Economic Impact of the Statewide Implementation of an Evidence-Based Treatment: Multisystemic Therapy in New Mexico.

Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings.

State Legislative Approach to Enumerating Behavioral Health Workforce Shortages: Lessons Learned in New Mexico.

Nationally, the behavioral health workforce is in crisis because of a lack of resources, culturally responsive services, quality clinical supervision, sufficient training in evidence-based practices, and targeted recruitment and retention. Disparities in access to behavioral health care are particularly significant in New Mexico, where 25% of the population live in rural areas, and behavioral health shortages are among the highest in the nation. Additionally, as a Medicaid expansion state, New Mexico providers experience increased demand for services at a time when the state is challenged with limited workforce capacity. To address this issue, the Health Care Work Force Data Collection, Analysis and Policy Act was legislatively enacted in 2011 to systematically survey all state licensed health professionals to determine reasons for the healthcare shortage and address the shortage through policy. The Act was amended in 2012 to transfer all data to the University of New Mexico Health Sciences Center. In 2015, a total of 4,488 behavioral health providers completed a survey as a mandatory part of their license renewal. Findings from the survey indicate a dearth of licensed behavioral health providers representative of the populations served, limited access to services via Medicaid and Medicare payer sources, limited access to providers working in public health settings, and limited access to Health Information Technology. This paper describes the workforce context in New Mexico, the purpose of the legislation, the analytic findings from the survey, the policies implemented as a result of these efforts, lessons learned, and a discussion of the relevancy of the New Mexico model for other states. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population.

Permanent supportive housing (PSH) is an evidence-based health intervention for persons experiencing homelessness, but the impact of individual mechanisms within this intervention on health requires further research. This study examines the longitudinal impact of the mechanism of supportive housing within a peer-delivered PSH model on overall health and mental health (as measured by psychological distress and self-report of bothersome symptoms) outcomes in an ethnically diverse population. The 237 participants in the study included persons who were homeless or at risk of homelessness and who also had been diagnosed with a serious mental illness. Sixty-one percent of all participants received supportive housing. All 3 outcomes were significantly associated with quality of life indicators, recovery, and social connectedness. In addition, overall health was significantly associated with employment, age, and psychological distress. Psychological distress was associated with gender, type of housing, and history of violence or trauma. Experiencing bothersome symptoms was associated with drug use, history of violence or trauma, and psychological distress. Longitudinal models of these 3 outcomes showed that supportive housing was significantly associated with good to excellent health 6 months after baseline (odds ratio = 3.11, 95% confidence interval [1.12, 8.66]). The models also demonstrated that the supportive housing and comparison groups experienced decreased psychological distress after baseline. The results of this study demonstrate the importance of supportive housing within the context of PSH, particularly for the overall health of participants, and the positive overall impact of PSH on mental health in a diverse population. (PsycINFO Database Record

Training psychiatrists for rural practice: a 20-year follow-up.

OBJECTIVE: This report describes the Rural Psychiatry Residency Program at the University of New Mexico (UNM RPRP) and presents findings from a survey of program graduates. METHODS: Current practice location of residency graduates was identified to learn whether graduates of the UNM RPRP continued to practice in rural communities compared to the graduates of the traditional residency program. Additionally, a web-based survey was completed by 37 of the 60 graduates who participated in the UNM RPRP since its inception in 1991 through 2010. Questions addressed current practice, perceived barriers, and perceptions of experiences. RESULTS: Thirty-seven percent of the graduates from the UNM RPRP currently practice in rural communities compared to 10 % of the graduates from the traditional residency track. Of the survey respondents, 95 % continue to work with underserved individuals. Reported barriers to practice in rural areas include professional isolation, lack of referral resources, and travel distances. Respondents reported valuing education about systems based practice and telepsychiatry. CONCLUSION: Purposeful and well-coordinated educational opportunities situated in rural community health clinics can address some of the barriers for recruiting and retaining practicing psychiatrists in rural areas. Practical skill building at the individual, agency, and system level is integral in training psychiatrists for work in these communities. In particular, the use of telepsychiatry emerged as an important practical application for the provision of rural mental health care.

Historical trauma among Indigenous Peoples of the Americas: concepts, research, and clinical considerations.

Indigenous Peoples of the Americas have experienced devastating collective, intergenerational massive group trauma and compounding discrimination, racism, and oppression. There is increasing evidence of emotional responses to collective trauma and losses among Indigenous Peoples, which may help to inform ways of alleviating psychological suffering and unresolved grief. Tribal cultural and regional differences exist which may impact how the wounding across generations and within an individual's lifespan are experienced and addressed. This article will review the conceptual framework of historical trauma, current efforts to measure the impact of historical trauma upon emotional distress, and research as well as clinical innovations aimed at addressing historical trauma among American Indians/Alaska Natives and other Indigenous Peoples of the Americas. We will discuss assessment of historical trauma and implications for research and clinical as well as community interventions, and conclude with recommendations.

Capacity for delivering culturally competent mental health services in New Mexico: results of a statewide agency survey.

The Federal government has promoted National Standards for Culturally and Linguistically Appropriate Services (CLAS) to reduce mental health disparities among Hispanic and Native American populations. In 2005, the State of New Mexico embarked upon a comprehensive reform of its behavioral health system with an emphasis on improving cultural competency. Using survey methods, we examine which language access services (i.e., capacity for bilingual care, interpretation, and translated written materials) and organizational supports (i.e., training, self-assessments of cultural competency, and collection of cultural data) mental health agencies in New Mexico had at the onset of a public sector mental health reform (Office of Minority Health 2001).