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Gudzune KA, Jerome GJ, Dalcin AT, Gao R, Mace E, Fink T, Minahan E, Yuan C, Xie A, Goldsholl S, Gennusa JV, Daumit GL. Scaling a behavioral weight-loss intervention for individuals with serious mental illness using the enhanced replicating effective programs framework: A preconditions phase proof-of-concept study. Obes Sci Pract 2023; 9:618-630. [PMID: 38090682 PMCID: PMC10712421 DOI: 10.1002/osp4.690] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background Given the obesity's high prevalence among individuals with serious mental illness (SMI), translating weight-loss interventions with demonstrated effectiveness is needed. This study describes the initial translation phase of such an intervention using the Enhanced Replicating Effective Programs (REP) Framework for delivery by mental health program staff. Methods The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (Achieving Healthy Lifestyles in Psychiatric Rehabilitation) trial intervention was preliminarily adapted to create the ACHIEVE-Dissemination (ACHIEVE-D) curriculum. A treatment-only study was conducted to rapidly evaluate the curriculum using a mixed-methods approach including surveys and focus groups. A study coach delivered an abbreviated curriculum to individuals with SMI from a single psychiatric program. Among all participants with SMI (n = 17), outcomes were attendance and satisfaction; 14 participated in a focus group. The program staff observed curriculum delivery and participated in a focus group (n = 3). Results Overall, 23 group sessions were delivered. Median attendance was 78.6% across participants with SMI; 92.9% would recommend ACHIEVE-D to others. The staff found the curriculum acceptable, particularly its structured nature, inclusion of weight management and exercise, and integrated goal setting and tracking. These improvements recommended by participants and/or staff were to assess participant readiness-to-change prior to enrollment, change the frequency of weigh-ins, and train staff coaches on anticipated challenges (e.g., exercise engagement, weight fluctuations). Conclusions During this first REP phase, individuals with SMI and program staff were satisfied with ACHIEVE-D. Additional refinements will aid future implementation and improve participant experience.
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Affiliation(s)
- Kimberly A. Gudzune
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionBaltimoreMarylandUSA
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Gerald J. Jerome
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of KinesiologyTowson UniversityTowsonMarylandUSA
| | - Arlene T. Dalcin
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionBaltimoreMarylandUSA
| | - Ruiyi Gao
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Elizabeth Mace
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Tyler Fink
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Eva Minahan
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Christina Yuan
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Armstrong Institute for Patient Safety and QualityJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Anping Xie
- Armstrong Institute for Patient Safety and QualityJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Stacy Goldsholl
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Joseph V. Gennusa
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Gail L. Daumit
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionBaltimoreMarylandUSA
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Régio L, Barros S, Ballan C, Aguiar C, Candido BDP, de Oliveira MAF. The care provided to black-skinned children and adolescents with mental health problems in the intersection between gender and race. Rev Lat Am Enfermagem 2023; 31:e3941. [PMID: 37341257 PMCID: PMC10306061 DOI: 10.1590/1518-8345.6058.3941] [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: 03/23/2022] [Accepted: 03/28/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE to characterize the sociofamily profile of black-skinned children and adolescents with mental health problems and to intersectionally describe who assumes responsibility for their care. METHOD a descriptive and exploratory study with a quantitative approach, developed in the Psychosocial Care Center for Children and Adolescents from the North region of the municipality of São Paulo. The data were collected from 47 family members of black-skinned children and adolescents, using a script with predefined variables submitted to statistical analysis. RESULTS a total of 49 interviews were conducted: 95.5% women with a mean age of 39 years old, 88.6% mothers and 85.7% black-skinned. Family income comes from wages for all the male caregivers and for 59% of the women. Among the black-skinned female caregivers, 25% live in their own house, whereas this percentage is 46.2% among the brown-skinned ones. Of all the caregivers, 10% have a job, 20% live in transferred properties, 35% in houses of their own and 35% in rented places. The social support network is larger among white-skinned people (16.7%), followed by brown-skinned (3.8%), and absent among black-skinned individuals (0%). CONCLUSION those responsible for the care of black-skinned children and adolescents monitored by the CAPS-IJ are almost entirely women, black-skinned (black or brown) "mothers or grandmothers", with unequal access to education, work and housing, constitutional social rights in Brazil.
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Affiliation(s)
- Luciane Régio
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa, Curso de Enfermagem, São Paulo, SP, Brasil
| | - Sônia Barros
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Universidade de São Paulo, Instituto de Estudos Avançados, São Paulo, SP, Brasil
| | - Caroline Ballan
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
| | - Carla Aguiar
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
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Avery M, LaVoice J. The effect of "failed" community mental health centers on non-white mortality. Health Econ 2023; 32:1362-1393. [PMID: 36864606 DOI: 10.1002/hec.4671] [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] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/04/2023]
Abstract
The Community Mental Health Act of 1963 established Community Mental Health Centers (CMHCs) across the country with the goal of providing continuous, comprehensive, community-oriented care to people suffering from mental illness. Despite this program being considered a failure by most contemporary accounts, the World Health Organization advocates for a transition from the institutionalization of the mentally ill to a system of community-centered care. In this paper, we construct a novel dataset documenting the rollout of CMHCs from 1971 to 1981 to identify the effect of establishing a CMHC on county level mortality rates, focusing on causes of death related to mental illness. Though we find little evidence that access to a CMHC impacted mortality rates in the white population, we find large and robust effects for the non-white population, with CMHCs reducing suicide and homicide rates by 8% and 14%, respectively. CMHCs also reduced deaths from alcohol in the female non-white population by 18%. These results suggest the historical narrative surrounding the failure of this program does not represent the non-white experience and that community care can be effective at reducing mental health related mortality in populations with the least access to alternative treatment options.
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Affiliation(s)
- Mallory Avery
- Department of Economics, Monash University, Clayton, Australia
| | - Jessica LaVoice
- Department of Economics, Bowdoin College, University of Pittsburgh, Brunswick, Maine, USA
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Holgersen KH, Pedersen SA, Brattland H, Hynnekleiv T. A scoping review of studies into crisis resolution teams in community mental health services. Nord J Psychiatry 2022; 76:565-574. [PMID: 35148238 DOI: 10.1080/08039488.2022.2029941] [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: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE OF ARTICLE Crisis Resolution Teams (CRT) for rapid assessment and short-term treatment of mental health problems have increasingly been implemented internationally over the last decades. Among the Nordic countries, the CRT model has been particularly influential in Norway, where 'Ambulante akutteam (AAT)' is a widespread psychiatric emergency service for adult patients. However, the clinical practice of these teams varies significantly. To aid further development of the service and guide future research efforts, we carried out a scoping review to provide an up-to-date overview of research available in primary studies focusing on phenomena related to CRTs in English and Scandinavian literature. METHODS A systematic literature search was conducted in the bibliometric databases MEDLINE, Embase, PsychINFO, Scopus, and SveMed+. Included studies were thematically analyzed using a qualitative method. RESULTS The search identified 1516 unique references, of which 129 were included in the overview. Thematic analysis showed that the studies could be assigned to: (1) Characteristics of CRTs (k = 45), which described key principles or specific interventions; (2) Implementation of CRTs (k = 54), which were descriptive about implementation in different teams, or normative about what clinical practice should include; and (3) Effect of CRTs (k = 38). CONCLUSIONS The international research literature on CRTs or equivalent teams is extensive. Many sub-themes have been studied with various research methodologies. Recent studies provide a better evidence base for how to organize services and to select therapeutic interventions, but there is still a need for more controlled studies in the field.
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Affiliation(s)
- Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway.,Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Sindre Andre Pedersen
- Library Section for Medicine and Health Sciences, NTNU University Library, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway
| | - Torfinn Hynnekleiv
- Department for Acute Psychiatry and Psychosis Treatment, Psychiatric Health Services Division, Sykehuset Innlandet Trust, Reinsvoll, Norway
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Alves JM, Kuczynski K, Vicenzi C, Lorini A, Jansen K. Correlation between the Implementation of Psychosocial Care Centers and the Rates of Psychiatric Hospitalizations and Suicide in Porto Alegre-RS from 2008 to 2018. Trends Psychiatry Psychother 2021. [PMID: 34800358 PMCID: PMC10241524 DOI: 10.47626/2237-6089-2021-0220] [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] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The Brazilian psychiatric reform has revolutionized the way that mental health care is provided throughout the country, introducing the Psychosocial Care Centers (CAPS) and encouraging care in freedom. The CAPS have a lot of objectives, such as the prevention of hospitalizations and crisis or suicide intervention. This paper aims to describe the correlation between the implementation of the CAPS and the rates of psychiatric hospitalizations as well as suicide from 2008 to 2018. METHODS This study has an ecological time series design and included residents in the city of Porto Alegre-RS and users hospitalized in the SUS (Sistema Único de Saúde - Unified Health System). The data were obtained from official database (DATASUS, CNES and IBGE), after calculating the indicators (the CAPS offer, hospitalization rate and suicide rate). Associations between the indicators were tested using Pearson's correlation. RESULTS We found a negative correlation between the provision of the CAPS and psychiatric hospitalizations (r= -0.607 p=0.048). CONCLUSION These results support the hypothesis that there is a negative correlation between the implementation of the CAPS and psychiatric hospitalizations. This reinforces the importance of implementing policies related to improving psychiatric reform.
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Affiliation(s)
| | | | | | | | - Karen Jansen
- Universidade Católica de Pelotas, Pelotas, RS, Brazil
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Bomboy KT, Graber JS, Wallis EP. Improved Prescriber Adherence to Guidelines on Antipsychotic Medication Management Through Increased Access to Metabolic Monitoring Forms. J Am Psychiatr Nurses Assoc 2021; 27:162-168. [PMID: 32054390 DOI: 10.1177/1078390320906196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION: Patients diagnosed with a chronic mental illness have a 2 to 3 times higher likelihood of developing metabolic abnormalities than their non-mentally ill counterparts due to prescription medication use. Metabolic syndrome has been reported in 52% of patients prescribed atypical antipsychotic medications, compared to the general population rate of 23%, and has been found to place individuals at high risk of death from diabetes and cardiovascular disease. AIM: This quality improvement project aimed to increase the rate of metabolic monitoring and related lab orders for patients prescribed atypical antipsychotic medications in a rural community mental health center to improve patient outcomes. METHOD: The use of a metabolic monitoring tool was implemented onsite. Chart audits were used to assess the effectiveness of introducing a metabolic monitoring form at a rural community mental health center and explore the feasibility of implementing a metabolic monitoring tool organization-wide. RESULTS: Metabolic lab orders increased from 1 to 59 at 8 weeks postimplementation for Clinic A after the implementation of a metabolic monitoring tool. CONCLUSION: Prescriber lab order rates improved using a metabolic monitoring form. Adherence to guideline-based care will improve patient outcomes by detecting the onset of metabolic syndrome earlier in the disease course. Early monitoring for metabolic changes will improve the health of patients diagnosed with a mental illness.
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Affiliation(s)
- Kristen T Bomboy
- Kristen T. Bomboy, DNP, MSN, PMHNP-BC, Lighthouse Behavioral Wellness Centers, Ardmore, OK, USA; Maryville University, St. Louis, MO, USA
| | - Jennifer S Graber
- Jennifer S. Graber, EdD, PMHCNS-BC, University of Delaware, Newark, DE, USA
| | - Eric P Wallis
- Eric P. Wallis, PhD, Coordinated Care Health Solutions Laboratory, Oklahoma City, OK, USA
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Diez-Canseco F, Rojas-Vargas J, Toyama M, Mendoza M, Cavero V, Maldonado H, Caballero J, Cutipé Y. Qualitative study of the implementation of the Continuity of Care and Rehabilitation Program for people with severe mental disorders in Peru. Rev Panam Salud Publica 2020; 44:e169. [PMID: 33417655 PMCID: PMC7778464 DOI: 10.26633/rpsp.2020.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
Objective. Describe the implementation of the Continuity of Care and Rehabilitation Program (PCC-R) in community mental health centers (CSMCs, Spanish acronym) in Peru. Methods. Qualitative study of the implementation of the PCC-R in four CSMCs in Lima and La Libertad, Peru. Forty-two individual semi-structured interviews were conducted, as well as a focus group with five participants, for a total of 47 informants, including users, family members, and professionals involved in the design, implementation, and monitoring of the program. Results. The PCC-R is a key program for community mental health services in Peru and it enjoys broad acceptability. Providers and users report satisfaction with its results; however, the program lacks a policy document specifying its objectives, organization, and activities. This would explain the variability in its implementation. The PCC-R has limitations in terms of management of financial and human resources, and it is necessary to improve training and supervision. There is consensus on the need, usefulness, and viability of developing a system to monitor the PCC-R. Good practices and suggestions are presented with a view to addressing these challenges. Conclusions. The PCC-R is a flagship program for the CSMCs and for mental health reform in Peru. It has achieved broad acceptability among providers and users. Its implementation combines successes and difficulties, with pending tasks that include developing a policy document, improving resource management, strengthening training and supervision, and implementing a monitoring system for continuous improvement of the program.
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Affiliation(s)
- Francisco Diez-Canseco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jefferson Rojas-Vargas
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mauricio Toyama
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Mendoza
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
| | - Victoria Cavero
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Humberto Maldonado
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
| | - July Caballero
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
| | - Yuri Cutipé
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
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Diez-Canseco F, Rojas-Vargas J, Toyama M, Mendoza M, Cavero V, Maldonado H, Caballero J, Cutipé Y. [Qualitative study of the implementation of the Continuity of Care and Rehabilitation Program for people with severe mental disorders in PeruEstudo qualitativo sobre a implementação do Programa de Continuidade de Cuidados e Rehabilitação para pessoas com transtornos mentais graves no Peru]. Rev Panam Salud Publica 2020; 44:e134. [PMID: 33337443 PMCID: PMC7737645 DOI: 10.26633/rpsp.2020.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Describir la implementación del Programa de continuidad de cuidados y rehabilitación (PCC-R) en centros de salud mental comunitaria (CSMC) del Perú. Métodos. Estudio cualitativo sobre la implementación del PCC-R en cuatro CSMC de Lima y La Libertad, Perú. Se realizaron 42 entrevistas semiestructuradas individuales y un grupo focal con cinco participantes, para un total de 47 informantes entre usuarios, familiares y profesionales vinculados al diseño, la implementación y el monitoreo del PCC-R. Resultados. El PCC-R es un programa central de los servicios de salud mental comunitaria en Perú, goza de amplia aceptación y los prestadores y usuarios refieren estar satisfechos con sus resultados. Sin embargo, el programa carece de un documento normativo que detalle sus objetivos, organización y actividades, lo que explicaría la variabilidad en su aplicación. Existen limitaciones en la gestión de recursos financieros y humanos del PCC-R y necesidades de capacitación y supervisión, que deben ser mejoradas. Existe consenso sobre la necesidad, la utilidad y la viabilidad de desarrollar un sistema de monitoreo del PCC-R. Se recogen buenas prácticas y sugerencias para enfrentar estos retos. Conclusiones. El PCC-R es un programa insignia de los CSMC y de la reforma de la salud mental en Perú, y ha logrado amplia aceptación entre los prestadores y usuarios. Su implementación combina aciertos y dificultades, y revela tareas pendientes como desarrollar un documento normativo, mejorar la gestión de recursos, fortalecer la capacitación y acompañamiento, y aplicar un sistema de monitoreo para favorecer la mejora continua del programa.
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Affiliation(s)
- Francisco Diez-Canseco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jefferson Rojas-Vargas
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Mauricio Toyama
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - María Mendoza
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
| | - Victoria Cavero
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Humberto Maldonado
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
| | - July Caballero
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
| | - Yuri Cutipé
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
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Uscher-Pines L, Raja P, Qureshi N, Huskamp HA, Busch AB, Mehrotra A. Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models. Psychiatr Serv 2020; 71:419-426. [PMID: 31996115 PMCID: PMC7271813 DOI: 10.1176/appi.ps.201900386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/18/2023]
Abstract
OBJECTIVE Although use of tele-mental health services is growing, there is limited research on how tele-mental health is deployed. This project aimed to describe how health centers use tele-mental health in conjunction with in-person care. METHODS The 2018 Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator database was used to identify community mental health centers and federally qualified health centers with telehealth capabilities. Maximum diversity sampling was applied to recruit health center leaders to participate in semistructured interviews. Inductive and deductive approaches were used to develop site summaries, and a matrix analysis was conducted to identify and refine themes. RESULTS Twenty health centers in 14 states participated. All health centers used telepsychiatry for diagnostic assessment and medication prescribing, and 10 also offered therapy via telehealth. Some health centers used their own staff to provide tele-mental health services, whereas others contracted with external providers. In most health centers, tele-mental health was used as an adjunct to in-person care. In choosing between tele-mental health and in-person care, health centers often considered patient preference, patient acuity, and insurance status or payer. Although most health centers planned to continue offering tele-mental health, participants noted drawbacks, including less patient engagement, challenges sharing information within the care team, and greater inefficiency. CONCLUSIONS Tele-mental health is generally used as an adjunct to in-person care. The results of this study can inform policy makers and clinicians regarding the various delivery models that incorporate tele-mental health.
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Affiliation(s)
| | - Pushpa Raja
- Greater Los Angeles VA Medical Center, Los Angeles CA
| | | | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Alisa B. Busch
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- McLean Hospital, Belmont, Massachusetts
| | - Ateev Mehrotra
- Greater Los Angeles VA Medical Center, Los Angeles CA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Brown B, Alphs L, Turkoz I, Yue Y. Baseline Demographics and Characteristics From a Paliperidone Palmitate Study in Subjects with Recent-Onset Schizophrenia or Schizophreniform Disorder. Psychopharmacol Bull 2017; 47:8-16. [PMID: 28839335 PMCID: PMC5546555] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Brianne Brown
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
| | - Larry Alphs
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
| | - Ibrahim Turkoz
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
| | - Yong Yue
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
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Storch EA, Salloum A, King MA, Crawford EA, Andel R, McBride NM, Lewin AB. A RANDOMIZED CONTROLLED TRIAL IN COMMUNITY MENTAL HEALTH CENTERS OF COMPUTER-ASSISTED COGNITIVE BEHAVIORAL THERAPY VERSUS TREATMENT AS USUAL FOR CHILDREN WITH ANXIETY. Depress Anxiety 2015; 32:843-52. [PMID: 26366886 DOI: 10.1002/da.22399] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 04/08/2015] [Revised: 06/26/2015] [Accepted: 06/30/2015] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE This study aims to examine the real-world effectiveness of a computer-assisted cognitive behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among anxious children presenting at community mental health centers. METHODS One hundred children (7-13 years) with clinically significant anxiety were randomized to receive either 12 weekly computer-assisted CBT sessions or TAU for an equivalent duration. Assessments were conducted by independent evaluators at screening/baseline, midtreatment, posttreatment, and 1-month followup (for computer-assisted CBT treatment responders). RESULTS There were significant between-group effects favoring the computer-assisted CBT condition on primary anxiety outcomes. Thirty of 49 (61.2%) children randomized to computer-assisted CBT responded to treatment, which was superior to TAU (6/51, 11.8%). Relative to TAU, computer-assisted CBT was associated with greater reductions in parent-rated child impairment and internalizing symptoms, but not child-rated impairment and anxiety and depressive symptoms. Treatment satisfaction and therapeutic alliance in those receiving computer-assisted CBT was high. Treatment gains in computer-assisted CBT responders were maintained at 1-month followup. CONCLUSIONS Within the limitations of this study, computer-assisted CBT is an effective and feasible treatment for anxious children when used in community mental health centers by CBT-naïve clinicians.
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Affiliation(s)
- Eric A Storch
- Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida.,Department of Health Policy and Management, University of South Florida, St. Petersburg, Florida.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, Florida.,Department of Psychology, University of South Florida, St. Petersburg, Florida.,Rogers Behavioral Health - Tampa Bay, Florida.,Mind-Body Branch, All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, Florida
| | - Alison Salloum
- School of Social Work, University of South Florida, St. Petersburg, Tampa Bay, Florida
| | - Morgan A King
- Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | - Erika A Crawford
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Ross Andel
- School of Aging Studies, University of South Florida, St. Petersburg, Florida
| | - Nicole M McBride
- Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | - Adam B Lewin
- Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, Florida.,Department of Psychology, University of South Florida, St. Petersburg, Florida
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12
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Glick G, Druss B, Pina J, Lally C, Conde M. Use of mobile technology in a community mental health setting. J Telemed Telecare 2015; 22:430-5. [PMID: 26519378 DOI: 10.1177/1357633x15613236] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/30/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION mHealth holds promise in transforming care for people with serious mental illness (SMI) and other disadvantaged populations. However, information about the rates of smartphone ownership and usage of mobile health apps among people with SMI is limited. The objective of this research is to examine the current ownership, usage patterns, and existing barriers to mobile health interventions for people with SMI treated in a public sector community mental health setting and to compare the findings with national usage patterns from the general population. METHODS A survey was conducted to determine rates of ownership of smartphone devices among people with SMI. Surveys were administered to 100 patients with SMI at an outpatient psychiatric clinic. Results were compared with respondents to the 2012 Pew Survey of mobile phone usage. RESULTS A total of 85% of participants reported that they owned a cell phone; of those, 37% reported that they owned a smartphone, as compared with 53% of respondents to the Pew Survey and 44% of socioeconomically disadvantaged respondents to the Pew Survey. DISCUSSION While cell phone ownership is common among people with SMI, their adoption of smartphone technology lags behind that of the general population primarily due to cost barriers. Efforts to use mHealth in these populations need to recognize current mobile ownership patterns while planning for anticipated expansion of new technologies to poor populations as cost barriers are reduced in the coming years.
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Affiliation(s)
- Gretl Glick
- Center for Behavioral Health Policy Studies, Emory University, USA
| | - Benjamin Druss
- Center for Behavioral Health Policy Studies, Emory University, USA
| | - Jamie Pina
- Center for the Advancement of Health IT, RTI International, USA
| | - Cathy Lally
- Center for Behavioral Health Policy Studies, Emory University, USA
| | - Mark Conde
- Center for Behavioral Health Policy Studies, Emory University, USA
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13
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Pratt SI, Bartels SJ, Naslund JA, Wolfe R, Pixley HS, Mueser KT, Josephson L. Feasibility and Effectiveness of an Automated Telehealth Intervention to Improve Illness Self-Management in People With Serious Psychiatric and Medical Disorders. Psychiatr Rehabil J 2013; 36:297-305. [PMID: 24320837 PMCID: PMC5472060 DOI: 10.1037/prj0000022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Effective monitoring and treatment are needed to address the elevated rates of medical comorbidity among individuals with serious mental illnesses. This study examined the feasibility and potential effectiveness of an automated telehealth intervention, supported by nurse health-care management, among adults with serious mental illnesses and chronic medical conditions. METHODS We conducted a single-arm pilot trial with 70 individuals with serious mental illnesses and chronic medical conditions who were medically unstable (determined by treatment team or defined as multiple emergency room visits/hospitalizations within the past year). The telehealth intervention was delivered for 6 months with feasibility and acceptability as the primary outcomes. Measures of illness management self-efficacy, psychiatric symptoms, subjective health status, health indicators, and service use were also collected at baseline and at 6 months. RESULTS Most individuals (n = 62; 89%) participated in at least 70% of the telehealth sessions. Participation was associated with improvements in self-efficacy for managing depression and diastolic blood pressure. Almost all participants (n = 68; 98%) rated their understanding of their medical condition as "much better" or "somewhat better" postintervention. Among a subgroup of individuals with diabetes, decreases in fasting blood glucose were achieved, and among those with diabetes and major depression or bipolar disorder there were reductions in urgent care and primary care visits. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These results demonstrate the feasibility and acceptability of automated telehealth supported by a nurse care manager and the potential effectiveness of this technology in improving self-management of psychiatric symptoms and chronic health conditions among these high-risk individuals.
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Affiliation(s)
| | | | | | | | | | | | - Louis Josephson
- Riverbend Community Mental Health Center, Concord, New Hampshire
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14
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Armijo J, Méndez E, Morales R, Schilling S, Castro A, Alvarado R, Rojas G. Efficacy of community treatments for schizophrenia and other psychotic disorders: a literature review. Front Psychiatry 2013; 4:116. [PMID: 24130534 PMCID: PMC3793168 DOI: 10.3389/fpsyt.2013.00116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 09/11/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Chile, the clinical guidelines "for the treatment of people from first episode of schizophrenia" aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals. OBJECTIVES This study compiles and synthesizes available scientific evidence from the last 14 years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders. METHODOLOGY An electronic search was carried out using PUBMED, LILACS, and Science Direct as databases. Criteria of inclusion: (i) randomized clinical trials, (ii) Community-based interventions, (iii) diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10). EXCLUSION CRITERIA (i) treatments exclusively pharmacological, (ii) interventions carried out in inpatient settings, (iii) bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). RESULTS Sixty-six articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status. CONCLUSION Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia.
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Affiliation(s)
- Julio Armijo
- Adult Psychiatry, José Horwitz Barak Psychiatric Hospital, Universidad de Santiago de Chile , Santiago , Chile
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