Home-based primary care-mental health integration in the Veterans Health Administration: An updated evaluation of practice patterns.

Starting in 2008, the U.S. Veterans Health Administration required the integration of mental health providers (MH providers) in Home-Based Primary Care (HBPC) programs to promote access to and quality of mental health services for veterans enrolled in HBPC. Surveys were administered in both 2010 and 2019 to HBPC program directors and MH providers to evaluate the status of mental health practice in HBPC programs and inform the continued development of program resources. Findings reported here summarize responses to the 2019 survey and highlight changes compared to 2010 in key areas (e.g., mental health staffing and workload, services provided, training needs, and integration with and impact on the HBPC team). In 2019, approximately half of invited HBPC program directors (n = 66) and MH providers (n = 136) completed the voluntary, anonymous, and confidential surveys. Descriptive and bivariate analyses of quantitative data, and thematic analyses of open-text responses, were conducted. Comparisons of survey responses were made between the 2019 surveys and those collected in 2010 from MH providers (n = 132) and program directors (n = 112), and indicated similar patterns of variability in program staffing and practices across sites, with ongoing behavioral/mental health education and training needs reported for both MH providers and teams. The perceived degree and value of mental health integration in HBPC also remained high. Survey responses suggest integration of mental health services into HBPC continues to be feasible and improves access to key services. Findings may inform the expansion of home-based mental health services for meeting the needs of an aging population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Application and clinical utility of the Glasgow Coma Scale over time: a study employing the NIDRR traumatic brain injury model systems database.

OBJECTIVE: To examine possible changes in Glasgow Coma Scale (GCS) scores related to changes in emergency management, such as intubation and chemical paralysis, and the potential impact on outcome prediction. PARTICIPANTS: 10 228 patients from the Traumatic Brain Injury Model Systems national database. DESIGN: Retrospective study examining 5-year epochs from 1987 to 2012. MAIN MEASURES: GCS score assessed in the Emergency Department (GCS scores for intubated, but not paralyzed, patients were estimated with a formula using 2 of the 3 GCS components), Outcome: Functional Independence Measure (FIM) assessed at rehabilitation admission. RESULTS: The rate of intubation prior to GCS scoring averaged 43% and did not increase across time. However, a clear increase over time was observed in the use of paralytics or heavy sedatives, with 27% of patients receiving this intervention in the most recent epoch. Estimated GCS scores classified 69% of intubated patients as severely brain injured and 8% as mildly injured. The GCS accounted for a modest, yet consistent, amount of variability (approximately 5%-7%) in FIM scores during most epochs. CONCLUSIONS: Given the frequency of intubation and/or paralysis following brain injury in this sample, estimating GCS or exploring other means to gauge injury severity is beneficial, particularly because a portion likely did not sustain severe brain injury. There is no evidence for declining predictive utility of the GCS over time.

Embedded indices of effort in the repeatable battery for the assessment of neuropsychological status (RBANS) in a geriatric sample.

The clinical utility of embedded indices of effort in the RBANS was examined in a geriatric sample. Patients were classified as providing suspect effort (n = 45) or probable good effort (n = 258) using the TOMM and clinical consensus. Following the methodology of Silverberg and colleagues (2007), selected individual subtests and a summary Effort Index were evaluated. Setting specificity at approximately 85% yielded cut-offs of <15 on List Recognition, <8 on Digit Span, and >3 on the Effort Index. The modest sensitivity (51.1-64.4%) suggests that the indices should be used in conjunction with additional effort measures. In addition, the RBANS Picture Naming subtest was examined and showed modest sensitivity to detect suboptimal effort, but did not show notable incremental validity for detecting suboptimal effort beyond the Effort Index.