Authors:Shira Maguen; Erin Madden; Olga V. Patterson; Scott L. DuVall; Lizabeth A. Goldstein; Kristine Burkman; Brian Shiner Pages: 519 - 529 Abstract: To derive a method of identifying use of evidence-based psychotherapy (EBP) for post-traumatic stress disorder (PTSD), we used clinical note text from national Veterans Health Administration (VHA) medical records. Using natural language processing, we developed machine-learning algorithms to classify note text on a large scale in an observational study of Iraq and Afghanistan veterans with PTSD and one post-deployment psychotherapy visit by 8/5/15 (N = 255,968). PTSD visits were linked to 8.1 million psychotherapy notes. Annotators labeled 3467 randomly-selected psychotherapy notes (kappa = 0.88) to indicate receipt of EBP. We met our performance targets of overall classification accuracy (0.92); 20.2% of veterans received ≥ one session of EBP over the study period. Our method can assist with identifying EBP use and studying EBP-associated outcomes in routine clinical practice. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0850-5 Issue No:Vol. 45, No. 4 (2018)
Authors:Kasper van Mens; Joran Lokkerbol; Richard Janssen; Mirjam L. van Orden; Margot Kloos; Bea Tiemens Pages: 530 - 537 Abstract: Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental design, we compared the cost-effectiveness of patients in the new setting with comparable patients from specialized mental healthcare in the old setting. Results showed that for this group of patients the average cost of treatment was significantly reduced by, on average, €2132 (p < 0.001), with similar health outcomes as in the old system. PubDate: 2018-07-01 DOI: 10.1007/s10488-017-0842-x Issue No:Vol. 45, No. 4 (2018)
Authors:Elizabeth Siantz; Eric Rice; Benjamin Henwood; Lawrence Palinkas Pages: 538 - 549 Abstract: Little is known about the involvement of peer providers in integrated behavioral health teams. This study asks where peer providers fit within integrated care teams in Los Angeles County. Social network analysis combined with qualitative fieldwork was used to understand the network positions of peer providers in 14 integrated pilot programs. Four programs’ peer providers were highly central, while 3 programs’ were on the network’s periphery. Positional variation appeared to be related to the peers’ mental health status. Targeted efforts are needed to support the implementation of peer providers on integrated teams at the program and system levels. PubDate: 2018-07-01 DOI: 10.1007/s10488-017-0843-9 Issue No:Vol. 45, No. 4 (2018)
Authors:Richard O’Reilly; Evelyn Vingilis Pages: 565 - 574 Abstract: Many jurisdictions have enacted community treatment order (CTO) legislation that requires a person, who suffers from a severe mental disorder, to follow a treatment plan when living in the community. CTOs have been a source of debate because of controversies on whether evidence of effectiveness should only be considered from randomized controlled trials (RCTs). RCTs are considered the “gold standard” method to evaluate effectiveness of simple therapeutic interventions such as medication, but they are problematic for evaluation of complex interventions because valid attribution of causation in complex interventions is not guaranteed with RCTs. CTOs are complex interventions that require the interaction of many individuals and organizations to achieve their effects and effectiveness research must measure these complexities of delivery and outcomes. This paper examines conceptual, methodological and analytical challenges of CTO research within the context of RCTs and other research designs. It also discusses the current state of knowledge on effectiveness of CTOs. Finally, we suggest a way forward by presenting alternative causal inference approaches and potential models for evaluation complex interventions, such as CTOs. We propose that these approaches should be used alongside other research designs in a nuanced approach that may involve using findings from initial studies to refine the intervention and/or its implementation. PubDate: 2018-07-01 DOI: 10.1007/s10488-017-0845-7 Issue No:Vol. 45, No. 4 (2018)
Authors:Rosaura E. Orengo-Aguayo; Rochelle F. Hanson; Angela D. Moreland; Lisa Jobe-Shields; Zachary W. Adams Pages: 575 - 586 Abstract: This mixed-methods study assessed providers’ views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment. PubDate: 2018-07-01 DOI: 10.1007/s10488-017-0846-6 Issue No:Vol. 45, No. 4 (2018)
Authors:Carrie B. Jackson; Lauren B. Quetsch; Laurel A. Brabson; Amy D. Herschell Pages: 587 - 610 Abstract: There has been an increase in the use of web-based training methods to train behavioral health providers in evidence-based practices. This systematic review focuses solely on the efficacy of web-based training methods for training behavioral health providers. A literature search yielded 45 articles meeting inclusion criteria. Results indicated that the serial instruction training method was the most commonly studied web-based training method. While the current review has several notable limitations, findings indicate that participating in a web-based training may result in greater post-training knowledge and skill, in comparison to baseline scores. Implications and recommendations for future research on web-based training methods are discussed. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0847-0 Issue No:Vol. 45, No. 4 (2018)
Authors:Kathleen C. Thomas; Hillary Owino; Sana Ansari; Leslie Adams; Julianne M. Cyr; Bradley N. Gaynes; Seth W. Glickman Pages: 611 - 622 Abstract: Little is known about what patients value in psychiatric crisis services or how they compare community-based services with those received in the emergency department. Three focus groups (n = 27) were held of participants who had received psychiatric crisis services in emergency departments or a community mental health center. Participants described care experiences and preferences. Focus groups were audio recorded, transcribed, and coded using a value-based lens. Themes included appreciation for feeling respected, basic comforts, and shared decision-making as foundations of quality care. Participants preferred the community mental health center. Research should address long-term outcomes to motivate change in psychiatric crisis care. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0849-y Issue No:Vol. 45, No. 4 (2018)
Authors:G. Hopkin; S. Evans-Lacko; A. Forrester; J. Shaw; G. Thornicroft Pages: 623 - 634 Abstract: Prisoners have high rates of mental illness and the transition from prison to the community is a problematic time for the provision of mental health services and a range of negative outcomes have been identified in this period. A systematic review was conducted to identify interventions for prisoners with diagnosed mental health conditions that targeted this transition period. Fourteen papers from 13 research studies were included. The interventions identified in this review were targeted at different stages of release from prison and their content differed, ranging from Medicaid enrolment schemes to assertive community treatment. It was found that insurance coverage, and contact with mental health and other services can be improved by interventions in this period but the impact on reoffending and reincarceration is complex and interventions may lead to increased return to prison. There is a developing evidence base that suggests targeting this period can improve contact with community mental health and other health services but further high quality evidence with comparable outcomes is needed to provide more definitive conclusions. The impact of programmes on return to prison should be evaluated further to establish the effect of interventions on clinical outcomes and to clarify the role of interventions on reincarceration. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0848-z Issue No:Vol. 45, No. 4 (2018)
Authors:Donal O’Keeffe; Ann Sheridan; Aine Kelly; Roisin Doyle; Kevin Madigan; Elizabeth Lawlor; Mary Clarke Pages: 635 - 648 Abstract: Little is known about how recovery oriented policy and legislative changes influence service users’ perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as experiences of service utilisation and suggestions for change with people diagnosed with a First Episode Psychosis between 1995 and 1999. Participants had used services during the 10 year period prior to, and 10 years post, policy and legislative shifts to the recovery approach. Semi-structured interviews were conducted with 10 participants who met criteria for ‘full functional recovery’ and 10 who did not. Data were analysed using Thematic Networks Analysis to develop Basic, Organising, and Global Themes. Over time, recovered participants perceived an improvement in service quality through the ‘humanising’ of treatment and non-recovered participants experienced their responsibility in recovery being recognised, but felt abandoned to the recovery approach. Findings suggest the importance of viewing service users as demonstrating personhood and having societal value; examining the personal meaning of psychotic experiences; and matching expectations with what services can feasibly provide. The implementation and the principal tenets of the recovery approach warrant further investigation. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0851-4 Issue No:Vol. 45, No. 4 (2018)
Authors:Alayna L. Park; Katherine H. Tsai; Karen Guan; Bruce F. Chorpita Pages: 649 - 660 Abstract: This study examined patterns of evidence-based treatment (EBT) delivery following a county-wide EBT reform initiative. Data were gathered from 60 youth and their 21 providers, who were instructed to deliver therapy as they normally would under the EBT initiative. Results showed limited applicability of county-supported EBTs to this service sample, and that most youth did not receive traditional delivery of EBTs. Findings suggest that it may be unrealistic to expect providers to deliver EBTs with fidelity with all clients, and that EBT implementation may be best thought of as a strategy for improving mental health services rather than a goal. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0853-2 Issue No:Vol. 45, No. 4 (2018)
Authors:Kathleen Biebel; Amy Ryder-Burge; Shums Alikhan; Heather Ringeisen; Marsha Ellison Pages: 661 - 671 Abstract: This manuscript describes efforts to support youth and young adults living with serious mental health conditions (SMHC) as they pursue their education goals. Case studies were conducted with three supported education initiatives across the US. Data were collected through individual interviews and focus groups. Key ingredients exist across various settings (e.g., mental health, post-secondary education) to support the pursuit of education goals for students living with SMHC, while individual settings have unique circumstances to address. Findings can inform stakeholders of relevant core components and implementation strategies across settings that support education goals for students with SMHCs. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0852-3 Issue No:Vol. 45, No. 4 (2018)
Authors:Kathleen Biebel; Amy Ryder-Burge; Shums Alikhan; Heather Ringeisen; Marsha Ellison Pages: 672 - 672 Abstract: The original version of this article unfortunately contained a mistake. The spelling of the fifth author’s name was incorrectly published as Masha Ellison. PubDate: 2018-07-01 DOI: 10.1007/s10488-018-0860-3 Issue No:Vol. 45, No. 4 (2018)
Authors:Lauren M. Haack; Jocelyn Meza; Yuanyuan Jiang; Eva A. Araujo; Linda Pfiffner Abstract: The original version of this article unfortunately contained a mistake. The co-author, Dr. Araujo’s name and the affiliation for Dr. Pfiffner was incorrect in the original version of the article. The correct information is given below. PubDate: 2018-07-11 DOI: 10.1007/s10488-018-0888-4
Authors:Brent A. Langellier; Yong Yang; Jonathan Purtle; Katherine L. Nelson; Ivana Stankov; Ana V. Diez Roux 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: 2018-07-11 DOI: 10.1007/s10488-018-0887-5
Abstract: This article examines the public safety rationale for a federal policy of prohibiting gun sales to veterans with psychiatric disabilities who are assigned a fiduciary to manage their benefits from the Department of Veterans Affairs. The policy was evaluated using data on 3200 post-deployment veterans from the Iraq and Afghanistan war era. Three proxy measures of fiduciary need—based on intellectual disability, drug abuse, or acute psychopathology—were associated in bivariate analysis with interpersonal violence and suicidality. In multivariate analysis, statistical significance remained only for the measure based on acute psychopathology. Implications for reforms to the fiduciary firearm restriction policy are discussed. PubDate: 2018-05-24 DOI: 10.1007/s10488-018-0881-y
Authors:Patrick H. DeLeon; Maegan M. Paxton; Tonya Spencer; Jouhayna E. Bajjani-Gebara Abstract: Current Veterans administration policy directly links a Veteran’s adjudged capacity to manage personal financial resources with their ability to purchase or possess a firearm, pursuant to the regulatory authority of the National Instant Criminal Background Check System (NICS). Preventing Veterans’ suicide is a highly laudable public health objective. Effectively utilizing scientific research to “inform” public policy is equally important. The authors should be congratulated for their efforts. However, it is important in utilizing large set population-based data, especially social science data, to evaluate policy alternatives that there be substantial face (i.e., clinical) validity. Correlation does not necessarily represent causation. PubDate: 2018-05-22 DOI: 10.1007/s10488-018-0885-7
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