Authors:Bowen McBeath; Emmeline Chuang; Sarah Carnochan; Michael J. Austin; Marla Stuart Pages: 115 - 127 Abstract: Despite emerging evidence of contracting for evidence-based practices (EBP), little research has studied how managers lead contract-based human service delivery. A 2015 survey of 193 managers from five San Francisco Bay Area county human service departments examined the relationship between contract-based service coordination (i.e., structuring cross-sector services, coordinating client referrals and eligibility, overseeing EBP implementation) and the predictors of managerial role, involvement, and boundary spanning. Multivariate regression results suggested that county managers identified fewer service coordination challenges if they were at the executive and program levels, had greater contract involvement, and engaged in contract-focused boundary spanning. In conclusion, we underscore the organizational and managerial dimensions of contract-based service delivery. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0899-1 Issue No:Vol. 46, No. 2 (2019)
Authors:Brent A. Langellier; Yong Yang; Jonathan Purtle; Katherine L. Nelson; Ivana Stankov; Ana V. Diez Roux Pages: 128 - 144 Abstract: We conducted a systematic review of studies employing complex systems approaches (i.e., agent based and system dynamics models) to understand drivers of mental health and inform mental health policy. We extracted key data (e.g., purpose, design, data) for each study and provide a narrative synthesis of insights generated across studies. The studies investigated drivers and policy intervention strategies across a diversity of mental health outcomes. Based on these studies and the extant literature, we propose a typology of mental health research and policy areas that may benefit from complex systems approaches. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0887-5 Issue No:Vol. 46, No. 2 (2019)
Authors:Edwin S. Wong; Matthew L. Maciejewski; Paul L. Hebert; John C. Fortney; Chuan-Fen Liu Pages: 145 - 153 Abstract: Older veterans can obtain care from the Veterans Affairs Health System (VA), Medicare or both. We examined whether their use of mental health care was impacted by capacity effects stemming from younger, uninsured veterans’ enrolling in VA to satisfy the individual mandate within Massachusetts Health Reform (MHR). Using administrative data, we applied a difference-in-difference approach to compare pre-post changes in mental health use following MHR implementation. Findings indicated MHR was associated with increases in use through Medicare and the probability of dual VA-Medicare use. These results provide support for the possibility that limited capacity led to care seeking outside VA. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0900-z Issue No:Vol. 46, No. 2 (2019)
Authors:Christopher J. Miller; Jennifer L. Sullivan; Bo Kim; A. Rani Elwy; Karen L. Drummond; Samantha Connolly; Rachel P. Riendeau; Mark S. Bauer Pages: 154 - 166 Abstract: The Collaborative Care Model (CCM) is an evidence-based approach for structuring care for chronic health conditions. Attempts to implement CCM-based care in a given setting depend, however, on the extent to which care in that setting is already aligned with the specific elements of CCM-based care. We therefore interviewed staff from ten outpatient mental health teams in the US Department of Veterans Affairs to determine whether care delivery was consistent or inconsistent with CCM-based care in those settings. We discuss implications of our findings for future attempts to implement CCM-based outpatient mental health care. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0901-y Issue No:Vol. 46, No. 2 (2019)
Authors:Allyson L. Dir; Lisa Saldana; Jason E. Chapman; Matthew C. Aalsma Pages: 167 - 174 Abstract: Despite high rates of mental health problems among juvenile justice-involved youth, mental health stigma among juvenile probation officers (JPOs) is under-studied. This cross-sectional study examined effects of job burnout and workplace participatory atmosphere on mental health stigma among JPOs across Indiana (n = 226). Participatory atmosphere moderated the relationship between JPO burnout-related cynicism and mental health stigma (interaction β = − 0.14, p = .04); burnout was related to greater mental health stigma at low levels of participatory atmosphere. Findings suggest participatory atmosphere mitigates effects of burnout on mental health stigma among JPOs. Organizational-level interventions might help to reduce mental health stigma and combat negative effects from burnout among JPOs. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0902-x Issue No:Vol. 46, No. 2 (2019)
Authors:Jessica F. Saunders; Asia A. Eaton; Stacy L. Frazier Pages: 175 - 187 Abstract: This qualitative study draws on a photo-elicitation method (“PhotoVoice”) and semi-structured interviews to examine the key areas stakeholders (30 young women between the ages of 18 and 35 in eating disorder recovery) identify as meaningful venues of policy-based change. Photography and the accompanying narratives capturing personally-meaningful social, cultural, and systemic influences on recovery were shared with the research team. Photographs and interviews were examined for policy implications using thematic analysis, and six areas of improvement emerged: media, healthcare practice and access, health insurance reform, education, objectification of the female body, and mental health stigma. Implications for reform are discussed. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0903-9 Issue No:Vol. 46, No. 2 (2019)
Authors:David H. Sommerfeld; Gregory A. Aarons; Jeanean B. Naqvi; Jason Holden; Dimitri Perivoliotis; Kim T. Mueser; Eric Granholm Pages: 188 - 199 Abstract: This study examined stakeholder perceptions of the “fit” between cognitive-behavioral social skills training (CBSST) and assertive community treatment (ACT) when implementing CBSST into existing community-based ACT teams. Focus group feedback was collected from a diverse set of stakeholders (i.e., clients, providers, supervisors, agency administrators, public sector representatives, and intervention developers). Results identified perceived client and provider benefits for integrating CBSST into ACT while highlighting the importance of purposeful adaptations, training, and implementation tools to facilitate structural and values fit between CBSST and ACT. Study findings will inform future endeavors to implement CBSST and other relevant EBPs into ACT. Trial Registry: ClinicalTrials.gov #NCT02254733. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0904-8 Issue No:Vol. 46, No. 2 (2019)
Authors:Winnie W. S. Mak; Randolph C. H. Chan; Sania S. W. Yau Pages: 200 - 208 Abstract: Recovery-oriented transformation of mental health service systems not only necessitates changes in mental health policies and practices, it also requires an adoption of recovery-oriented mindset, which includes knowledge and attitudes, among service providers. It is also important that service users are informed about the changes and can fully participate in the process. The present study developed and evaluated the efficacy of a recovery psychoeducation program in enhancing recovery-oriented knowledge and attitudes among mental health service providers and users in Hong Kong. In study 1, 111 service providers were randomly assigned to 2-day psychoeducation group or control group. Results showed that participants in psychoeducation group had significantly better recovery knowledge and more positive attitudes towards recovery after the intervention than the control counterparts. The effect of the recovery psychoeducation program on recovery attitudes was fully mediated by the improvement in recovery knowledge. In study 2, 93 people with mental illness were randomized into 2-week psychoeducation group or control group. Participants in the psychoeducation group had a significant improvement in the level of recovery-oriented knowledge immediately after the workshops, but the effect could not be sustained at follow-up. To transform into a recovery-oriented service system, having an effective program to orient service providers and users to recovery is essential. This study provided initial support to the use of a brief psychoeducational program for recovery-oriented knowledge enhancement. Given the short-term efficacy and feasibility of the interventions, service leaders and managers in different clinical and social service settings should consider implementing the programs as part of staff and users’ service orientation to build a recovery-supporting workforce and empower their service users early in the recovery process. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0905-7 Issue No:Vol. 46, No. 2 (2019)
Authors:Christine M. Wienke Totura; Christa D. Labouliere; Kim Gryglewicz; Marc S. Karver Pages: 209 - 219 Abstract: This study examined the roles that youth involvement and youth trainee–trainer alliance play in school mental health prevention within the context of youth suicide gatekeeper training. Measures included youth involvement in programming, trainee–trainer alliance, and intentions to refer at-risk youth at pre- and post-training. A moderated-mediation design was used to examine associations among these factors. Results show alliance mediating pre- and post-training referral intentions, and involvement moderating the relationship between alliance and post-training intentions. On average, trainee intentions improved from pre- to post-training, but trainees reporting high alliance endorsed higher post-training referral intentions regardless of involvement level. Low alliance resulted in lower than average post-training referral intentions, even with active involvement in programming, and those with both low alliance and involvement showed the lowest post-training referral intentions. Given these findings, fostering the youth trainee–trainer relationship may be an avenue to optimize prevention program effectiveness. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0907-5 Issue No:Vol. 46, No. 2 (2019)
Authors:Juan Chen; Duoduo Xu; Xiaogang Wu Pages: 220 - 237 Abstract: Family members, rather than mental health professionals, are often the first responders for emotional or mental problems, particularly in Chinese societies where family is regarded as the primary care unit. Using data from the third wave of a representative sample of Chinese adults in the Hong Kong Panel Study of Social Dynamics, we investigate how family, and particularly family functioning, is associated with individual mental health help seeking and perceived barriers to professional service use, and how the associations vary across different generations of immigrants and between individuals with high versus low psychological distress. Our results demonstrate that family is still the primary source of help sought for mental health problems. Stronger family functioning is particularly significant for second-generation immigrants when they consider seeking help from immediate family members. Seeking professional help is uncommon, and stronger family functioning is associated with a lower probability of seeking help from general health professionals and alternative services. A well-functioning family is related to certain structural and cultural barriers to seeking professional help, yet trust in professional mental health services does not diminish along with stronger family functioning, even among the high psychological distress subgroup. The findings indicate that family can facilitate mental illness prevention and service integration. It is recommended that appropriate family support and services be incorporated into mental health treatment according to clients’ differential family circumstances. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0906-6 Issue No:Vol. 46, No. 2 (2019)
Authors:Michelle P. Salyers; Jennifer M. Garabrant; Lauren Luther; Nancy Henry; Sadaaki Fukui; Dawn Shimp; Wei Wu; Tim Gearhart; Gary Morse; Mary M. York; Angela L. Rollins Pages: 238 - 254 Abstract: Clinician burnout is presumed to negatively impact healthcare quality; yet scant research has rigorously addressed this hypothesis. Using a mixed-methods, randomized, comparative effectiveness design, we tested two competing approaches to improve care—one addressing clinician burnout and the other addressing how clinicians interact with consumers—with 192 clinicians and 469 consumers at two community mental health centers. Although qualitative reports were promising, we found no comparative effectiveness for either intervention on burnout, patient-centered processes, or other outcomes. Discussion includes identifying ways to strengthen approaches to clinician burnout. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0908-4 Issue No:Vol. 46, No. 2 (2019)
Authors:Lawrence A. Palinkas; Douglas Zatzick Pages: 255 - 270 Abstract: Pragmatic clinical trials of mental health services are increasingly being developed to establish comparative effectiveness, influence sustainable implementation, and address real world policy decisions. However, use of time and resource intensive qualitative methods in pragmatic trials may be inconsistent with the aims of efficiency and cost minimization. This paper introduces a qualitative method known as Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) that combines the techniques of Rapid Assessment Procedures with clinical ethnography. A case study is presented to illustrate how RAPICE can be used to efficiently understand pragmatic trial implementation processes and associated real world policy implications. PubDate: 2019-03-01 DOI: 10.1007/s10488-018-0909-3 Issue No:Vol. 46, No. 2 (2019)
Authors:Sonia C. Izmirian; Jaime P. Chang; Brad J. Nakamura Abstract: The current investigation conducted descriptive analyses on key variables in community-based residential (CBR) settings and investigated the extent to which disruptive youth between the ages of 13 and 17 years improved based on therapists’ reported alignment with using practices derived from the evidence-base (PDEBs). Results from both the descriptive analyses and multilevel modeling suggested that therapists are using practices that both do and do not align with the evidence-base for disruptive youth. In addition, both PDEBs and practices with minimal evidence-support predicted or marginally predicted final average progress rating for these youth. Findings are discussed as they relate to the importance of continued exploration of treatment outcomes for CBR youth. PubDate: 2019-02-14 DOI: 10.1007/s10488-019-00925-2
Authors:Daniel M. Cheron; Angela A. W. Chiu; Cameo F. Stanick; H. Gemma Stern; Aberdine R. Donaldson; Eric L. Daleiden; Bruce F. Chorpita Abstract: There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children’s community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes. PubDate: 2019-02-01 DOI: 10.1007/s10488-019-00922-5
Authors:Nikhil Gupta; Ish P. Bhalla; Robert A. Rosenheck Abstract: Patients with psychiatric disorders are treated by both mental health specialists and non-specialists. We use national data from the Veterans Health Administration to evaluate changing proportions of patients seen exclusively by non-specialists during the study year (FY 2012) limit as well as differences in socio-demographic, clinical and service use characteristics. There has been a five-fold increase in veterans with mental disorders seen by non-specialists over 20 years from 7 to 38%, findings similar to those in non-VA settings. Veterans treated by mental health specialists were younger, more likely to have been homeless and disabled, and had more severe and more numerous psychiatric diagnoses. There is a need to maintain specialty services and to strengthen non-specialty care through education and research. PubDate: 2019-01-31 DOI: 10.1007/s10488-018-00920-z
Authors:Viktor Lushin; Emily M. Becker-Haimes; David Mandell; Jordan Conrad; Victor Kaploun; Sophia Bailey; Ai Bo; Rinad S. Beidas Abstract: Mental health clinicians do not consistently use evidence-based assessment (EBA), a critical component of accurate case conceptualization and treatment planning. The present study used the Unified Theory of Behavior to examine determinants of intentions to use EBA in clinical practice among a sample of Masters’ level social work trainees (N = 241). Social norms had the largest effect on intentions to use EBA. Injunctive norms in reference to respected colleagues accounted for the most variance in EBA intentions. Findings differed for respondents over 29 years of age versus younger respondents. Implications for implementation strategies and further research are discussed. PubDate: 2019-01-29 DOI: 10.1007/s10488-019-00923-4
Authors:Virve Pekurinen; Maritta Välimäki; Marianna Virtanen; Mika Kivimäki; Jussi Vahtera Abstract: We examined the associations between work stress (job strain, effort-reward imbalance), perceived job insecurity, workplace social capital, satisfaction with leadership and working hours in relation to the likelihood of encountering patient aggression (overall exposure, assaults on ward property, mental abuse, physical assaults). We conducted a cross-sectional survey for nurses (N = 923) in 84 psychiatric units. Both work stress indicators were associated higher odds for different types of patient aggression. Poorer satisfaction with leadership was associated with higher odds for overall exposure to patient aggression. These findings were robust to adjustment for several nurse and work characteristics, and unit size. PubDate: 2019-01-25 DOI: 10.1007/s10488-018-00919-6
Authors:Carlos R. García-Alonso; Nerea Almeda; José Alberto Salinas-Pérez; Mencía R. Gutiérrez-Colosía; Luis Salvador-Carulla Abstract: The current prevalence of mental disorders demands improved ways of the management and planning of mental health (MH) services. Relative technical efficiency (RTE) is an appropriate and robust indicator to support decision-making in health care, but it has not been applied significantly in MH. This article systematically reviews the empirical background of RTE in MH services following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Finally, 13 studies were included, and the findings provide new standard classifications of RTE variables, efficiency determinants and strategies to improve MH management and planning. PubDate: 2019-01-09 DOI: 10.1007/s10488-019-00921-6
Authors:Marvin So; Russell F. McCord; Jennifer W. Kaminski Abstract: Policies have potential to help families obtain behavioral healthcare for their children, but little is known about evidence for specific policy approaches. We reviewed evaluations of select policy levers to promote accessibility, affordability, acceptability, availability, or utilization of children’s mental and behavioral health services. Twenty articles met inclusion criteria. Location-based policy levers (school-based services and integrated care models) were associated with higher utilization and acceptability, with mixed evidence on accessibility. Studies of insurance-based levers (mental health parity and public insurance) provided some evidence for affordability outcomes. We found no eligible studies of workforce development or telehealth policy levers, or of availability outcomes. PubDate: 2019-01-02 DOI: 10.1007/s10488-018-00916-9
Authors:Shirli Werner; Ira Stern; Dana Roth; Ariel Tenenbaum Abstract: This study examined the roles of stigma and of enabling factors in help-seeking by parental caregivers of individuals with intellectual disabilities and dual diagnosis. Questionnaires were completed by 195 family caregivers. Lower family stigma was related to higher personal enabling factors (e.g. knowledge about services and previous experience in seeking help), which in turn was related to higher help-seeking behaviors. Higher professional enabling factors (e.g. attitude of the professional, services in the vicinity) were related to higher intentions to seek help, which were related to higher help-seeking behaviors. Professionals can help families achieve a greater sense of self-efficacy in their own help-seeking process by providing them with knowledge about services and facilitating a more positive experience in the process. PubDate: 2019-01-02 DOI: 10.1007/s10488-018-00915-w
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