Improving Access and Quality of Behavioral Health Services for Healthcare Employees

OBJECTIVE

To describe key features and the initial implementation of an employer-sponsored program designed to increase access to quality mental health treatment for employees of a large healthcare system.

METHODS

Retrospective data were collected on employer's efforts to develop a programmatic solution to address barriers to accessing quality mental health treatment among its employees and on initial program implementation.

RESULTS

Data from the initial cohort (N = 1049) of program participants support the use of low threshold digital tools to enhance access to care, the importance of care navigation and a robust curated provider network in matching employees to appropriate care options, and the value of providing online, evidence-based psychotherapy to facilitate high rates of treatment engagement.

CONCLUSIONS

Findings can help inform employers about approaches to improve access to quality mental health treatment for their employees.

Adapting the Stress First Aid Model for Frontline Healthcare Workers during COVID-19

The coronavirus pandemic has generated and continues to create unprecedented demands on our healthcare systems. Healthcare workers (HCWs) face physical and psychological stresses caring for critically ill patients, including experiencing anxiety, depression, and posttraumatic stress symptoms. Nurses and nursing staff disproportionately experienced COVID-19-related psychological distress due to their vital role in infection mitigation and direct patient care. Therefore, there is a critical need to understand the short- and long-term impact of COVID-19 stress exposures on nursing staff wellbeing and to assess the impact of wellbeing programs aimed at supporting HCWs. To that end, the current study aims to evaluate an evidence-informed peer support stress reduction model, Stress First Aid (SFA), implemented across units within a psychiatric hospital in the New York City area during the pandemic. To examine the effectiveness of SFA, we measured stress, burnout, coping self-efficacy, resilience, and workplace support through self-report surveys completed by nurses and nursing staff over twelve months. The implementation of SFA across units has the potential to provide the workplace-level and individual-level skills necessary to reduce stress and promote resilience, which can be utilized and applied during waves of respiratory illness acuity or any other healthcare-related stressors among this population.

Mobile Health Platform to Augment Behavioral Health in Primary Care: A Feasibility Study (Preprint)

Background

The collaborative care model is a well-established system of behavioral health care within primary care settings. There is potential for mobile health (mHealth) technology to augment collaborative behavioral health care in primary care settings, thereby improving scalability, efficiency, and clinical outcomes.

Objective

We aimed to assess the feasibility of engaging with and the preliminary clinical outcomes of an mHealth platform that was used to augment an existing collaborative care program in primary care settings.

Methods

We performed a longitudinal, single-arm feasibility study of an mHealth platform that was used to augment collaborative care. A total of 3 behavioral health care managers, who were responsible for coordinating disease management in 6 primary care practices, encouraged participants to use a mobile app to augment the collaborative model of behavioral health care. The mHealth platform’s functions included asynchronous chats with the behavioral health care managers, depression self-report assessments, and psychoeducational content. The primary outcome was the feasibility of engagement, which was based on the number and type of participant-generated actions that were completed in the app. The primary clinical end point was a comparison of the baseline and final assessments of the Patient Health Questionnaire-9.

Results

Of the 245 individuals who were referred by their primary care provider for behavioral health services, 89 (36.3%) consented to app-augmented behavioral health care. Only 12% (11/89) never engaged with the app during the study period. Across all participants, we observed a median engagement of 7 (IQR 12; mean 10.4; range 0-130) actions in the app (participants: n=78). The chat function was the most popular, followed by psychoeducational content and assessments. The subgroup analysis revealed no significant differences in app usage by age (P=.42) or sex (P=.84). The clinical improvement rate in our sample was 73% (32/44), although follow-up assessments were only available for 49% (44/89) of participants.

Conclusions

Our preliminary findings indicate the moderate feasibility of using mHealth technology to augment behavioral health care in primary care settings. The results of this study are applicable to improving the design and implementation of mobile apps in collaborative care.

Squalestatin 1, a potent inhibitor of squalene synthase, which lowers serum cholesterol in vivo

Squalestatin 1 is a member of a novel family of fermentation products isolated from a previously unknown Phoma species (Coelomycetes). Squalestatin 1 is a potent, selective inhibitor of squalene synthase, a key enzyme in cholesterol biosynthesis; in vitro, 50% inhibition of enzyme activity is observed at a concentration of 12 +/- 5 nM (range of 4-22 nM). Squalestatin 1 inhibits cholesterol biosynthesis from [14C]acetate by isolated rat hepatocytes (50% inhibition at 39 nM) and by rat liver in vivo. In marmosets, a species with a lipoprotein profile similar to that of man, squalestatin 1 lowers serum cholesterol by up to 75%. This compound will allow further investigation of the control of the sterol biosynthesis pathway and could also lead to the development of new therapies for elevated serum cholesterol.

Effect of vitamin C deficiency and excess on the liver: a histopathological and biochemical study in guinea pigs fed normal or high cholesterol diet

When guinea pigs were kept on a restricted vitamin C intake of only 0.5 mg daily, their serum ascorbic acid fell to 0.16 +/- 0.06 mg/d1 in 16 weeks as compared to 0.73 +/- 0.11 in control. This was associated with significant increase in liver cholesterol and triglycerides. When they were simultaneously challenged with a high cholesterol load, this fat accumulation was markedly exaggerated. The weight of the liver now increased by almost two-and-half times. Liver cholesterol rose to 12.90 +/- 2.63 mg/gm as compared to 3.23 +/- 0.56 mg/gm with low vitamin C alone. Histopathology showed marked distension and vacuolation of hepatocytes, focal necrosis and fibroplasia. Administration of excess vitamin C (100 mg daily) significantly countered these changes. The vitamin C-lipid relationship has important clinical bearings and liver could be an important site of vitamin C action.