Machine Learning with Human Resources Data: Predicting Turnover among Community Mental Health Center Employees

BACKGROUND

Human resources (HR) departments collect extensive employee data that can be useful for predicting turnover. Yet, these data are not often used to address turnover due to the complex nature of recorded data forms.

AIMS OF THE STUDY

The goal of the current study was to predict community mental health center employees' turnover by applying machine learning (ML) methods to HR data and to evaluate the feasibility of the ML approaches.

METHODS

Historical HR data were obtained from two community mental health centers, and ML approaches with random forest and lasso regression as training models were applied.

RESULTS

The results suggested a good level of predictive accuracy for turnover, particularly with the random forest model (e.g., Area Under the Curve was above .8) compared to the lasso regression model overall. The study also found that the ML methods could identify several important predictors (e.g., past work years, wage, work hours, age, job position, training hours, and marital status) for turnover using historical HR data. The HR data extraction processes for ML applications were also evaluated as feasible.

DISCUSSION

The current study confirmed the feasibility of ML approaches for predicting individual employees' turnover probabilities by using HR data the organizations had already collected in their routine organizational management practice. The developed approaches can be used to identify employees who are at high risk for turnover. Because our primary purpose was to apply ML methods to estimate an individual employee's turnover probability given their available HR data (rather than determining generalizable predictors at the wider population level), our findings are limited or restricted to the specific organizations under the study. As ML applications are accumulated across organizations, it may be expected that some findings might be more generalizable across different organizations while others may be more organization-specific (idiographic).

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE

The organization-specific findings can be useful for the organization's HR and leadership to evaluate and address turnover in their specific organizational contexts. Preventing extensive turnover has been a significant priority for many mental health organizations to maintain the quality of services for clients.

IMPLICATIONS FOR HEALTH POLICIES

The generalizable findings may contribute to broader policy and workforce development efforts.

IMPLICATIONS FOR FURTHER RESEARCH

As our continuing research effort, it is important to study how the ML methods and outputs can be meaningfully utilized in routine management and leadership practice settings in mental health (including how to develop organization-tailored intervention strategies to support and retain employees) beyond identifying high turnover risk individuals. Such organization-based intervention strategies with ML applications can be accumulated and shared by organizations, which will facilitate the evidence-based learning communities to address turnover. This, in turn, may enhance the quality of care we can offer to clients. The continuing efforts will provide new insights and avenues to address data-driven, evidence-based turnover prediction and prevention strategies using HR data that are often under-utilized.

Outcome trajectories in a county mental health clinic before and after telemental health: a retrospective COVID-19 cohort study

Background/objectives

Telemental health (TMH) care has received increased attention, most recently due to the COVID-19 pandemic. Many treatment settings and clinicians were forced to rapidly shift to TMH modalities, including clinicians with limited exposure to and possibly negative attitudes toward alternative treatment delivery formats. With the shift to new modalities, effectiveness research is necessary to understand if patients are receiving the same quality of care as before the pandemic and their receipt of mostly in person services. This study compared the naturalistic treatment outcome trajectories for a cohort of patients who received in-person services prior to the pandemic and a distinct cohort of patients who received TMH services after the onset of the pandemic, in a community mental health setting with limited exposure to TMH prior to the COVID-19 pandemic.

Materials and methods

We adopted a retrospective cohort design to examine treatment modality as a between-group moderator of symptom change trajectory on the self-report Patient Health Questionnaire (PHQ-9) in a sample of N = 958 patients in the Northeast United States. Treatment durations differed in the naturalistic treatment setting and we examined patient-reported outcomes up to a maximum of one year.

Results

Statistically significant average decreases in symptom severity were found over the course of up to one year of treatment, yet the average outcome trajectory was not significantly different between two modality cohorts (in person delivery before the pandemic versus TMH delivery after pandemic onset).

Conclusion

These findings suggest that even in a setting with limited exposure to or training in TMH, the average outcome trajectory for patients who received TMH was statistically similar to the outcome trajectory for patients in an earlier cohort who received in-person services prior to the pandemic onset. Overall, the results appear to support continued use of TMH services in community treatment settings.

Emotional eating experiences of individuals with severe mental disorders: A qualitative study

PURPOSE

The aim of this study is to understand the emotional eating experiences of individuals with severe mental disorders.

DESIGN AND METHODS

The study used a descriptive qualitative design. Data were collected from 19 individuals who displayed emotional eating behavior and a severe mental disorder.

FINDINGS

The main themes of this study are "Triggers," "Emotional Eating Process," and "Feelings after Emotional Eating." Participants stated that negative emotions and certain initiating factors were the triggers of their emotional eating; they also experienced feelings of regret and guilt after emotional eating.

PRACTICE IMPLICATIONS

It was concluded that programs for regulating the eating behaviors of individuals with severe mental disorders should be organized and that psychosocial interventions to prevent emotional eating among these individuals should be integrated into the programs' contents.

An investigation of internalized stigma and recovery levels of patients registered in a Community Mental Health Center

AIM

This study was carried out to investigate the internalized stigma and recovery levels of patients registered in a Community Mental Health Center (CMHC).

MATERIAL AND METHODS

This descriptive study was completed with 230 psychiatric patients to a registered Community Mental Health Center is located in Turkey. Data were collected using a sociodemographic characteristics' form, the Internalized Stigma of Mental Illness Scale (ISMI), and the Maryland Assessment of Recovery in Serious Mental Illness (MARS).

RESULTS

A statistically significant negative relationship was found between total ISMI and MARS scores (p < 0.05).

CONCLUSION

The internalized stigma and recovery levels of individuals diagnosed with mental illness registered at the CMHC were found to be normal.

Organizational Readiness for Implementing an Internet-Based Cognitive Behavioral Therapy Intervention for Depression Across Community Mental Health Services in Albania and Kosovo: Directed Qualitative Content Analysis

Background

The use of digital mental health programs such as internet-based cognitive behavioral therapy (iCBT) holds promise in increasing the quality and access of mental health services. However very little research has been conducted in understanding the feasibility of implementing iCBT in Eastern Europe.

Objective

The aim of this study was to qualitatively assess organizational readiness for implementing iCBT for depression within community mental health centers (CMHCs) across Albania and Kosovo.

Methods

We used qualitative semistructured focus group discussions that were guided by Bryan Weiner’s model of organizational readiness for implementing change. The questions broadly explored shared determination to implement change (change commitment) and shared belief in their collective capability to do so (change efficacy). Data were collected between November and December 2017. A range of health care professionals working in and in association with CMHCs were recruited from 3 CMHCs in Albania and 4 CMHCs in Kosovo, which were participating in a large multinational trial on the implementation of iCBT across 9 countries (Horizon 2020 ImpleMentAll project). Data were analyzed using a directed approach to qualitative content analysis, which used a combination of both inductive and deductive approaches.

Results

Six focus group discussions involving 69 mental health care professionals were conducted. Participants from Kosovo (36/69, 52%) and Albania (33/69, 48%) were mostly females (48/69, 70%) and nurses (26/69, 38%), with an average age of 41.3 years. A directed qualitative content analysis revealed several barriers and facilitators potentially affecting the implementation of digital CBT interventions for depression in community mental health settings. While commitment for change was high, change efficacy was limited owing to a range of situational factors. Barriers impacting “change efficacy” included lack of clinical fit for iCBT, high stigma affecting help-seeking behaviors, lack of human resources, poor technological infrastructure, and high caseload. Facilitators included having a high interest and capability in receiving training for iCBT. For “change commitment,” participants largely expressed welcoming innovation and that iCBT could increase access to treatments for geographically isolated people and reduce the stigma associated with mental health care.

Conclusions

In summary, participants perceived iCBT positively in relation to promoting innovation in mental health care, increasing access to services, and reducing stigma. However, a range of barriers was also highlighted in relation to accessing the target treatment population, a culture of mental health stigma, underdeveloped information and communications technology infrastructure, and limited appropriately trained health care workforce, which reduce organizational readiness for implementing iCBT for depression. Such barriers may be addressed through (1) a public-facing campaign that addresses mental health stigma, (2) service-level adjustments that permit staff with the time, resources, and clinical supervision to deliver iCBT, and (3) establishment of a suitable clinical training curriculum for health care professionals.

Trial Registration

ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883

Views of patient relatives and health professionals about the reasons of the patients enrolled in the community mental health center to discontinue or irregularly continue the center

BACKGROUND

The aim of the study was to determine the views of patient relatives and health professionals about the reasons of patients enrolled in the community mental health center to discontinue or irregularly continue the center.

METHODS

This study is qualitative and phenomenological. The study group consisted of 17 patient relatives and eight health professionals according to the maximum variation sampling method. In the study, the data were collected using the personal information form in semi-structured interviews. The data were analyzed with the descriptive (thematic) method in the MAXQDA 2018 package program.

RESULTS

In line with the research findings, themes and codes were determined based on the statements of patient relatives and health professionals. For patient relatives, the themes were determined as disease symptoms, disease effect/coping difficulties, misbeliefs-fears, problems about the center, and social and economic causes. For health professionals, the themes were determined as reasons for not coming to the community mental health center, problems related to center health professionals, level/severity of the disease and treatment compliance, socio-economic conditions and problems experienced by health professionals.

CONCLUSION

It can be said that the views of patient relatives and health professionals about the discontinuity of patients to the center were similar. It was seen that the problems regarding factors such as disease severity, disease effects, knowledge and beliefs of the family, stigma, functionality and promotion of the center were effective in patient's continuity to the center. In line with the research findings, it was recommended to improve the quality of the activities in the center to increase the number of patients enrolled in the community mental health center and their continuity, develop training programs that also involve health professionals to increase the quality of service, and increase the cooperation with patient relatives.

Effect of Adjunct Psychosocial Skills Training on Social Functioning of Schizophrenia Patients Who Get Occupational Therapy in a Community Mental Health Center: A Comparative Study

Introduction

Antipsychotic drugs are effective in relieving symptoms in the treatment of schizophrenia, but decreased social functioning is resistant to drugs. In this study, the effect of adjunct Psychosocial Skills Training (PSST) on social functioning for schizophrenia patients who receive service in the community mental health center (CMHC) was investigated.

Method

Schizophrenia patients who received routine case management and occupational therapy in CMHC (n=22), patients receiving PSST in addition to CMHC service (n=21) and patients who were followed up in the Psychotic Disorders Outpatient Clinic as control group (n=21), three groups were formed. In the initial evaluations of the participants, the sociodemographic data form was filled. Social functioning and severity of clinical symptoms were evaluated at the beginning and at end of three-month follow-up period with the Social Functionality Scale (SFS), Personal and Social Performance Scale (PSP), Positive and Negative Syndrome Scale (PANSS).

Results

At the end of the follow-up period, there was a significant decrease in PANSS total scores, a significant increase in PSP and SFS total scores in the last test evaluations of the study groups. There was not any statistically significant change in the control group. The decrease in PANSS total score in PSST group is significantly higher than CMHC group. There was no significant difference between PSP and SFS scores between intervention groups.

Conclusion

The psychiatric rehabilitation in CMHC has a positive effect on the social functioning and clinical symptoms of schizophrenic patients. Adjunct PSST to routine service seems to help relieving clinical symptoms.

Attitude Towards Drug Therapy in a Community Mental Health Center Evaluated by the Drug Attitude Inventory

INTRODUCTION

Negative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term.

PURPOSES

The purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors.

METHODS

The DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed.

RESULTS

With a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach's alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach's alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach's alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach's alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy.

DISCUSSION

Among the selected variables, "monotherapy" and "total number of hospitalizations" were negatively correlated to the final score of DAI-30, whereas being "married" was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients.

How people with serious mental illness use smartphones, mobile apps, and social media

OBJECTIVE

Research shows that people with serious mental illness are increasingly using mobile devices. Less is known about how these individuals use their mobile devices or whether they access social media. We surveyed individuals with serious mental illness to explore their use of these technologies.

METHOD

Individuals with serious mental illness engaged in lifestyle interventions through community mental health centers completed a survey about their use of mobile and online technologies. Responses were compared with data from the general population.

RESULTS

Among respondents (n = 70), 93% owned cellphones, 78% used text messaging, 50% owned smartphones, and 71% used social media such as Facebook. Most respondents reported daily use of text messaging, mobile apps, and social media. Technology use was comparable to the general population, though smartphone ownership was lower.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

These findings can inform future interventions that fully leverage this group's use of popular digital technologies. (PsycINFO Database Record

[A Review of Taiwan's Community Mental Health Policies: Current Developments and Future Prospect]

Community mental health is an important area of public health. This study initially elaborates from the perspective of community psychology the concept and basis of the practice of community mental health work, including the importance of prevention over treatment, of valuing personal advantages and capabilities, and of adopting an ecological perspective, a respect for diversity, empowerment, and scientific cooperation and integration. Subsequently, this paper reviews the history of the development of community mental health work in Taiwan and of the operations, developmental issues, and difficulties currently faced by community mental health centers. Finally, this paper addresses the future prospects for community mental health work in Taiwan in hopes that the government will attach greater importance to related policies and implementation plans, optimize the service and delivery systems of community mental health organizations, reinforce community mental health education, develop effective community mental health promotion strategies, provide accessible and continuous direct services, integrate community mental health resources, and support the families of mental health patients in order to consolidate and better promote community-based mental health work.

The sensitivity and specificity of cognitive screening instruments to detect cognitive impairment in older adults with severe psychiatric illness

BACKGROUND

Older adults with severe psychiatric illness are often treated at community mental health centers (CMHCs) and these individuals commonly have numerous risk factors for cognitive impairment (CI). Brief cognitive screening instruments are frequently used to evaluate cognitive functioning in CMHCs, but the validity of these measures for detecting CI has not been adequately evaluated in this patient population.

OBJECTIVES

To determine the sensitivity and specificity of 2 cognitive screening measures (the Mini-Mental Status Examination [MMSE] and the Stroop Color and Word Test [SCWT]) for detecting CI in a sample of older adults with severe psychiatric illness.

METHODS

Data were collected from 52 older adults receiving services at a CMHC. Diagnosis of CI was made by a neuropsychologist. Sensitivity and specificity coefficients for 2 cutoff scores for the MMSE and the SCWT were calculated.

RESULTS

A cutoff score of 25 on the MMSE yielded a sensitivity of 43.3% and a specificity of 90.4% for detecting CI, whereas a cutoff score of 21 yielded sensitivity of 13.1% and 100% specificity. Using an age- and education-corrected scaled score (SS) on the SCWT falling at or below 7 as the criterion the SCWT had 88.8% sensitivity and 36.8% specificity, whereas a cutoff score of 5 or below yielded sensitivity of 59.2% and specificity of 57.8%.

CONCLUSIONS

Overall, the MMSE was found to be the more clinically useful cognitive screening tool for use in CMHC. Yet, because of the poor sensitivity of the MMSE for detecting CI in this patient population, alternative screening methods should be explored.