher NR, Hicks R, Schiffman J, Asarnow JR, Calkins ME, Dauberman JL, Garrett CD, Koli RL, Larrauri CA, Loewy RL, McGough CA, Murphy JM, Niendam TA, Roaten K, Rodriguez J, Staglin BK, Wissow L, Woodberry KA, Young JF, Gur RE, Bearden CE, Barch DM. Youth Mental Health Screening and Linkage to Care. Psychiatr Serv 2023:appips202200008. [PMID: 36695011 DOI: 10.1176/appi.ps.202200008] [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: 01/26/2023]
Abstract
One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-24 years) with mental health difficulties, including serious mental illness, in the United States. This article synthesizes and builds on discussions from those meetings by outlining and recommending potential steps and considerations for the development and integration of a novel measurement-based screening process in youth-facing school and medical settings to increase early identification of mental health needs and linkage to evidence-based care. Meeting attendees agreed on an initiative incorporating a staged assessment process that includes a first-stage brief screener for several domains of psychopathology. Individuals who meet threshold criteria on the first-stage screener would then complete an interview, a second-stage in-depth screening, or both. Screening must be followed by recommendations and linkage to an appropriate level of evidence-based care based on acuity of symptoms endorsed during the staged assessment. Meeting attendees proposed steps and discussed additional considerations for creating the first nationwide initiative for screening and linkage to care, an initiative that could transform access of youths to mental health screening and care.
Collapse
Affiliation(s)
- Nicole R Karcher
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Ramona Hicks
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Jason Schiffman
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Joan R Asarnow
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Monica E Calkins
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Judith L Dauberman
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Chantel D Garrett
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Roshni L Koli
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Carlos A Larrauri
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Rachel L Loewy
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Cecilia A McGough
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - J Michael Murphy
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Tara A Niendam
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Kimberly Roaten
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Jacqueline Rodriguez
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Brandon K Staglin
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Lawrence Wissow
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Kristen A Woodberry
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Jami F Young
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Raquel E Gur
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Carrie E Bearden
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| | - Deanna M Barch
- Department of Psychiatry, School of Medicine (Karcher, Barch), and Department of Psychological and Brain Sciences (Barch), Washington University in St. Louis, St. Louis; One Mind, Rutherford, California (Hicks, Staglin); Department of Psychological Science, University of California, Irvine, Irvine (Schiffman); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Asarnow, Bearden); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Calkins, Young, Gur); Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford (Dauberman); Department of Health Services (Garrett) and Department of Psychiatry and Behavioral Sciences, School of Medicine (Wissow), University of Washington, Seattle; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin (Koli); National Alliance on Mental Illness, Arlington, Virginia (Larrauri); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Loewy); Students With Psychosis, New York City (McGough); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Murphy); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam); Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas (Roaten); Student Support and Health Services, Sacramento City Unified School District, Sacramento, California (Rodriguez); Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, and Department of Psychiatry, Tufts School of Medicine, Boston (Woodberry); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young, Gur)
| |
Collapse
|
47
|
Mathai M, Mbwayo A, Concepcion T, Mutavi T, Njeru M, Waruinge S, Dorsey S, Schafer A, Pedersen GA, Sinha M, Kohrt BA, Collins PY. Sustainable Partnerships to Ensure Quality in Psychological Support (EQUIP) for Adolescents. Psychiatr Serv 2023:appips20220200. [PMID: 36625140 DOI: 10.1176/appi.ps.20220200] [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: 01/11/2023]
Abstract
Ensuring that sustainable and effective mental health services are available for children and adolescents is a growing priority for national governments. However, little guidance exists on how to support service implementation. In Kenya, partnerships were formed among regional government, nongovernmental organizations, and universities to implement Ensuring Quality in Psychological Support (EQUIP)-Nairobi, a pilot project to train and supervise nonspecialists delivering psychological support to adolescents. Lessons were learned about integrating psychological services into existing health services by using the EQUIP platform to assess competencies, engaging partners for supervision and quality improvement, and involving youth stakeholders. The partnerships facilitated a rapid transition to remote services during the COVID-19 pandemic. The EQUIP-Nairobi project results offer lessons for partnerships in other low-resource settings.
Collapse
Affiliation(s)
- Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Tessa Concepcion
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Teresia Mutavi
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Michael Njeru
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Stella Waruinge
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Shannon Dorsey
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Alison Schafer
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Gloria A Pedersen
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Moitreyee Sinha
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Brandon A Kohrt
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| | - Pamela Y Collins
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Mathai, Mbwayo, Mutavi); Departments of Global Health (Concepcion, Collins), Psychology (Dorsey), and Psychiatry and Behavioral Sciences (Collins), University of Washington, Seattle; citiesRISE, Nairobi, Kenya (Njeru), and New York City (Sinha); Mental Health Unit, Health Directorate, Nairobi County Government, Nairobi, Kenya (Waruinge); Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva (Schafer); Global Mental Health Progam, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, George Washington University, Washington, D.C. (Pedersen, Kohrt)
| |
Collapse
|
48
|
Gajera GV, Pandey P, Malathesh BC, Nirisha PL, Suchandra KHH, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Suresha BM, Jain S. Effectiveness of blended versus fully digital training in primary care psychiatry: A retrospective comparison from India. J Neurosci Rural Pract 2023; 14:91-97. [PMID: 36891122 PMCID: PMC9945417 DOI: 10.25259/jnrp-2022-4-20] [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: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives We compared effectiveness of blended mode (consisting of traditional classroom teaching and e-learning sessions) and fully digital mode (e-learning sessions alone) of primary care psychiatry training for primary care doctors in Chhattisgarh. Materials and Methods We retrospectively compared the engagement in training, knowledge (K), attitude (A), and practice (P) in primary care psychiatry, and patient identification by primary care doctors (n = 941) from Chhattisgarh region who underwent training through either blended training mode (n = 546) or fully digital training mode (n = 395) for 16 h each, using Clinical Schedules for Primary Care Psychiatry based modules between June 2019 and November 2020 with a tertiary care center (NIMHANS, Bengaluru) as hub. Statistical Analysis The Statistical Package for the Social Sciences version 27 was used to analyze the data. Continuous variables were analyzed using the independent samples t-test, and discrete variables were analyzed using the Chi-square test. A repeated measures analysis of variance (ANOVA) (two-way mixed design) was used to see the interaction of training type and time of pre- and post-KAP measurement while controlling for years of experience. The number of patients identified by both training groups over 8 months was also compared using the repeated measures ANOVA (two-way mixed design). Results Engagement inferred by the number of participants completing pre-KAP forms (75%), post-KAP forms (43%), post-session assessments (37- 47%), case presentation (33.9%), and certification (32.1%) was better in the blended group (P < 0.05). The mean gain in KAP scores was significantly higher in the blended group controlling for the years of experience as primary care doctor (PCD) (F = 30.36, P < 0.001). PCDs in the blended training group consistently identified a higher number of patients with mental illness over 8 months of follow-up (F = 6.21, P < 0.001). Conclusion The blended mode yielded better results in primary care psychiatry training compared to fully digital mode. In-person interactions while provided for a very brief proportion of the training seem to have an unmistakable imprint on the outcomes and seem critical for better consolidation and assimilation of information, which translates into better practice.
Collapse
Affiliation(s)
- Gopi V. Gajera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Praveen Pandey
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Barikar C. Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Hyderabad, Telangana, India
| | - P. Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K. Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ferose Azeez Ibrahim
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Bada Math Suresha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sumi Jain
- Department of Non-Communicable Diseases, National Health Mission, Chhattisgarh, India
| |
Collapse
|
49
|
Awaad R, Obaid E, Kouser T, Ali S. Addressing Mental Health Through Community Partnerships in a Muslim Community. Psychiatr Serv 2023; 74:96-99. [PMID: 36065581 DOI: 10.1176/appi.ps.202100505] [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
The mental health of American Muslims remains significantly understudied and unaddressed, despite known obstacles to Muslims' utilization of mental health services, such as stigma and institutional mistrust. Since the inception of the Stanford Muslim Mental Health and Islamic Psychology Lab in 2014, partnerships across the Bay Area were formed among key Muslim community establishments to address obstacles to good mental health. Through a community-centered approach, diverse stakeholders engaged to identify and address the community's most pressing mental health challenges. Successful outcomes of this approach include facilitated research and mental health initiatives to support the Bay Area Muslim community.
Collapse
Affiliation(s)
- Rania Awaad
- Stanford Muslim Mental Health and Islamic Psychology Lab, School of Medicine, Stanford University, Stanford, California
| | - Eiman Obaid
- Stanford Muslim Mental Health and Islamic Psychology Lab, School of Medicine, Stanford University, Stanford, California
| | - Taimur Kouser
- Stanford Muslim Mental Health and Islamic Psychology Lab, School of Medicine, Stanford University, Stanford, California
| | - Sara Ali
- Stanford Muslim Mental Health and Islamic Psychology Lab, School of Medicine, Stanford University, Stanford, California
| |
Collapse
|
50
|
Parrish C, Basu A, McConnell KJ, Frogner BK, Reddy A, Zatzick DF, Kreuter W, Sabbatini AK. Evaluation of a Health Information Exchange for Linkage to Mental Health Care After an Emergency Department Visit. Psychiatr Serv 2022; 74:555-558. [PMID: 36545771 PMCID: PMC10159871 DOI: 10.1176/appi.ps.20220231] [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: 12/24/2022]
Abstract
Aligning with Washington State's goal of reducing unnecessary emergency department (ED) use and improving linkage to outpatient primary and behavioral health care, this study evaluated whether an Emergency Department Information Exchange (EDIE) improved linkage to care for Medicaid enrollees with mental health conditions. Follow-up with any physician at 30 days increased slightly, although mental health-specific follow-up declined over time. Difference-in-differences estimates revealed no effect of EDIE on linkage to care after an ED visit. Medicaid beneficiaries with mental health needs and high utilization of the ED likely require additional support to increase timely and appropriate follow-up care.
Collapse
Affiliation(s)
- Canada Parrish
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Anirban Basu
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - K John McConnell
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Bianca K Frogner
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Ashok Reddy
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Douglas F Zatzick
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - William Kreuter
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Amber K Sabbatini
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| |
Collapse
|