Authors:Kelsie H. Okamura; Puanani J. Hee; David Jackson; Brad J. Nakamura Pages: 699 - 708 Abstract: Abstract Examining therapist evidence-based practice (EBP) knowledge seems an important step for supporting successful implementation. Advances in implementation science suggest a distinction between practice specific (i.e., knowing which practices are derived from the evidence base) and EBP process (i.e., integrating research evidence, clinical experience, client characteristics, and monitoring outcomes) knowledge. An examination of how these knowledge types are measured and relate to attitudes appears warranted. In our sample of 58 youth community therapists, both practice specific and EBP process knowledge accounted for EBP attitude scores, which varied by therapist demographic variables. Implications for measurement of therapist constructs and future research in identifying therapist predictors of EBP use and youth clinical improvement are discussed. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0854-1 Issue No:Vol. 45, No. 5 (2018)
Authors:Mir M. Ali; Sara Lackey; Ryan Mutter; Richard McKeon Pages: 709 - 715 Abstract: Abstract This study utilizes data from the National Survey of Drug Use and Health (NSDUH) to analyze the relationship between perceived unmet mental health care needs and suicidal ideation and attempt. Estimates from multivariable logistic regression models suggest that individuals who report perceived unmet mental health care needs have higher probability of experiencing suicidal ideation and attempt. Perceived unmet mental health care need has an important association with suicidal ideation and attempt, and efforts aimed at improving access to care are needed to address this issue. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0856-z Issue No:Vol. 45, No. 5 (2018)
Authors:Gabriela M. Rodríguez; Dainelys Garcia; Angela Blizzard; Nicole E. Barroso; Daniel M. Bagner Pages: 716 - 730 Abstract: Abstract Mental health interventions for infants typically target high-risk groups and can prevent long-term negative outcomes. Despite federal initiatives promoting early intervention, minimal research has examined usual care services for infants, which is important to improve routine care. The current study characterized usual care practices in infant mental health through the adaptation and administration of a provider survey. Providers (n = 126) reported using a wide range of intervention strategies and few intervention programs with varied evidence. Findings can inform future research to identify quality improvement targets of usual mental health care for high-risk infants and their families. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0855-0 Issue No:Vol. 45, No. 5 (2018)
Authors:Mir M. Ali; Judith Teich; Sean Lynch; Ryan Mutter Pages: 731 - 740 Abstract: Abstract There is increasing recognition that some preschool-aged children suffer from mental health conditions, but little is known about the treatment they receive. Using the 2014 MarketScan Commercial Claims and Encounters database (N = 1,987,759) the study finds that only a small proportion of preschool-aged children receive any behavioral interventions, including psychotherapy, in conjunction with having a filled psychiatric prescription. Nearly all of the preschool-aged children who had psychotropic prescriptions filled had no other claims for treatment, and among those children who had prescriptions for psychotropic medication filled, the vast majority did not have a mental health diagnosis on a claim. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0858-x Issue No:Vol. 45, No. 5 (2018)
Authors:Jennifer L. A. Tran; Rena Sheng; Allyson Beaulieu; Miguel Villodas; Keith McBurnett; Linda J. Pfiffner; Leslie Wilson Pages: 741 - 750 Abstract: Abstract We conducted a cost-effectiveness analysis (CEA) of two behavioral psychosocial interventions for children with ADHD-inattentive type: Child Life and Attention Skills (CLAS) program and parent-focused treatment (PFT) compared to community-based treatment as usual (TAU). The CEA evaluated cost per ADHD case resolved measured by parent and teacher reports of ADHD inattentive symptoms. Total cost per patient for CLAS, PFT, and TAU were $1559, $710, and $0. CLAS, the costliest treatment, was more effective than PFT and TAU. The incremental cost-effectiveness ratios (ICER) per disordered case resolved are: $3997 for CLAS versus TAU, $3227 for PFT versus TAU, and $4994 for CLAS versus PFT. PFT is the more cost-effective option based on initial CEA. However, CLAS may be comparably cost-effective by streamlining the model, which resulted in an ICER of $29 compared to PFT. Notably, cost for CLAS is substantially below the annual cost for unresolved ADHD. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0857-y Issue No:Vol. 45, No. 5 (2018)
Authors:Jacqueline Horan Fisher; Emily Lichvar; Aaron Hogue; Sarah Dauber Pages: 751 - 764 Abstract: Abstract This study examines clinical and family predictors of perceived need for treatment and engagement in mental health treatment services among community-referred racial/ethnic minority adolescents and their primary caregivers. Findings indicated that the majority of families perceived a need for treatment, but that perceived need was not associated with treatment engagement. Family factors (i.e., low cohesion and high conflict within the family) predicted perceived need for treatment among adolescents, whereas clinical factors (i.e., adolescent internalizing and externalizing symptomatology) predicted caregiver perceived need for adolescent treatment. Neither clinical nor family factors predicted treatment engagement. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0863-0 Issue No:Vol. 45, No. 5 (2018)
Authors:Tim Kaiser; Lisa Schmutzhart; Anton-Rupert Laireiter Pages: 765 - 779 Abstract: Abstract While monitoring systems in psychotherapy have become more common, little is known about the attitudes that mental health practitioners have towards these systems. In an online survey among 111 Austrian psychotherapists and trainees, attitudes towards therapy monitoring were measured. A well-validated questionnaire measuring attitudes towards outcome monitoring, the Outcome Measurement Questionnaire, was used. Clinicians’ theoretical orientations as well as previous knowledge and experience with monitoring systems were associated with positive attitudes towards monitoring. Possible factors that may have led to these findings, like the views of different theoretical orientations or obstacles in Austrian public health care, are discussed. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0862-1 Issue No:Vol. 45, No. 5 (2018)
Authors:Emily B. H. Treichler; William D. Spaulding Pages: 780 - 789 Abstract: Abstract Despite the strengths of routine outcome monitoring (ROM) in community mental health settings, there are a number of barriers to effective implementation of ROM, including measurement error due to provider factors (e.g., training level) and non-target client factors (i.e., client characteristics which have no meaningful relationship to the outcome of interest). In this study, ROM data from 80 client-provider dyads were examined for sources of variance due to provider factors and non-target client factors. Results indicated that provider factors and non-target client factors accounted for between 9.6 and 54% of the variance in the ROM measures. Our findings supported past research that provider characteristics impact ROM, and added the novel finding that client gender, age, diagnosis, and cognition also impact ROM. Methods to increase accuracy and utility of ROM in community mental health are discussed. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0861-2 Issue No:Vol. 45, No. 5 (2018)
Authors:Ricardo Araya; Pedro Zitko; Niina Markkula Pages: 790 - 799 Abstract: Abstract Universal health care programmes have the potential to reduce treatment gaps. We explored the potential impact of an equity-oriented universal health care programme on access to care for depression, hypertension and diabetes using data from two nationally representative health surveys in Chile. The likelihood a depressed individual had accessed health care appears to have increased significantly after the programme was introduced whereas those for hypertension and diabetes remained unchanged. Depressed women seem to have benefited mostly from the programme. Universal health care programmes for depression could substantially increase coverage and reduce inequities in access to health care in middle-income countries. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0864-z Issue No:Vol. 45, No. 5 (2018)
Authors:Abby Bailin; Sarah Kate Bearman; Rafaella Sale Pages: 800 - 812 Abstract: Abstract Clinical supervision is an element of quality assurance in routine mental health care settings serving children; however, there is limited scientific evaluation of its components. This study examines the format and microskills of routine supervision. Supervisors (n = 13) and supervisees (n = 20) reported on 100 supervision sessions, and trained coders completed observational coding on a subset of recorded sessions (n = 57). Results indicate that microskills shown to enhance supervisee competency in effectiveness trials and experiments were largely absent from routine supervision, highlighting potential missed opportunities to impart knowledge to therapists. Findings suggest areas for quality improvement within routine care settings. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0865-y Issue No:Vol. 45, No. 5 (2018)
Authors:John A. Cosgrove Pages: 813 - 819 Abstract: Abstract Surveys tend to yield low response rates among human service professionals. This study examined whether a randomly-assigned prepaid $2 incentive increased response rates over time, and was cost-effective for increasing response count, among social workers and volunteer mediators. The incentive was enclosed with a mixed-mode survey of factors related to burnout and intention-to-remain. The incentive increased response rates over time. The effect of the incentive did not differ between mediators and social workers. The $2 incentive was not cost-effective for increasing response count. Implications are discussed for reducing nonresponse bias, decreasing time-to-response, and considering response rate versus response count. PubDate: 2018-09-01 DOI: 10.1007/s10488-018-0866-x Issue No:Vol. 45, No. 5 (2018)
Authors:Rachel R. Ouellette; Melanie Pellecchia; Rinad S. Beidas; Rukiya Wideman; Ming Xie; David S. Mandell Abstract: Abstract This study examined the association between (1) beginning-of-the-year emotional exhaustion and use of three evidence-based practices (EBP) for children with autism spectrum disorder; and (2) use of these EBP and end-of-year emotional exhaustion among 46 kindergarden to 2nd grade autism support teachers participating in a randomized trial. Emotional exhaustion was measured at the end and beginning of the school year using a subscale of the Maslach Burnout Inventory. Fidelity was measured using monthly observations, coded by research assistants trained to reliability. Correlations were used to examine unadjusted associations and ordinary least squares regression was used to examine associations adjusted for beginning-of-year burnout, years teaching, and average change in student cognitive functioning. Emotional exhaustion at the beginning of the year was not associated with EBP use. Greater fidelity to each EBP was associated with lower end-of-year emotional exhaustion (coefficients ranging from − .34 to − 1.13, all p’s < .05). Results indicate that helping teachers implement EBP with greater fidelity may help reduce burnout, a substantial challenge in the field. PubDate: 2018-09-17 DOI: 10.1007/s10488-018-0894-6
Authors:Evelyn Cho; Phillip K. Wood; Erin K. Taylor; Estee M. Hausman; Jack H. Andrews; Kristin M. Hawley Abstract: Abstract Previous surveys indicate infrequent use of evidence-based treatment (EBT) manuals in usual care youth mental health, but the extent to which providers use core and common EBT strategies and what contextual factors impact EBT strategy implementation need further study. In a national, multidisciplinary survey of 1092 youth-serving providers, providers reported regular use of many EBT strategies. Provider learning theory orientation, more recent degree, more standardized and ongoing assessment use, more positive attitudes toward innovation and evidence, fewer low-income clients, and perceptions that their agency valued quality care and provided fewer training resources predicted more frequent EBT strategy use. PubDate: 2018-09-12 DOI: 10.1007/s10488-018-0896-4
Authors:Joshua Breslau; Bradley D. Stein; Hao Yu; Rachel M. Burns; Bing Han Abstract: Abstract We examine the impact of insurance expansion under the Affordable Care Act’s Dependent Care Expansion (DCE) on allocation of mental health care across illness severity, types of care and racial/ethnic groups. Evidence suggests that the increase in mental health care utilization resulting from the DCE was restricted to individuals with clinically significant mental health conditions. There is no evidence suggesting that the increase occurred disproportionately in medication-only treatment or that it increased racial/ethnic disparities. The DCE appears to have been successful in increasing utilization of mental health care among a high need group without lowering quality or increasing disparities. PubDate: 2018-09-10 DOI: 10.1007/s10488-018-0895-5
Authors:Mohammad Akbari; Mousa Alavi; Jahangir Maghsoudi; Alireza Irajpour; Violeta Lopez; Michelle Cleary Abstract: Abstract Responsive support systems, designed and promoted by policy makers, are critical in supporting family caregivers. The purpose of this study was to explore viewpoints of service providers in supporting family caregivers of mental health patients in Iran. In this qualitative study, a purposive sample of 29 service providers and policy makers consented to participate in semi-structured interviews. Data were analyzed through qualitative content analysis and three main categories and seven sub-categories were identified. The main categories were: interpersonal collaboration, intra-organization collaboration and inter-sectorial collaboration. A common theme in this study was that service providers play a key role in coordinating responsive support services for Iranian family caregivers of mental health patients across all levels. The increasing complexity of the health care system and resource limitations have created complex problems, which require the use of participatory approaches by the various specialties, disciplines and departments to provide complementary services and mutual support. This approach is the best way of ensuring that service users receive the most relevant services from the right service providers in the right place as and when needed. PubDate: 2018-08-31 DOI: 10.1007/s10488-018-0893-7
Authors:Xiaoling Xiang; Randall Owen; F. L. Fredrik G. Langi; Kiyoshi Yamaki; Dale Mitchell; Tamar Heller; Amol Karmarkar; Dustin French; Neil Jordan Abstract: Abstract This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization. PubDate: 2018-08-31 DOI: 10.1007/s10488-018-0892-8
Authors:A. L. van Melle; Y. Voskes; H. C. W. de Vet; J. van der Meijs; C. L. Mulder; G. A. M. Widdershoven Abstract: Abstract This study aims to validate the HIC monitor as a model-fidelity scale to the High and Intensive Care (HIC) model, a recently developed model for acute psychiatric wards. To assess the psychometric properties of the HIC monitor, 37 audits were held on closed inpatient wards at 20 psychiatric hospitals in the Netherlands. Interrater reliability, construct validity and content validity were examined. Our results suggest that the HIC monitor has good psychometric properties. It can be used as a tool for assessing the implementation of the HIC model on acute psychiatric wards in the Netherlands, and for quality assessment and improvement. PubDate: 2018-08-17 DOI: 10.1007/s10488-018-0890-x
Authors:Marie-Josée Fleury; Guy Grenier; Lambert Farand; Francine Ferland Abstract: Abstract This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users. PubDate: 2018-08-03 DOI: 10.1007/s10488-018-0889-3
Authors:Anne-Katharina Schiefele; Wolfgang Lutz; Michael Barkham; Julian Rubel; Jan Böhnke; Jaime Delgadillo; Mark Kopta; Dietmar Schulte; David Saxon; Stevan L. Nielsen; Michael J. Lambert Abstract: The original version of this article unfortunately contained a mistake. In Results section, under the heading the “Application”, CI difference values were incorrect in one of the sentences. The corrected sentence is given below. PubDate: 2018-07-31 DOI: 10.1007/s10488-018-0891-9
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
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