Administration and Policy in Mental Health and Mental Health Services Research最新文献

The Research-to-Practice Gap often hinders the translation of effective healthcare interventions from clinical trials to routine care. Individual Placement and Support (IPS), an evidence-based practice designed to help individuals with mental health conditions achieve and maintain employment, has notably bridged this gap. Unlike many interventions that struggle with widespread implementation, IPS has successfully scaled to over 2,000 programs across all U.S. states and 30 other countries. This paper examines the strategies that have facilitated the rapid and extensive adoption of IPS, offering insights into best practices for integrating randomized controlled trial (RCT) findings into everyday clinical settings. Key factors contributing to the success of IPS include conducting RCTs in settings with real-world patients and clinicians, fostering collaboration through the International IPS Learning Community, developing comprehensive implementation materials and a dynamic fidelity scale, and engaging in regular, systematic meetings with stakeholders such as providers, advocates, and policymakers. These approaches have ensured that IPS remains adaptable, responsive to patient needs, and maintains fidelity to its core principles while promoting continuous improvement. The experience with IPS underscores the importance of integrating real-world evidence with clinical practice through ongoing collaboration among all stakeholders. The principles underpinning IPS-real-world application, stakeholder engagement, and adaptability-provide a model that could guide future efforts to close the research-to-practice gap across diverse healthcare settings and interventions.

This paper examines the frequency of post-traumatic stress disorder (PTSD) and factors associated with mental health counseling utilization among adult refugees and asylum-seekers in Malaysia. Participants (n = 286) were recruited using venue-based random sampling from three health clinics in 2018. Framed by Andersen's model of health care utilization, we used a multilevel logistic regression and hypothesized that predisposing factors (female, older age, not married, higher education, lived longer in Malaysia, registered refugee), greater enabling factors (easy access to healthcare, larger household income, not needing interpreter, health literacy, larger household), and greater need factors (higher PTSD symptoms) would be associated with counseling attendance. We found one-third (34.3%) of participants screened positive for PTSD and most (71.9%) never attended counseling services. Our hypothesis was partially supported. Older age was associated with counseling attendance [OR:1.03 (95% CI:1.00,1.06)]. Enabling factors associated with counseling attendance include easy access to a health facility [OR:9.82 (95% CI:3.15,30.59)] and not needing interpreter services [OR:4.43 (95% CI:1.34,14.63)]. Greater need factor/PC-PTSD score [OR:0.69 (95% CI:0.52,0.91)]; however, was associated with lower counseling attendance. Other predisposing/enabling/need factors did not show significant associations. Understanding factors associated to care can benefit health clinics address gaps in counseling utilization for refugees and asylum-seekers in Malaysia.

Government of New Brunswick implemented One-at-a-Time (OAAT) therapy, a single-session approach to care, within Addiction and Mental Health (A&MH) services. We conducted interviews to understand determinants of implementation from program champions. Champions of the OAAT therapy implementation (N = 19; Child/Youth n = 8, Adult n = 11) working within A&MH services and school districts were recruited through the provincial implementation team. Transcripts were synthesized using thematic analysis. Determinants were organized as facilitators and barriers in accordance with the Consolidated Framework for Implementation Research (CFIR). Thematic analysis resulted in 18 themes and 5 recommendations. Facilitators within the inner setting included: (1) need for change and perceived benefits of OAAT therapy; (2) compatibility of OAAT therapy with previous practice and service processes; and (3) support received from champions and colleagues. Insufficient resources (e.g., staff and physical infrastructure), and a culture that favored long-term therapy were barriers. Navigating age of consent, and implementation around COVID-19 were barriers within the outer setting. Facilitators within the implementation process domain included: (1) interconnected teams across sites, regions and the province; (2) collaborative implementation planning; (3) flexibility to tailor implementation at sites; and (4) mentorship provided by champions. Insufficient standardization of the implementation and limited representation among affected parties (e.g., community partners) were barriers within the implementation process. This study elucidated determinants that influenced implementation of a new service delivery within an Eastern Canadian provincial health care system. Findings can serve as a heuristic for organizations looking to enact similar implementation initiatives.

Peer roles have increased within mental health and alcohol and other drug services. However, there is a lack of understanding about the 'lived experience' necessary for success in these roles and how to recruit effectively. This study explores participants' views on the essential knowledge and skills derived from lived experience to inform the design of peer roles and support effective recruitment. This qualitative study involved 132 participants employed across five multi-disciplinary organizations in the United States. Participants represent three cohorts: designated peer workers, management, and colleagues in other roles. Fourteen focus groups and eight individual interviews were conducted, with separate focus groups for peers, colleagues in non-designated roles, and management. Findings indicate essential aspects of lived experience comprise three domains: life-changing or life-shaping individual experiences (including intersectionality); common impacts of adverse experiences, identification as a peer, and understanding and application of the collective peer thinking and values; and ultimately, Lived Expertise, a unique, experientially developed knowledge base and set of skills that can benefit others. The study identifies Lived Expertise as a unique combination of individual and collectively derived experiential knowledge. Understanding what comprises Lived Expertise can guide the design of roles and improve recruitment strategies, thereby enhancing the effectiveness of roles and support for the peer workforce. This study offers a model for understanding Lived Expertise that can be readily applied in developing recruitment materials, including position descriptions.

Many Veterans who complete prolonged exposure (PE) or cognitive processing therapy (CPT) report residual symptoms, but it is unclear how to best address the mental health needs of these individuals. Examining patterns of mental health service utilization following completion of these two treatments may provide insight into how to best serve this group of individuals. In a large cohort of Veterans (N = 12,514) who sought treatment in the Veterans Health Administration during Fiscal Years 2015-2019, logistic regression models were used to assess the odds of initiating an additional course of trauma-focused (i.e., PE or CPT) or depression-focused psychotherapy in the year following completion of PE or CPT based on demographic, psychiatric, and treatment effectiveness-related variables. Approximately 9% of Veterans engaged in either trauma-(6%) or depression-(3%) related psychotherapy in the year following discharge from PE or CPT. Factors associated with increased odds of trauma-focused treatment initiation included having a sleep disorder diagnosis (OR = 1.23), a substance use disorder diagnosis (OR = 1.27), or experiencing military sexual trauma (OR = 1.64). Factors associated with increased odds of depression-focused treatment initiation included having a depression diagnosis (OR = 2.02). This study suggests that certain subgroups of Veterans who engage in PE or CPT (e.g., Veterans with comorbid sleep or substance use problems) are more likely to seek additional evidence-based treatment and may require augmentations to maximize clinical benefits, either during the initial course of treatment or subsequent to PTSD treatment.

Developing tailored implementation strategies to increase the use of evidence-based practice (EBP) requires accurate identification of predictors of their use. However, known difficulties with measuring EBP use complicates interpretation of the extant literature. In this proof-of-concept study, we examined whether the same predictors of use of cognitive behavioral therapy (CBT) are identified when CBT use is measured with clinician self-report compared to direct observation. We examined four candidate predictors of CBT use - clinician participation in an EBP training initiative, years of experience, caseload, and employment status - in a sample of 36 clinicians (64% female; 72% White and 28% Black) from 19 community mental health agencies treating youth in greater Philadelphia. CBT use was captured for 100 unique client sessions (M = 2.8 recorded sessions per clinician) through both clinician self-report and direct observation, using parallel measures. We used three-level (client, clinician, and agency) regression models with random intercepts to estimate the relationship between each predictor variable and CBT use in both measures and compared the magnitude and direction of each model across self-report and direct observation using z-tests. There was no alignment for any of the four candidate predictors between predictive relationships identified by self-report compared to those identified by direct observation. The findings in this study extend literature documenting limitations of using clinician self-report to capture clinician behavior and suggest that even the characteristics that predict higher self-reported CBT use do not align with (and often are discordant with) those that predict directly observed CBT use. This raises questions about the utility of relying on self-reported use to inform implementation strategy design.

Mental disorders impact approximately one-third of the global population, affecting adults, children, and youth worldwide. Recently, electronic mental health (e-mental health) technologies have been proposed to facilitate the provision of mental health care by professionals and other stakeholders, aiming to address the challenges associated with delivering mental health services. The objective of this study was to investigate the existing factors influencing engagement with e-mental health technologies. This study was a systematic review of existing reviews conducted in 2024. PubMed, Scopus, ProQuest, and Cochrane databases were searched. The authors assessed the quality of the studies using the CASP (Critical Appraisal Skills Programme) Checklist. Subsequently, they extracted and analyzed the data, utilizing the Boyatzis thematic analysis approach. The systematic review resulted in 15 papers, all of which exhibited an acceptable level of quality and risk of bias. The thematic analysis classified the data into five main themes: 'Technical', 'Ethical and Legal', 'Clinical', 'Organizational', and 'Social'. The study underscored the significance of ensuring accessibility, affordability, and reimbursement to effectively engage patients with e-mental health services. Additionally, transparency-facilitated by self-certification and user involvement-alongside critical factors like informed consent and privacy safeguards, was presented as playing a pivotal role in the process. Moreover, facilitators, including tailored interventions that consider the specific needs of particular groups and temporary project teams composed of individuals working together on specific initiatives, were identified as essential contributors. Overall, the factors influencing engagement with e-mental health technologies and potential solutions for enhancing such engagement appear to be interconnected.