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1.
Community Ment Health J ; 59(7): 1428-1435, 2023 10.
Article in English | MEDLINE | ID: mdl-36939990

ABSTRACT

The objective was to determine the feasibility of an Open Dialogue-inspired approach in a metropolitan, public hospital setting with predominately African American participants. Participants were ages 18-35, experienced psychosis within the past month, and involved at least one support person in their care. We evaluated domains of feasibility including implementation, adaptation, practicality, acceptability, and limited-efficacy. An organizational change model (Addressing Problems Through Organizational Change) facilitated implementation. Clinicians received three trainings and ongoing supervision. Network meetings were successfully implemented with good self-reported fidelity to principles of dialogic practice. Some adaptations (less frequent meetings and no home visits) were necessary. A subset of individuals completed research assessments over 12 months. Qualitative interviews with participants suggested the intervention was acceptable. Symptom and functional outcomes were preliminary but trended toward improvement. Implementation was feasible with relatively brief training, organizational change processes, and context-specific adaptations. Lessons learned can assist in planning a larger research study.


Subject(s)
Psychotic Disorders , Humans , Young Adult , Feasibility Studies , Psychotic Disorders/therapy , Self Report
2.
Psychiatr Serv ; 73(10): 1165-1168, 2022 10 01.
Article in English | MEDLINE | ID: mdl-35378994

ABSTRACT

Although it is widely accepted that patients do better when evidence-based health care practices are used, there is less acknowledgment of the positive outcomes associated with evidence-based policy making. To address the need for high-quality evidence to inform mental health policies, Psychiatric Services has recently launched a new article format: the Policy Review. This review type defines a specific policy-relevant issue affecting behavioral health systems, describes current knowledge and limitations, and discusses policy implications. Reviews can focus on mental health policies or examine how other health or social policies affect people with mental illness or substance use disorders. This brief overview of the need for a policy review article type describes differences between evidence-based policy making and practices and looks at research approaches focused on evidence-based policy making, as well as legislative and other efforts to support it. Broad guidelines for potential submissions are also provided.


Subject(s)
Mental Health Services , Health Policy , Health Services Research , Humans , Mental Health
4.
Psychiatr Serv ; 71(11): 1158-1162, 2020 11 01.
Article in English | MEDLINE | ID: mdl-32517639

ABSTRACT

The response to the global COVID-19 pandemic has important ramifications for mental health systems and the patients they serve. This article describes significant changes in mental health policy prompted by the COVID-19 crisis across five major areas: legislation, regulation, financing, accountability, and workforce development. Special considerations for mental health policy are discussed, including social determinants of health, innovative technologies, and research and evaluation. These extraordinary advances provide an unprecedented opportunity to evaluate the effects of mental health policies that may be adopted in the post-COVID-19 era in the United States.


Subject(s)
Coronavirus Infections/epidemiology , Health Policy/trends , Mental Health/trends , Pneumonia, Viral/epidemiology , COVID-19 , Humans , Inventions , Pandemics , Social Determinants of Health , United States , Workforce
5.
Psychol Serv ; 17(S1): 62-68, 2020.
Article in English | MEDLINE | ID: mdl-30920275

ABSTRACT

Engaging in advocacy is an ethical responsibility for behavioral health professionals, as reflected in professional competencies across disciplines and in personal accounts of wanting to affect change at various levels of patients'/clients' and communities' ecologies. However, the literature is replete with examples of barriers to routine advocacy engagement, including lack of an organized structure into which efforts can be embedded. There exists the desire among behavioral health professionals to engage in more advocacy work, yet a shared sense of not knowing how to incorporate this work into existing professional roles. One way to address these barriers is to establish more collaborative advocacy work environments within the public sector settings that employ behavioral health professionals. This article offers the first descriptive account of developing, implementing, and maintaining such a collaborative interprofessional advocacy workgroup. To that end, this case study is one example of such a group, the Atlanta Behavioral Health Advocates, based within the Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences and situated also within Grady Health System, a public health care system. This paper details our experiences forming and engaging in this group, which we believe can serve as a model for others developing similar advocacy workgroups in public sector settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

6.
F1000Res ; 8: 288, 2019.
Article in English | MEDLINE | ID: mdl-31131095

ABSTRACT

International experts have recommended actions that funders can take to improve the value of research investments. They state that self-assessment and public sharing are the basis for accountability and improvement. We examined our policies and practice to determine the extent to which the Patient-Centered Outcomes Research Institute's (PCORI) policies and practices as a research funder align with international best practice recommendations. A self-audit of current policies and practice against 17 recommendations and 35 sub-recommendations representing five major stages of research production, based on adapted methods used for self-assessment by another funder, was performed.  Fit of existing PCORI policies and practices with 35 sub-recommendations, qualitative assessment of adequacy (area of strength; area of partial strength; area of growth; not applicable) for 17 recommendations for five stages of research production was assessed. Of the 17 recommendations, 15 were applicable to PCORI's research mission and focus.  PCORI has policies and practices in place for all elements of six recommendations ("area of strength") and policies that address each element but with some still in active development for three ("area of partial strength"). PCORI is partially addressing six of the 15 relevant recommendations ("area of growth"). Areas for growth include making study protocols publicly available, improving policies on data sharing, and enhancing collaboration with other funders to reduce redundant funding. A voluntary consortium of international funders is underway to encourage further progress, including additional self-assessment and public sharing for accountability. These findings indicate PCORI has undertaken efforts to align its funding practices with international recommendations to ensure the value of public dollars invested in research.  Further efforts will likely require additional coordination and collaboration between funders and stakeholders.


Subject(s)
Academies and Institutes , Patient Outcome Assessment , Humans , Information Dissemination
7.
Ethn Dis ; 28(Suppl 2): 407-416, 2018.
Article in English | MEDLINE | ID: mdl-30202194

ABSTRACT

Objective: The New York City's Thrive (ThriveNYC) and the Los Angeles County Health Neighborhood Initiative (HNI) are two local policies focused on addressing the social determinants of behavioral health as a preventive strategy for improving health service delivery. On January 29, 2016, leaders from both initiatives came together with a range of federal agencies in health care, public health, and policy research at the RAND Corporation in Arlington, Virginia. The goal of this advisory meeting was to share lessons learned, consider research and evaluation strategies, and create a dialogue between stakeholders and federal funders - all with the purpose to build momentum for policy innovation in behavioral health equity. Methods: This article analyzes ethnographic notes taken during the meeting and in-depth interviews of 14 meeting participants through Kingdon's multiple streams theory of policy change. Results: Results demonstrated that stakeholders shared a vision for behavioral health policy innovation focused on community engagement and social determinants of health. In addition, Kingdon's model highlighted that the problem, policy and politics streams needed to form a window of opportunity for policy change were coupled, enabling the possibility for behavioral health policy innovation. Conclusions: The advisory meeting suggested that local policy makers, academics, and community members, together with federal agents, are working to implement behavioral health policy innovation.


Subject(s)
Delivery of Health Care , Health Policy/trends , Mental Health , Policy Making , Quality Improvement/organization & administration , Social Determinants of Health , California , Community Participation , Delivery of Health Care/methods , Delivery of Health Care/standards , Humans , Mental Health/standards , Mental Health/trends , New York City , Social Determinants of Health/standards , Social Determinants of Health/trends
9.
J Am Acad Child Adolesc Psychiatry ; 57(6): 438-439, 2018 06.
Article in English | MEDLINE | ID: mdl-29859560

ABSTRACT

The clinical guidance based on the research article, "Specific Components of Pediatricians' Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Improvement," published in the June 2017 issue,1 might be premature. The authors, Epstein et al., suggest that "Physicians do not need to necessarily rely on office visits to monitor medication response and side effects in the week(s) after initially prescribing medication, but instead could use phone calls or email correspondence to check in with the family" (p. 489). However, this advice has the potential to be misinterpreted that phone or email contact is acceptable clinical practice to monitor stimulant medication safety and efficacy, especially during the maintenance phase. It also could be erroneously interpreted that phone or email contact is sufficient for follow-up care for children receiving medication treatment for attention-deficit/hyperactivity disorder (ADHD) for national quality measures.


Subject(s)
Central Nervous System Stimulants , Office Visits , Pediatricians , Practice Guidelines as Topic/standards , Attention Deficit Disorder with Hyperactivity , Central Nervous System Stimulants/therapeutic use , Child , Humans , Patient Safety , Practice Patterns, Physicians'/standards
10.
J Fam Pract ; 64(4): 232-7, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25973454

ABSTRACT

Consider CBT for patients who you suspect have anxiety or trauma-related disorders. The benefits of this short-term, goal-oriented approach are detailed in this review and in the accompanying evidence-based table.


Subject(s)
Cognitive Behavioral Therapy , Family Practice , Mental Disorders/therapy , Patient Selection , Humans
11.
Motiv Interviewing ; 1(1): 7-15, 2012 Jan 01.
Article in English | MEDLINE | ID: mdl-23789116

ABSTRACT

Evidence-based practices, such as motivational interviewing (MI), are not widely used in community alcohol and drug treatment settings. Successfully broadening the dissemination of MI will require numerous trainers and supervisors who are equipped to manage common barriers to technology transfer. The aims of the our survey of 36 MI trainers were: 1) to gather opinions about the optimal format, duration, and content for beginning level addiction-focused MI training conducted by novice trainers and 2) to identify the challenges most likely to be encountered during provision of beginning-level MI training and supervision, as well as the most highly recommended strategies for managing those challenges in addiction treatment sites. It is hoped that the findings of this survey will help beginning trainers equip themselves for successful training experiences.

14.
Arch Gen Psychiatry ; 66(8): 906-14, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19652130

ABSTRACT

CONTEXT: Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes. OBJECTIVE: To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study. DESIGN: Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input. SETTING: A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita. PARTICIPANTS: Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination. MAIN OUTCOME MEASURES: Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources. RESULTS: Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately. CONCLUSIONS: Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.


Subject(s)
Delivery of Health Care/organization & administration , Disaster Planning/organization & administration , Disasters/statistics & numerical data , Health Care Costs/statistics & numerical data , Mental Disorders/rehabilitation , Relief Work/economics , Relief Work/statistics & numerical data , Adult , Child , Costs and Cost Analysis/statistics & numerical data , Cyclonic Storms/economics , Cyclonic Storms/statistics & numerical data , Decision Support Techniques , Delivery of Health Care/economics , Disaster Planning/economics , Disasters/economics , Female , Health Services Accessibility/organization & administration , Humans , Life Change Events , Male , Markov Chains , Mental Disorders/psychology , Mental Disorders/therapy , Needs Assessment/statistics & numerical data , Outcome Assessment, Health Care , Rescue Work/economics , Rescue Work/statistics & numerical data , Stress Disorders, Post-Traumatic/psychology , Survivors/psychology , Survivors/statistics & numerical data , United States
17.
Psychiatr Serv ; 58(1): 100-8, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17215419

ABSTRACT

OBJECTIVE: The study examined whether a managed behavioral health care organization (MBHO) shifted treatment costs. METHODS: Four years of claims data (1991-1995) from an insurer that introduced an MBHO in 1992 to control treatment costs were analyzed. Although the MBHO was not at direct financial risk for specialty mental health treatment, it faced incentives related to reputation and contract renewal to shift costs to primary care treatment or prescription drugs. It was hypothesized that if cost shifting occurred, an increase would be noted in the use of psychotropic medications without concurrent use of specialty mental health treatment. Simple t tests and a generalized estimating equations probit specification were used to test this hypothesis. Separate tests were performed for use of any psychotropic medication, any newer antidepressant, and any stimulant in a large employer group that simultaneously implemented parity coverage (75,360 enrollees) and a group of smaller employers that did not (9,228 enrollees). RESULTS: The use of any psychotropic medication rose 64% in relative terms (p<.001) over the four-year period among enrollees of the large employer group and by 87% in the smaller groups (p<.001). In general, there were downward secular trends in the use of psychotropic medications without specialty care. Introduction of the MBHO was not significantly associated with the use of psychotropic medication alone. For newer antidepressants, introduction of the MBHO was associated in the large group with a 2.4 (p=.003) absolute percentage point decrease in medication use alone. CONCLUSIONS: No evidence was found to suggest that the MBHO shifted treatment costs.


Subject(s)
Drug Therapy/statistics & numerical data , Health Care Costs , Health Maintenance Organizations/economics , Health Maintenance Organizations/organization & administration , Mental Disorders/economics , Mental Disorders/therapy , Mental Health Services/economics , Mental Health Services/organization & administration , Adult , Cost Allocation , Cost-Benefit Analysis , Drug Therapy/economics , Female , Humans , Male , Mental Disorders/drug therapy , United States
18.
Am J Psychiatry ; 163(4): 579-85, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16585430

ABSTRACT

OBJECTIVE: Stimulant medications, such as methylphenidate and amphetamines, are commonly prescribed to treat attention deficit hyperactivity disorder. Stimulant use increased fourfold from 1987 (0.6%) to 1996 (2.4%) among subjects 18-year-old and younger in the U.S. The aim of this study was to determine whether pediatric use of stimulants continued to rise during the period 1997-2002. METHOD: The Medical Expenditure Panel Survey (MEPS) database for the years 1997-2001 was analyzed. The MEPS is a yearly survey of a nationally representative sample of civilian, noninstitutionalized U.S. households, conducted by the U.S. Agency for Health Care Research and Quality. Previously reported estimates from the 1996 MEPS and the 1987 National Medical Expenditure Survey, the predecessor to MEPS, were also replicated to compare recent trends to changes between 1987 and 1996. RESULTS: The prevalence use of stimulants among subjects under 19 years of age was 2.7% (95% C.I. 2.3-3.1) in 1997 and 2.9% (95% C.I. 2.5-3.3) in 2002, with no statistically significant change during these 6 years. Likewise, when pooling data across years and comparing the rate in 1997-1998 (2.8%) with the rate in 2001-2002 (3.0%), no statistically significant changes emerged. Use was highest among 6-12 year olds (4.8% in 2002), as compared with 3.2% among 13-19 year olds and 0.3% among children under 6. An estimated 2.2 million (95% C.I. 1.9-2.6) children received stimulant medication in 2002 as compared to 2.0 million (95% C.I. 1.7-2.3) in 1997. CONCLUSIONS: The steep increase in the utilization of stimulants among children 18 years and younger that occurred over the 1987-1996 period attenuated in the following years through 2002, and has remained stable among very young children.


Subject(s)
Central Nervous System Stimulants/therapeutic use , Adolescent , Age Distribution , Age Factors , Amphetamines/therapeutic use , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Child, Preschool , Drug Utilization/statistics & numerical data , Drug Utilization/trends , Female , Health Services Research/statistics & numerical data , Humans , Male , Meta-Analysis as Topic , Methylphenidate/therapeutic use , Practice Patterns, Physicians'/statistics & numerical data , Prevalence , United States/epidemiology
19.
J Am Acad Child Adolesc Psychiatry ; 45(3): 271-279, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16540811

ABSTRACT

OBJECTIVE: A threefold increase in the use of antidepressants has been reported among children (18 years old and younger) between 1987 (0.3%) and 1996 (1.0%). The aim of this study was to determine whether pediatric use of antidepressants continued to rise at a national level during the period 1997-2002. METHOD: The Medical Expenditure Panel Survey (MEPS) database for the years 1997-2002 was analyzed. The MEPS is a yearly survey of a nationally representative sample of civilian, noninstitutionalized U.S. households, conducted by the U.S. Agency for Healthcare Research and Quality. Overall response rate ranged between 64% and 68%. RESULTS: An estimated 1.4 million (95% confidence interval [CI] 1.1-1.7) children received antidepressant medication in 2002 as compared to 0.9 million (95% CI 0.7-1.2) in 1997 (p = .01). The percentage of users increased from 1.3% (95% CI 0.9-1.6) in 1997 to 1.8% (95% CI 1.5-2.1) in 2002 (p < .01). Adolescent use (2.1% in 1997 versus 3.9% in 2002 (p < .001) accounted for the increase, with no change among children younger than 13 years. Also among adolescents, the use rate remained stable during the 2000-2002 period. The increase was caused by use of selective serotonin reuptake inhibitors and other newer antidepressants, whereas use of TCAs remained stable in adolescents (p = .84) and declined in prepubertal children (p = .04). Antidepressant use was similar among males and females and higher among whites than blacks and Hispanics. CONCLUSIONS: Nationwide, the use of selective serotonin reuptake inhibitor antidepressant medications continued to increase in adolescents in the late 1990s and until the year 2000, with no further increase through 2002, and remained stable in prepubertal children.


Subject(s)
Antidepressive Agents/therapeutic use , Depression/drug therapy , Depression/epidemiology , Drug Utilization/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Humans , Incidence , Infant , Male , Prevalence , United States/epidemiology
20.
Am J Psychiatry ; 163(1): 28-40, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16390886

ABSTRACT

OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression, but the rates, timing, and baseline predictors of remission in "real world" patients are not established. The authors' primary objectives in this study were to evaluate the effectiveness of citalopram, an SSRI, using measurement-based care in actual practice, and to identify predictors of symptom remission in outpatients with major depressive disorder. METHOD: This clinical study included outpatients with major depressive disorder who were treated in 23 psychiatric and 18 primary care "real world" settings. The patients received flexible doses of citalopram prescribed by clinicians for up to 14 weeks. The clinicians were assisted by a clinical research coordinator in the application of measurement-based care, which included the routine measurement of symptoms and side effects at each treatment visit and the use of a treatment manual that described when and how to modify medication doses based on these measures. Remission was defined as an exit score of or=50% in baseline QIDS-SR score. RESULTS: Nearly 80% of the 2,876 outpatients in the analyzed sample had chronic or recurrent major depression; most also had a number of comorbid general medical and psychiatric conditions. The mean exit citalopram dose was 41.8 mg/day. Remission rates were 28% (HAM-D) and 33% (QIDS-SR). The response rate was 47% (QIDS-SR). Patients in primary and psychiatric care settings did not differ in remission or response rates. A substantial portion of participants who achieved either response or remission at study exit did so at or after 8 weeks of treatment. Participants who were Caucasian, female, employed, or had higher levels of education or income had higher HAM-D remission rates; longer index episodes, more concurrent psychiatric disorders (especially anxiety disorders or drug abuse), more general medical disorders, and lower baseline function and quality of life were associated with lower HAM-D remission rates. CONCLUSIONS: The response and remission rates in this highly generalizable sample with substantial axis I and axis III comorbidity closely resemble those seen in 8-week efficacy trials. The systematic use of easily implemented measurement-based care procedures may have assisted in achieving these results.


Subject(s)
Citalopram/therapeutic use , Depressive Disorder, Major/drug therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , Adolescent , Ambulatory Care , Chronic Disease , Comorbidity , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Male , Mental Disorders/epidemiology , Middle Aged , Personality Inventory , Psychiatric Status Rating Scales/statistics & numerical data , Secondary Prevention , Treatment Outcome
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