Community Mental Health Journal最新文献

While shared decision-making (SDM) is widely recognized as a reference model in adult psychiatry, its implementation in youth psychiatry remains under-explored, despite the specific challenges inherent to this field. This exploratory qualitative study investigates how child and adolescent psychiatrists describe and adjust their decision-making practices in clinical care, including their attitudes, strategies, and perceived limits of SDM. Sixteen semi-structured interviews were conducted with youth psychiatrists via videoconferencing. Data were analyzed using thematic analysis. Five overarching themes were developed : (1) the perceived benefits of SDM, such as improved adherence and engagement; (2) a dynamic continuum of decision-making practices, from full collaboration to ethically guided protective decisions; (3) the role of parents as co-participants in the decision-making process; (4) the modulation of the clinician-patient relationship along a vertical-horizontal axis; and (5) contextual influences, including institutional constraints and limited resources. Psychiatrists generally support SDM as a desirable framework. However, their accounts point to a broader and more flexible continuum of practices, in which the degree of sharedness varies depending on factors such as the young person's age, developmental stage, illness severity, crisis situations, and parental involvement. Some practices described by clinicians fall outside strict definitions of SDM and belong instead to the domain of substituted or protective decision-making. These findings invite a nuanced and context-sensitive understanding of decision-making in youth psychiatry.

Patients with methamphetamine use disorder (MaUD) face social, financial, and systemic barriers to accessing evidence-based addiction treatment. We designed a care navigation intervention to better engage patients with MaUD in treatment after an acute care encounter. This intervention was modeled after linkage-to-care strategies for infectious diseases and emphasized rapport building, trauma-informed care, and practical assistance in overcoming barriers to treatment. We also added elements of contingency management given its treatment efficacy with MaUD. We describe the development of the care navigation model, characteristics and care needs of subjects receiving the intervention, and intervention engagement outcomes. Among 94 patients who received this intervention as part of a randomized controlled trial, 64% were considered engaged with at least 2 or more visits with the care navigator Patients had substantial barriers to care-85% of patients were not stably housed, 83% were unemployed, and 46% lacked access to a phone-and the most common domains of need were accessing addiction treatment, housing resources, or communication needs such as a phone or interpreter services. This intervention poses a model for connecting patients with MaUD to treatment after acute care encounters.

Culturally responsive peer support services can improve access to and engagement with substance use and mental health services among Latinx persons, but how to implement a culturally responsive peer support program in a Spanish-speaking peer-run behavioral health organization is unclear. This qualitative study used the Consolidated Framework for Implementation Research (CFIR) to explore determinants for implementing a culturally responsive peer support program. We conducted 14 interviews with peer support program leadership, Certified Peer Specialists (CPS), and CPS supervisors about implementation of and experience with the peer support program. Interviews were conducted and analyzed in Spanish and English using constant comparative methods and organized according to the CFIR. Key CFIR elements included: (1) Intervention characteristics: a culturally responsive approach that alleviated stigma while celebrating recovery culture and Latinx peer culture; (2) Outer setting: outside of the study setting, barriers to accessing behavioral health care were driven by cultural differences between providers and clients; (3) Inner setting: A robust model of culturally responsive and linguistically appropriate peer-to-peer supervision and a built environment that fosters a mutual aid-oriented organizational culture; (4) Individuals involved: supervision strengthens CPS knowledge and skills to deliver peer support; (5) Implementation Process: despite organizational supports, CPS work is emotionally draining. Future studies should explore the scalability of the supervision model and other implementation supports described here, using a culturally responsive lens.

During the perinatal period, many parents experience mental health difficulties of varying severity, which have been associated with adverse outcomes. Examples include perinatal obsessive-compulsive disorder (OCD) which can be thought to exist on a continuum from subclinical symptoms (e.g., intrusive thoughts (ITs)) to clinical diagnosis of OCD. Similarly postpartum psychosis can range from subclinical 'psychotic like experiences' (PLEs) to clinical diagnosis. These disorders are distinct conditions, yet some argue an overlap or comorbidity in symptoms, including co-occurrence postnatally, and they are therefore explored in tandem in this study. Limited literature explores these difficulties in community perinatal populations, and less is known about distress, or potential associations with parenting experiences. A cross-sectional, quantitative design was applied. Participants were parents in the postnatal period (12 months after birth); they completed an anonymous, online survey, exploring experiences of ITs, PLEs, parenting (perceived competence and stress) and mental health (depression, anxiety, and stress). Of 349 participants, 96% reported at least one IT, 90.8% reported associated distress and 95% engaged in behaviours to cope. Considering PLEs, 89% experienced at least one PLE, 88.8% reported associated distress and 30.4% could be considered 'at-risk' for developing psychosis. Distressing ITs and PLEs were significantly associated with lower perceived competence and satisfaction, increased parenting stress and mental health symptoms, although this relationship was indirectly mediated by depression and anxiety. Males reported more ITs, parenting stress, depression, anxiety, and lower perceived competence than females. More research is needed to better understand ITs and PLEs across and beyond the perinatal period.

Place-based health interventions are becoming popular in public health, but have been less common in behavioral health services. This study implemented mental health screenings with a total of 195 individuals across seven laundromats in Texas from March 2024-April 2025 to examine the potential to treat laundromats as a new, unique setting for place-based behavioral health interventions. The sample of laundromat users was screened for Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) and asked about their receptiveness to receiving healthcare interventions in laundromats. Multivariable analyses were conducted to examine individual characteristics associated with positive screens for MDD and AUD. Results found that 19.9% of laundromat users screened positive for MDD, which was comparable to county, state, and national estimates. However, 17.4% screened positive for AUD, which was higher than state and national estimates. The majority of the sample was Hispanic, had less than a college education, and reported annual incomes below $50,000. Laundromat users who were aged 60 years or older or who reported financial barriers to healthcare were significantly more likely to screen positive for MDD. Of the total sample, 83 (42.6%) completed a 1-month follow-up assessment and were re-screened for MDD and AUD which revealed no significant changes in rates of either disorder. Generally, participants reported a positive experience with the screenings in laundromats and reported being receptive to receiving other healthcare interventions in laundromats. In conclusion, this study found that providing health screenings in laundromats may reach underserved individuals. Laundromats may serve an important setting for further interventions after screenings.

Tobacco use among individuals with behavioral health conditions is higher than in the general population and a leading cause for morbidity and early mortality. This study examines a value-based payment (VBP) model to incentivize provision of tobacco cessation counseling (TCC) and pharmacological treatment with varenicline among 38 behavioral health homes (a person-centered approach to coordinating comprehensive healthcare in behavioral health service settings for individuals with chronic behavioral and physical health conditions) within a non-profit Medicaid behavioral health managed care network utilizing the Behavioral Health Home Plus (BHHP) model. Pre-post comparisons indicate that rates of filled varenicline prescriptions increased in the BHHP population from 10.01 per 1,000 service users to 19.01 per 1,000 service users following implementation of the VBP (p < .0001). Comparisons with other in-network behavioral health service users without BHHP or VBP indicate higher receipt of TCC (p < .0001) and varenicline (p < .0001) among the BHHP VBP group. This study provides some evidence that value-based purchasing may be used to incentivize provider agencies with behavioral health homes to increase access to tobacco cessation treatment for individuals with behavioral health conditions.

This study aimed to evaluate the effectiveness of a CHIME-based psychoeducational group intervention on personal recovery in individuals diagnosed with schizophrenia. A randomized controlled trial with a pretest-posttest design was conducted between January and July 2024. A total of 60 participants receiving services from a Community Mental Health Center and meeting the inclusion criteria were randomly assigned to either the intervention group (n = 29) or the control group (n = 30). The intervention group participated in a structured "CHIME-Based Psychoeducation Program" comprising seven weekly sessions, each lasting approximately 60 min. Outcome measures included the Subjective Recovery Assessment Scale (SRAS), Psychological Resilience Assessment Scale (PRAS), and Schizophrenia Hope Scale (SHS). Assessments were conducted at baseline, post-intervention, and three-month follow-up. Both groups continued to receive standard community mental health services throughout the study. Statistical analyses included descriptive statistics, Chi-square tests, Mann-Whitney U tests, Friedman tests, and intention-to-treat (ITT) analysis for handling missing data. Accordingly, the CHIME-Based Group Psychoeducation Program can be considered an effective intervention to enhance personal recovery, psychological resilience, and hope. ClinicalTrials.gov Identifier number is NCT06284096.