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Burgess J, Kim HM, Porath BR, Van T, Osatuke K, Boden M, Sripada RK, Wong ES, Zivin K. The Importance of Autonomy and Performance Goals in Perceived Workload Among Behavioral Health Providers. Psychiatr Serv 2024:appips20230406. [PMID: 38532686 DOI: 10.1176/appi.ps.20230406] [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
OBJECTIVE The authors sought to assess workplace characteristics associated with perceived reasonable workload among behavioral health care providers in the Veterans Health Administration. METHODS The authors evaluated perceived reasonable workload and workplace characteristics from the 2019 All Employee Survey (AES; N=14,824) and 2019 Mental Health Provider Survey (MHPS; N=10,490) and facility-level staffing ratios from Mental Health Onboard Clinical Dashboard data. Nine AES and 15 MHPS workplace predictors of perceived reasonable workload, 11 AES and six MHPS demographic predictors, and facility-level staffing ratios were included in mixed-effects logistic regression models. RESULTS In total, 8,874 (59.9%) AES respondents and 5,915 (56.4%) MHPS respondents reported having a reasonable workload. The characteristics most strongly associated with perceived reasonable workload were having attainable performance goals (average marginal effect [AME]=0.10) in the AES and ability to schedule patients as frequently as indicated (AME=0.09) in the MHPS. Other AES characteristics significantly associated with reasonable workload included having appropriate resources, support for personal life, skill building, performance recognition, concerns being addressed, and no supervisor favoritism. MHPS characteristics included not having collateral duties that reduce care time, staffing levels not affecting care, support staff taking over some responsibilities, having spirit of teamwork, primary care-mental health integration, participation in performance discussions, well-coordinated mental health care, effective veteran programs, working at the top of licensure, and feeling involved in improving access. Facility-level staffing ratios were not significantly associated with perceived reasonable workload. CONCLUSIONS Leadership may consider focusing resources on initiatives that support behavioral health providers' autonomy to schedule patients as clinically indicated and develop attainable performance goals.
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Affiliation(s)
- Jennifer Burgess
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Hyungjin Myra Kim
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Brittany R Porath
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Tony Van
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Katerine Osatuke
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Matthew Boden
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Rebecca K Sripada
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Edwin S Wong
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Kara Zivin
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
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Aragón MJ, Gravelle H, Castelli A, Goddard M, Gutacker N, Mason A, Rowen D, Mannion R, Jacobs R. Measuring the overall performance of mental healthcare providers. Soc Sci Med 2024; 344:116582. [PMID: 38394864 DOI: 10.1016/j.socscimed.2024.116582] [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: 01/03/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
To date there have been no attempts to construct composite measures of healthcare provider performance which reflect preferences for health and non-health benefits, as well as costs. Health and non-health benefits matter to patients, healthcare providers and the general public. We develop a novel provider performance measurement framework that combines health gain, non-health benefit, and cost and illustrate it with an application to 54 English mental health providers. We apply estimates from a discrete choice experiment eliciting the UK general population's valuation of non-health benefits relative to health gains, to administrative and patient survey data for years 2013-2015 to calculate equivalent health benefit (eHB) for providers. We measure costs as forgone health and quantify the relative performance of providers in terms of equivalent net health benefit (eNHB): the value of the health and non-health benefits minus the forgone benefit equivalent of cost. We compare rankings of providers by eHB, eNHB, and by the rankings produced by the hospital sector regulator. We find that taking account of the non-health benefits in the eNHB measure makes a substantial difference to the evaluation of provider performance. Our study demonstrates that the provider performance evaluation space can be extended beyond measures of health gain and cost, and that this matters for comparison of providers.
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Affiliation(s)
- María José Aragón
- HCD Economics, Daresbury Innovation Centre, Keckwick Lane, Daresbury, Warrington, WA4 4FS, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, Heslington York, YO10 5DD, UK
| | - Adriana Castelli
- Centre for Health Economics, University of York, Heslington York, YO10 5DD, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, Heslington York, YO10 5DD, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, Heslington York, YO10 5DD, UK
| | - Anne Mason
- Centre for Health Economics, University of York, Heslington York, YO10 5DD, UK
| | - Donna Rowen
- Sheffield Centre for Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, Park House, University of Birmingham, Edgbaston, Birmingham, B15 2RT, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, Heslington York, YO10 5DD, UK.
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Åhs JW, Ranheim A, Eriksson H, Mazaheri M. Encountering suffering in digital care: a qualitative study of providers' experiences in telemental health care. BMC Health Serv Res 2023; 23:418. [PMID: 37127655 PMCID: PMC10150682 DOI: 10.1186/s12913-023-09367-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers' lived experiences of encountering patient suffering during telemental health care. METHODS A qualitative phenomenological approach was used to uncover participants' experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology. RESULTS Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers' lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief. CONCLUSIONS This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.
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Affiliation(s)
- Jill W Åhs
- Department of Health Sciences, Swedish Red Cross University, P.O. Box 1059, Huddinge, 141 21, Sweden.
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden.
| | - Albertine Ranheim
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden
| | - Henrik Eriksson
- Section for Health Promotion and Care Sciences, University West, Trollhättan, Sweden
| | - Monir Mazaheri
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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Mannion R, Konteh FH, Jacobs R. Organisational drivers of performance in mental health providers. J Health Organ Manag 2023; ahead-of-print:273-287. [PMID: 36927953 PMCID: PMC10430795 DOI: 10.1108/jhom-01-2022-0017] [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: 01/17/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 03/18/2023]
Abstract
PURPOSE This study aims to compare and contrast the core organisational processes across high and low performing mental health providers in the English National Health Service (NHS). DESIGN/METHODOLOGY/APPROACH A multiple case study qualitative design incorporating a full sample of low and high performing mental health providers. FINDINGS This study suggests that the organisational approaches used to govern and manage mental health providers are associated with their performance, and the study's findings give clues as to what areas might need attention. They include, but are not limited to: developing appropriate governance frameworks and organisational cultures, ensuring that staff across the organisation feel "psychologically safe" and able to speak up when they see things that are going wrong; a focus on enhancing quality of services rather than prioritising cost-reduction; investing in new technology and digital applications; and nurturing positive inter-organisational relationships across the local health economy. ORIGINALITY/VALUE Highlights considerable divergence in organisation and management practices that are associated with the performance of mental health trusts in the English NHS.
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Affiliation(s)
- Russell Mannion
- Health Services Management Centre
,
University of Birmingham
, Birmingham,
UK
| | | | - Rowena Jacobs
- Centre for Health Economics
,
University of York
, Heslington,
UK
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5
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Abstract
BACKGROUND Research suggests that a major barrier to mental health treatment is not knowing where to go for services, yet little is known about the specific steps people take to find treatment. AIMS To (1) understand the process people would undertake if they decided they needed mental health treatment and (2) examine how well the process that current non-treatment-seeking individuals describe matches that used by individuals currently in treatment. METHODS Adults recruited online via Amazon's Mechanical Turk (N = 669) answered questions about finding a mental health provider. Participants who had (N = 167) and had not (N = 502) seen a mental health provider in the past month were compared. RESULTS Both groups indicated they would rely on Internet searches and recommendations of family, friends and physicians to find mental health providers. The order in which participants indicated they would use each step was similar across groups as was participants' confidence these steps would help them find a provider. Differences emerged in the factors each group indicated were important to their selection of a provider. CONCLUSIONS Results can inform mental health providers and policy makers regarding the importance of clear and informative online mental health information, including thorough information about appropriate mental health providers.
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Affiliation(s)
| | - Shireen L Rizvi
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
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6
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Dreison KC, White DA, Bauer SM, Salyers MP, McGuire AB. Integrating Self-Determination and Job Demands-Resources Theory in Predicting Mental Health Provider Burnout. Adm Policy Ment Health 2018; 45:121-30. [PMID: 27783240 DOI: 10.1007/s10488-016-0772-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Limited progress has been made in reducing burnout in mental health professionals. Accordingly, we identified factors that might protect against burnout and could be productive focal areas for future interventions. Guided by self-determination theory, we examined whether supervisor autonomy support, self-efficacy, and staff cohesion predict provider burnout. 358 staff from 13 agencies completed surveys. Higher levels of supervisor autonomy support, self-efficacy, and staff cohesion were predictive of lower burnout, even after accounting for job demands. Although administrators may be limited in their ability to reduce job demands, our findings suggest that increasing core job resources may be a viable alternative.
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Chavarria J, Liu M, Kast L, Salem E, King AC. A pilot study of Counsel to Quit®: Evaluating an Ask Advise Refer (AAR)-based tobacco cessation training for medical and mental healthcare providers. J Subst Abuse Treat 2019; 99:163-170. [PMID: 30797390 DOI: 10.1016/j.jsat.2019.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Despite tobacco use as the largest preventable cause of premature death in the US, many healthcare providers continue to lack the knowledge and confidence in employing the Ask, Advise, Refer (AAR) model in tobacco cessation treatment delivery. This pilot study evaluated the feasibility and effectiveness of a novel AAR-styled training program, Counsel to Quit®, across a range of healthcare providers and disciplines (i.e., medical, mental health, other). The Counsel to Quit® training program primarily targeted publically-funded settings that serve communities with high smoking rates. METHODS Pre- and post-training surveys were administered to medical, mental health, and other professionals (N = 297) to evaluate the effectiveness of the 60-90 minute Counsel to Quit® counselor training program for improving confidence in the ability to discuss approved tobacco cessation interventions and address the current state of knowledge about the role of electronic cigarettes in tobacco cessation. The trainings were held across 14 different non-profit institutional settings in Chicago, IL. RESULTS The Counsel to Quit® program improved AAR beliefs, the confidence and ability to discuss smoking cessation, and knowledge on the role of electronic cigarettes in tobacco cessation among medical, mental health, and other providers (ps < .001). Interactions showed that Counsel to Quit® improved medical provider confidence in referring patients for smoking cessation the most (p < .001), and also improved mental health providers belief in the importance of tobacco cessation for preventative care the most (ps < .05). CONCLUSIONS Counsel to Quit® is a feasible and effective training for improving AAR beliefs across multiple healthcare provider domains and at different types of publicly-funded healthcare institutions. Further, this training increased provider preparedness to discuss the lack of evidence for e-cigarette use as a form of tobacco cessation.
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Affiliation(s)
- Jesus Chavarria
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S. Maryland Ave (MC-3077), Chicago, IL 60637, USA
| | - Melissa Liu
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S. Maryland Ave (MC-3077), Chicago, IL 60637, USA
| | - Lainie Kast
- Respiratory Health Association, 1440 W. Washington Blvd., Chicago, IL 60607, USA
| | - Erica Salem
- Respiratory Health Association, 1440 W. Washington Blvd., Chicago, IL 60607, USA
| | - Andrea C King
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S. Maryland Ave (MC-3077), Chicago, IL 60637, USA.
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Ramseyer Winter V, Brett A, Pevehouse-Pfeiffer D, O'Neill EA, Ellis-Ordway N. Body Image Assessment Among Community Mental Health Providers. Community Ment Health J 2018; 54:600-606. [PMID: 29138959 DOI: 10.1007/s10597-017-0194-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
Although research suggests an association between body image and mental health, with poor body image related to several mental illnesses, there is no research exploring mental health clinicians' body image screening practices. This study aims to fill this gap among a sample of community mental health providers (N = 216). Using a cross-sectional design, clinicians in Community Health Centers were recruited through email using purposeful and snowball sampling in a Midwest state. The majority of participants identified as women (88.4%) and White (88.4%). Additionally, the mean age of the sample was 36.66 years and participants reported working an average of 8.44 years as a mental health provider. We ran descriptive and Chi square analyses. Results suggest a relationship between viewing body image screening as important and level of preparedness as well as level of preparedness and actual assessment. Training and assessment tools may be warranted to increase clinician's preparedness. Additional clinical and policy recommendations are discussed.
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Affiliation(s)
| | - Anna Brett
- School of Journalism, University of Missouri, Columbia, MO, 65211, USA
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Abstract
OBJECTIVE The study evaluated the presence of mental health providers in the Medicare Shared Savings Program (MSSP) accountable care organizations. METHODS On the basis of data for all 105,155 providers participating in the 220 MSSPs in 2012 and 2013, MSSPs were classified by whether they included psychiatrists, psychologists, or clinical social workers. Descriptive statistics were calculated, including the number and type of mental health providers. RESULTS The inclusion of mental health providers varied substantially over time and across MSSPs. Only 52% of MSSPs included at least one mental health provider in April 2012. This proportion increased to 64% in July 2012 and was 61% in January 2013. MSSPs including mental health providers had a mean average of 26 such practitioners (minimum of 1, median of 11, and maximum of 240). CONCLUSIONS Although the MSSP model generally incentivized high-quality, coordinated care, it has largely overlooked mental health services.
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Affiliation(s)
- Julia Driessen
- The authors are with the Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (e-mail: )
| | - Yuting Zhang
- The authors are with the Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (e-mail: )
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Reiss M, Greene CA, Ford JD. Is it time to talk? Understanding specialty child mental healthcare providers' decisions to engage in interdisciplinary communication with pediatricians. Soc Sci Med 2017; 175:66-71. [PMID: 28064011 PMCID: PMC5293609 DOI: 10.1016/j.socscimed.2016.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/29/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022]
Abstract
Communication between pediatric mental health and primary care providers is often inconsistent and frequently rated as unsatisfactory by providers of both disciplines. While numerous studies report pediatricians' desire for increased feedback from mental health providers, less is known about mental health providers' perspectives on collaborative communication with pediatricians. In the current qualitative study, 9 practitioners at 2 mental health practices participated in interviews about their experiences related to collaborating and communicating with pediatric providers. The interviews were analyzed inductively using thematic analysis procedures. Mental health providers consistently described the decision to communicate with pediatric primary care providers as occurring primarily when initiated by them, and on a "case by case" basis. Four determinants of the decision to initiate communication emerged from the interviews: severity of client concerns, mental health providers' own positive beliefs about collaborative/integrative mental health-pediatric care, perceptions of and past experiences with the primary care providers with whom they interact, and professional relationships with specific primary care providers. The findings of this study suggest that understanding and addressing the attitudes and beliefs that underlie both mental health and pediatric health care providers' decisions to engage in interprofessional communication is essential to establishing truly collaborative care.
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Affiliation(s)
- Michael Reiss
- Psychology Department, University of Hartford, 200 Bloomfield Avenue, West Hartford, CT, 06117, USA
| | - Carolyn A Greene
- Department of Psychiatry, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Julian D Ford
- Department of Psychiatry, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA
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Stefanovics E, He H, Ofori-Atta A, Cavalcanti MT, Rocha Neto H, Makanjuola V, Ighodaro A, Leddy M, Rosenheck R. Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries. Psychiatr Q 2016; 87:63-73. [PMID: 25939823 DOI: 10.1007/s11126-015-9363-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.
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Moran V, Jacobs R, Mason A. Variations in Performance of Mental Health Providers in the English NHS: An Analysis of the Relationship Between Readmission Rates and Length-of-Stay. Adm Policy Ment Health 2016; 44:188-200. [PMID: 26749002 DOI: 10.1007/s10488-015-0711-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Indexed: 11/29/2022]
Abstract
Length-of-stay (LOS) for inpatient mental health care is a major driver of variation in resource use internationally. We explore determinants of LOS in England, focusing on the impact of emergency readmission rates which can serve as a measure of the quality of care. Data for 2009/2010 and 2010/2011 are analysed using hierarchical and non-hierarchical models. Unexplained residual variation among providers is quantified using Empirical Bayes techniques. Diagnostic, treatment and patient-level demographic variables are key drivers of LOS. Higher emergency readmission rates are associated with shorter LOS. Ranking providers by residual variation reveals significant differences, suggesting some providers can improve performance.
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Affiliation(s)
- Valerie Moran
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Rowena Jacobs
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
| | - Anne Mason
- Centre for Health Economics and Department of Economics and Related Studies, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
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