Authors:Michele L Allen; Benjamin Lê Cook; Nicholas Carson; Alejandro Interian; Martin La Roche; Margarita Alegría Pages: 431 - 440 Abstract: Patient activation, often conceptualized as an individual trait, contributes to mental health outcomes. This study assessed the relational contributors to activation by estimating the longitudinal association of patient-provider communication and two factors of therapeutic alliance (agreement on tasks/goals and bond), with patient activation. Participants were patients (n = 264) from 13 community-based mental health clinics across the United States. In multivariate models, controlling for patients’ individual and clinical characteristics, the task/goal factor of therapeutic alliance emerged as a significant and independent predictor of greater change in patient activation scores. Improving patient activation may require addressing patient-provider interactions such as coming to collaborative agreement on the tasks/goals of care. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0655-8 Issue No:Vol. 44, No. 4 (2017)
Authors:Andrew J. Pisansky; Douglas R. Wholey; Cindy Cain; Xi Zhu Pages: 441 - 451 Abstract: Assertive community treatment (ACT) teams are linked to high quality outcomes for individuals with severe mental illness. This paper tests arguments that influence shared between team members is associated with better encounter preparedness, higher work satisfaction, and improved performance in ACT teams. Influence is conceptualized in three ways: the average level according to team members, the team’s evaluation of the dispersion of team member influence, and as the person-organization fit of individual perception of empowerment. The study design is a retrospective observational design using survey data from a longitudinal study of 26 ACT teams (approximately 275 team members total) over 18 months. This study finds that average team influence and person-organization fit are positively correlated with encounter preparedness and satisfaction. Dispersion of influence was not significantly correlated with study outcomes. Influence in ACT teams has multiple dimensions, each with differential effects on team outcomes. These findings provide guidance as to how one might encourage equal and substantive contribution from ACT team members. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0659-4 Issue No:Vol. 44, No. 4 (2017)
Authors:Pietro Muratori; Annarita Milone; Azzurra Manfredi; Lisa Polidori; Laura Ruglioni; Furio Lambruschi; Gabriele Masi; John E. Lochman Pages: 452 - 462 Abstract: Multi-component interventions based on cognitive behavioral principles and practices have been found effective in reducing behavioral problems in children with disruptive behavior disorders (oppositional defiant disorder and conduct disorder). However, it is still unclear if these interventions can affect children’s callous-unemotional traits, which are predictive of subsequent antisocial behavior. Furthermore, it could be important to identify empirically supported treatment protocols for specific disorders addressed by child mental health services. The present study aimed to test the following two hypotheses: first, the Coping Power (CP) treatment program is able to reduce externalizing behaviors in children with disruptive behavior disorders treated in a mental health care unit; second, the CP program can reduce children’s callous unemotional traits. The sample included 98 Italian children, 33 treated with the CP program; 37 with a less focused multi-component intervention, and 28 with child psychotherapy. The results showed that the CP program was more effective than the other two treatments in reducing aggressive behaviors. Furthermore, only the CP program was associated with a decrease in children’s callous unemotional traits. The CP program was also associated with lower rate of referrals to mental health services at one-year follow-up. These findings support the importance of disseminating manualized and focused intervention programs in mental health services. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0660-y Issue No:Vol. 44, No. 4 (2017)
Authors:Erick G. Guerrero; Lesley Harris; Howard Padwa; William A. Vega; Lawrence Palinkas Pages: 463 - 469 Abstract: Little is known about how the Affordable Care Act (ACA) will be implemented in publicly funded addiction health services (AHS) organizations. Guided by a conceptual model of implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from 30 AHS clinical supervisors in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. Supervisors expected several potential effects of ACA implementation, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization. However, supervisors were not prepared for actions to align their programs’ strategic change plans with policy expectations. Findings point to the need for health care policy interventions to help treatment providers effectively respond to ACA principles of improving standards of care and reducing disparities. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0662-9 Issue No:Vol. 44, No. 4 (2017)
Authors:Michel L. A. Dückers; Anke B. Witteveen; Jonathan I. Bisson; Miranda Olff Pages: 470 - 479 Abstract: This study confirms that the developmental stage of post-disaster psychosocial support planning and delivery systems in Europe is associated with countries’ level of disaster vulnerability. Lower vulnerability is accompanied by more evolved planning and delivery systems. Countries in north, west and central regions have more developed planning and delivery systems and lower vulnerability levels than those in the south, southeast and east. The highest proportion of variance in vulnerability is located at the regional level, most of the variance in planning and delivery systems is at the individual level. Possible implications and chances for the optimization of psychosocial services are discussed. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0671-8 Issue No:Vol. 44, No. 4 (2017)
Authors:Gregory A. Aarons; Mark G. Ehrhart; Lauren R. Farahnak; Marisa Sklar; Jonathan Horowitz Pages: 480 - 491 Abstract: The role of leadership in the management and delivery of health and allied health services is often discussed but lacks empirical research. Discrepancies are often found between leaders’ self-ratings and followers’ ratings of the leader. To our knowledge no research has examined leader–follower discrepancies and their association with organizational culture in mental health clinics. The current study examines congruence, discrepancy, and directionality of discrepancy in relation to organizational culture in 38 mental health teams (N = 276). Supervisors and providers completed surveys including ratings of the supervisor transformational leadership and organizational culture. Polynomial regression and response surface analysis models were computed examining the associations of leadership discrepancy and defensive organizational culture and its subscales. Discrepancies between supervisor and provider reports of transformational leadership were associated with a more negative organizational culture. Culture suffered more where supervisors rated themselves more positively than providers, in contrast to supervisors rating themselves lower than the provider ratings of the supervisor. Leadership and leader discrepancy should be a consideration in improving organizational culture and for strategic initiatives such as quality of care and the implementation and sustainment of evidence-based practice. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0672-7 Issue No:Vol. 44, No. 4 (2017)
Authors:Emily B. Jones; Julia Zur; Sara Rosenbaum Pages: 492 - 500 Abstract: Community health centers provide co-located medical, behavioral, and case management services to meet the unique and complex needs of the underserved, including homeless individuals. Multivariate analysis of staffing patterns in health centers serving high homeless caseloads highlights above-average behavioral and case management staffing, regardless of Health Care for the Homeless funding status. Rural health centers and those in the South had lower behavioral health and enabling services staffing. Implications include the need to monitor disparities, link health centers with available technical assistance, and emphasize integrating co-located behavioral health, enabling, and medical services through grant oversight mechanisms. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0674-5 Issue No:Vol. 44, No. 4 (2017)
Authors:Laysha Ostrow; Donald Steinwachs; Philip J. Leaf; Sarah Naeger Pages: 501 - 511 Abstract: This study sought to understand whether knowledge of the Affordable Care Act (ACA) was associated with willingness of mental health peer-run organizations to become Medicaid providers. Through the 2012 National Survey of Peer-Run Organizations, organizational directors reported their organization’s willingness to accept Medicaid reimbursement and knowledge about the ACA. Multinomial logistic regression was used to model the association between willingness to accept Medicaid and the primary predictor of knowledge of the ACA, as well as other predictors at the organizational and state levels. Knowledge of the ACA, Medicaid expansion, and discussions about healthcare reform were not significantly associated with willingness to be a Medicaid provider. Having fewer paid staff was associated with not being willing to be a Medicaid provider, suggesting that current staffing capacity is related to attitudes about becoming a Medicaid provider. Organizations had both ideological and practical concerns about Medicaid reimbursement. Concerns about Medicaid reimbursement can potentially be addressed through alternative financing mechanisms that should be able to meet the needs of peer-run organizations. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0675-4 Issue No:Vol. 44, No. 4 (2017)
Authors:Elizabeth B. Matthews Pages: 512 - 523 Abstract: Despite increasing rates of electronic health record (EHR) adoption, the impact of these systems on the delivery of behavioral health treatment remains poorly understood. This qualitative study examined the experiences of 37 behavioral health providers using EHRs during face-to-face visits. Providers described environmental, relational and system related strategies that were used to meaningfully integrate EHRs into treatment and enhance the patient-centeredness of clinical encounters. Barriers to deploying these techniques were also identified. Results contribute to limited research exploring EHR use in behavioral health care, and provide important insight into how systems can be optimized within this context. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0676-3 Issue No:Vol. 44, No. 4 (2017)
Authors:Joy R. Pemberton; Nicola A. Conners-Burrow; Benjamin A. Sigel; Chad M. Sievers; Lauren D. Stokes; Teresa L. Kramer Pages: 524 - 533 Abstract: For proficiency in an evidence-based treatment (EBT), mental health professionals (MHPs) need training activities extending beyond a one-time workshop. Using data from 178 MHPs participating in a statewide TF-CBT dissemination project, we used five variables assessed at the workshop, via multiple and logistic regression, to predict participation in three post-workshop training components. Perceived in-workshop learning and client-treatment mismatch were predictive of consultation call participation and case presentation respectively. Attitudes toward EBTs were predictive of trauma assessment utilization, although only with non-call participants removed from analysis. Productivity requirements and confidence in TF-CBT skills were not associated with participation in post-workshop activities. PubDate: 2017-07-01 DOI: 10.1007/s10488-015-0677-2 Issue No:Vol. 44, No. 4 (2017)
Authors:Evan D. Holloway; Keith R. Cruise; Sarah M. Downs; Patrick O. Monahan; Matthew C. Aalsma Pages: 534 - 546 Abstract: Justice-involved youth endorse high rates of mental health problems. Juvenile probation is the most common disposition in the justice system and juvenile probation officers (JPOs) are crucial for connecting justice-involved youth with appropriate care. We examined the role of mental health competency on the use of self-report case management strategy types (deterrence, restorative justice, and treatment) by JPOs and whether jurisdiction-level differences were relevant. Results suggest that mental health competency predicted use of restorative justice and treatment strategies and all three strategy types varied at the county level. The role of mental health competency in use of treatment strategies is relevant to connecting justice-involved youth to mental health care. Furthermore, a substantial amount of the variance predicting the use of all three strategies was accounted for at the county level. PubDate: 2017-07-01 DOI: 10.1007/s10488-016-0734-5 Issue No:Vol. 44, No. 4 (2017)
Authors:Juliette K. Berg; Catherine P. Bradshaw; Booil Jo; Nicholas S. Ialongo Pages: 558 - 571 Abstract: Complier average causal effect (CACE) analysis is a causal inference approach that accounts for levels of teacher implementation compliance. In the current study, CACE was used to examine one-year impacts of PAX good behavior game (PAX GBG) and promoting alternative thinking strategies (PATHS) on teacher efficacy and burnout. Teachers in 27 elementary schools were randomized to PAX GBG, an integration of PAX GBG and PATHS, or a control condition. There were positive overall effects on teachers’ efficacy beliefs, but high implementing teachers also reported increases in burnout across the school year. The CACE approach may offer new information not captured using a traditional intent-to-treat approach. PubDate: 2017-07-01 DOI: 10.1007/s10488-016-0738-1 Issue No:Vol. 44, No. 4 (2017)
Authors:Yunqiao Wang; Christine A. Henriksen; Margreet ten Have; Ron de Graaf; Murray B. Stein; Murray W. Enns; Jitender Sareen Pages: 572 - 581 Abstract: The study aimed to determine whether some depressive, anxiety, and substance-use (DAS) disorders are mild, transient cases that remit without treatment. The first two waves of the first Netherlands Mental Health Survey and Incidence Study were used (age 18–64 years at baseline; wave two N = 5618). Mental disorders were assessed using CIDI 1.1. Past-year and past-month measures of DAS disorders, health service use, and quality of life were assessed at both waves. Individuals with a past-year DAS disorder who received no prior lifetime treatment were significantly more likely than those who received treatment to: (1) remit from their index disorder(s) without subsequent treatment, (2) be free of comorbid disorders, and (3) not have attempted suicide during follow-up (remission rates: 68.5 versus 32.0 %, respectively, p < 0.001). However, these individuals had lower quality of life compared to healthy individuals. Results were similar for past-month measures. Results show that many people who meet criteria for a DAS disorder remit without treatment. However, the lowered quality of life scores in this group nonetheless underscores the negative impact on the presence of residual symptoms. PubDate: 2017-07-01 DOI: 10.1007/s10488-016-0745-2 Issue No:Vol. 44, No. 4 (2017)
Authors:Nikki R. Wooten; Rachel Sayko Adams; Beth A. Mohr; Diana D. Jeffery; Wendy Funk; Thomas V. Williams; Mary Jo Larson Pages: 582 - 594 Abstract: We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence estimates were: 26.2 % for any select MHDX and 18.1 % for any MHT. Army women who had physical injuries since FY2002 or any behavioral health treatment between FY2002 and the pre-deployment year had increased odds of pre-deployment year MHT. During the pre-deployment year, a substantial percentage of Army women had MHDX and at least one MHT encounter or stay. Future research should determine if pre-deployment MHDX among Army women reflect vulnerability to future MHDX, or if pre-deployment MHT results in protection from chronic symptoms. PubDate: 2017-07-01 DOI: 10.1007/s10488-016-0744-3 Issue No:Vol. 44, No. 4 (2017)
Authors:E. de Beurs; E. H. Warmerdam; S. C. C. Oudejans; M. Spits; P. Dingemanse; S. D. D. de Graaf; I. W. de Groot; H. Houben; W. G. E. Kuyck; E. O. Noorthoorn; M. A. Nugter; S. C. C. Robbers; G. E. van Son Abstract: Assessing performance of mental health services (MHS) providers merely by their outcomes is insufficient. Process factors, such as treatment cost or duration, should also be considered in a meaningful and thorough analysis of quality of care. The present study aims to examine various performance indicators based on treatment outcome and two process factors: duration and cost of treatment. Data of patients with depression or anxiety from eight Dutch MHS providers were used. Treatment outcome was operationalized as case mix corrected pre-to-posttreatment change scores and as reliable change (improved) and clinical significant change (recovered). Duration and cost were corrected for case mix differences as well. Three performance indicators were calculated and compared: outcome as such, duration per outcome, and cost per outcome. The results showed that performance indicators, which also take process variability into account, reveal larger differences between MHS providers than mere outcome. We recommend to use the three performance indicators in a complementary way. Average pre-to-posttreatment change allows for a simple and straightforward ranking of MHS providers. Duration per outcome informs patients on how MHS providers compare in how quickly symptomatic relief is achieved. Cost per outcome informs MHS providers on how they compare regarding the efficiency of their care. The substantial variation among MHS providers in outcome, treatment duration and cost calls for further exploration of its causes, dissemination of best practices, and continuous quality improvement. PubDate: 2017-07-22 DOI: 10.1007/s10488-017-0818-x
Authors:Jack Tsai; Andrea Finlay; Bessie Flatley; Wesley J. Kasprow; Sean Clark Abstract: Although there are now over 400 veterans treatment courts (VTCs) in the country, there have been few studies on participant outcomes in functional domains. Using national data on 7931 veterans in the Veterans Affairs (VA) Veterans Justice Outreach program across 115 VA sites who entered a VTC from 2011 to 2015, we examined the housing, employment, income, and criminal justice outcomes of VTC participants; and identified veteran characteristics predictive of outcomes. VTC participants spent an average of nearly a year in the program and 14% experienced a new incarceration. From program admission to exit, 10% more participants were in their own housing, 12% more were receiving VA benefits, but only 1% more were employed. Controlling for background characteristics, a history of incarceration predicted poor criminal justice, housing, and employment outcomes. Participants with property offenses or probation/parole violations and those with substance use disorders were more likely to experience a new incarceration. Participants with more mental health problems were more likely to be receiving VA benefits and less likely to be employed at program exit. Together, these findings highlight the importance of proper substance abuse treatment as well as employment services for VTC participants so that they can benefit from the diversion process. PubDate: 2017-07-21 DOI: 10.1007/s10488-017-0816-z
Authors:Taeho Greg Rhee; Jon C. Schommer; Benjamin D. Capistrant; Ronald L. Hadsall; Donald L. Uden Abstract: Using data from 2002 to 2012 National Ambulatory Medical Care Survey, we estimated that the prevalence of overall antidepressant prescriptions increased almost twofold from 5.2% in 2002 to 10.1% in 2012 in office-based outpatient visits made by older adults. In addition, older adults were exposed to the risk of potentially avoidable adverse drug events in approximately one in ten antidepressant-related visits, or 2.2 million visits annually. Amitriptyline and doxepin were the two most frequent disease-independent potentially inappropriate antidepressants. Racial/ethnic minorities, and Medicaid beneficiaries had higher odds of potentially inappropriate antidepressant prescriptions (P < 0.05). Efforts to minimize potentially inappropriate antidepressant prescriptions are needed. PubDate: 2017-07-20 DOI: 10.1007/s10488-017-0817-y
Authors:Miya L. Barnett; Araceli Gonzalez; Jeanne Miranda; Denise A. Chavira; Anna S. Lau Abstract: This systematic review evaluates efforts to date to involve community health workers (CHWs) in delivering evidence-based mental health interventions to underserved communities in the United States and in low- and middle-income countries. Forty-three articles (39 trials) were reviewed to characterize the background characteristics of CHW, their role in intervention delivery, the types of interventions they delivered, and the implementation supports they received. The majority of trials found that CHW-delivered interventions led to symptom reduction. Training CHWs to support the delivery of evidence-based practices may help to address mental health disparities. Areas for future research as well as clinical and policy implications are discussed. PubDate: 2017-07-20 DOI: 10.1007/s10488-017-0815-0
Authors:Stephen S. Johnston; David S. Salkever; Nicholas S. Ialongo; Eric P. Slade; Elizabeth A. Stuart Abstract: When candidates for school-based preventive interventions are heterogeneous in their risk of poor outcomes, an intervention’s expected economic net benefits may be maximized by targeting candidates for whom the intervention is most likely to yield benefits, such as those at high risk of poor outcomes. Although increasing amounts of information about candidates may facilitate more accurate targeting, collecting information can be costly. We present an illustrative example to show how cost-benefit analysis results from effective intervention demonstrations can help us to assess whether improved targeting accuracy justifies the cost of collecting additional information needed to make this improvement. PubDate: 2017-07-08 DOI: 10.1007/s10488-017-0811-4
Authors:Mike Lucock; Michael Barkham; Gillian Donohoe; Stephen Kellett; Dean McMillan; Sarah Mullaney; Andrew Sainty; David Saxon; Richard Thwaites; Jaime Delgadillo Abstract: Practice research networks (PRNs) can support the implementation of evidence based practice in routine services and generate practice based evidence. This paper describes the structure, processes and learning from a new PRN in the Improving Access to Psychological Therapies programme in England, in relation to an implementation framework and using one study as a case example. Challenges related to: ethics and governance processes; communications with multiple stakeholders; competing time pressures and linking outcome data. Enablers included: early tangible outputs and impact; a collaborative approach; engaging with local research leads; clarity of processes; effective dissemination; and committed leadership. PubDate: 2017-07-01 DOI: 10.1007/s10488-017-0810-5
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