Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network.

OBJECTIVE: Critical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change. METHOD: Four case examples illustrate how MHTTCs employ the Exploration-Preparation-Implementation-Sustainment (EPIS) implementation framework and intensive implementation strategies to educate clinicians, manage change, and improve processes. These examples include implementing motivational interviewing, cognitive-behavioral therapy for people with psychosis, strategies to decrease the no show rate for virtual appointments, and school mental health systems development. RESULTS: From Preparation through Sustainment, MHTTCs successfully employed implementation strategies including learning communities, audit and feedback, and coaching to bring about change. Each project attended to inner and outer contexts to eliminate barriers. The examples also show the benefit of integrating process improvement alongside implementation. CONCLUSIONS: The MHTTCs are a model for using implementation science to design technical assistance that leads to more successful practical execution of EBPs; thus reducing the gap between research and practice.

Challenges Experienced by Behavioral Health Organizations in New York Resulting from COVID-19: A Qualitative Analysis.

This paper presents a qualitative content analysis of survey data collected from behavioral health care providers from throughout New York regarding the challenges faced as a result of COVID-19. Survey responses from 295 agency and program administrators and staff, representing 238 organizations, were analyzed. Ten themes were identified: business operations, service provision, telehealth, safety, client concerns, staff concerns, supplies, technology, illness/grief/loss, and communication. These themes represent concerns that arose from the rapid transition to widespread use of telehealth, limited technology accessibility for both staff and clients, reduced revenue and billing changes, impact of COVID-19 infection itself and subsequent deaths of clients and staff, and necessary modifications for organizational communication both internally and externally. The implications of these challenges and the need for further research to identify how to best address them are discussed.

Effect of Psychiatric Symptoms on Employment Outcomes for Individuals Receiving Supported Employment Services: A Preliminary Study.

Psychiatric symptoms are often cited by community-based providers as barriers to employment for individuals with mental health conditions. The current study assessed whether psychiatric symptoms and hospitalization in the past year predicted employment outcomes for participants receiving supported employment (SE) services. A total of 105 participants enrolled in SE services were assessed on their level of psychiatric symptoms, hospitalization in the past year, and employment outcomes. Simultaneous logistic regression was used. Eighty-two participants met for the 6-month follow up. Findings indicate that higher overall scores on the 6-month Brief Symptom Inventory (BSI) are predictive of an employment outcome, and suggest that psychiatric symptoms were not a barrier to employment. Participants with higher overall scores on the BSI, thus suggesting greater symptoms, were more likely to gain employment than individuals with lower BSI scores. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 33-38.].

In-vivo job development training among peer providers of homeless veterans supported employment programs.

TOPIC: This column describes a goal-oriented, time-limited in vivo coaching/training approach for skills building among peer veterans vocational rehabilitation specialists of the Homeless Veteran Supported Employment Program (HVSEP). PURPOSE: Planning, implementing, and evaluating the training approach for peer providers was intended, ultimately, to support veterans in their goal of returning to community competitive employment. SOURCES USED: The description draws from the training experience that aimed to improve the ability of peer providers to increase both rates of employment and wages of the homeless veterans using their services. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Training peers using an in vivo training approach provided a unique opportunity for the veterans to improve their job development skills with a focus to support employment outcomes for the service users. Peers who received training also expressed that learning skills through an in vivo training approach was more engaging than typical classroom trainings. (PsycINFO Database Record

Improving Employment Outcomes in Assertive Community Treatment (ACT): The Role of the ACT Nurse.

Assertive community treatment (ACT) for individuals with serious mental illness is a community-based mental health service model where nurses play a significant leadership role as health and wellness educators and consultants to consumers and fellow staff members. The ACT model was designed to include a vocational focus as an important aspect of community integration. Nevertheless, research suggests that ACT does not assist a significant number of consumers in achieving employment goals. Nurses can play a critical part in the recovery and wellness of individuals receiving ACT services. Individual placement and support principles provide a foundation for implementing employment into current services.

The relationship between hope and symptoms.

OBJECTIVE: Hope is a critical aspect of the recovery process for persons with serious mental illnesses. The goal of this pilot study was to assess the relationship between hope and symptoms for a cohort of individuals with mental illnesses receiving supported employment services. METHOD: A total of 74 participants enrolled in supported employment were assessed on their level of hopefulness, hopelessness and psychiatric symptoms. Correlations were performed to determine the relationship between hope and psychiatric symptoms, and hopelessness and psychiatric symptoms. RESULTS: The findings indicated a significant inverse relationship between hope and symptoms, and a significant positive relationship between hopelessness and symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Hope and symptoms were inversely related, highlighting the importance of developing a wellness strategy that addresses managing symptoms as part of one's recovery process. Additionally, this finding highlights the critical role of PsyR providers in supporting people in recovery with developing a wellness strategy that will both help ameliorate symptoms and increase hope.

A study of the perceived barriers to the implementation of circles of support.

OBJECTIVE: The purpose of this study was to identity barriers to implementing the social support intervention, Circle of Support, in supported employment (SE) services for people with psychiatric disabilities. METHOD: Semi-structured interviews were administered to SE staff at three month intervals up to one year. Two focus groups were held with service recipients who did not participate in a circle of support. Interviews were conducted with two individuals receiving SE services who participated in a pilot project in which study researchers implemented circles of support. RESULTS: Common themes regarding the barriers to implementing a circle of support developed from the data. Service recipients who did not participate in a circle of support and those who did expressed the perceived and actual barriers to this approach as being: time, too much focus on the participant, and lack of control/facilitation of circle activities. Service recipients who participated in a pilot who had circles of support reported that this intervention was beneficial to them. Staff and service recipients identified time, running of the actual circle of support meetings, and supporter issues as barriers to implementing this technique. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although certain barriers to this technique were identified, there were features of this approach that both staff and service recipients, who had a circle of support, found beneficial. Since ongoing support is a critical component of successful employment, individuals may benefit from the use of these Circles of Support techniques.