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

This paper explores the impact of an initiative designed to promote trauma resilient communities by mitigating social determinants of health and reducing health disparities through capacity-building partnerships. Nine regional partnerships in Los Angeles County were funded to build community capacity to adapt to and recover from traumatic events through outreach and engagement with community members, training related to the impact of trauma, linkages of community members to existing services, and developing new services for target populations. Primary quantitative and qualitative data on community impact were gathered from agency leads (N = 10), partnership members (N = 136), and community members (N = 42). A convergent sequential mixed methods design (qual → QUAN → qual) was selected to provide both breadth and depth of understanding about the impact of community capacity-building from multiple perspectives. From January 2018 through July 2023, partnerships conducted over 30,000 community capacity-building activities with over 1.4 M community members and created 101,370 successful linkages to resources and services among 12,663 unique community members. Agency leads, partnership members, and community members converged on three main themes describing the initiative's impact: (1) Building more empowered and resilient communities; (2) Normalizing help-seeking and reducing the stigma of mental health; and (3) Connections within partnerships/families and with community members. On average, 82% of partnership members endorsed medium to large positive changes in the impacts identified during qualitative analysis. Future work should examine whether contracting with community-based organizations is an effective approach for health systems to promote health equity.

Youth in foster care are more likely than their peers to require mental health supports to promote their well-being, and this level of need has likely been heightened by individual, familial, system-level, and societal factors arising during the COVID-19 pandemic. These changes have simultaneously produced a shortage in the supply of available community-based providers; a lack of available beds in emergency, inpatient, and residential mental health settings; and staggering delays in the provision of necessary services once such youths' needs are brought to the attention of relevant professionals. As a result, youth have increasingly experienced treatment and placement delays that have resulted in lengthy psychiatric boarding episodes and improper placements in hotels and child welfare offices. This study employed community-based system dynamics and group model-building methods to understand the complex factors and processes that have contributed to treatment access barriers and placement delays for this population. Results suggest that increases in the prevalence of complex mental health needs among children, insufficient preventative and screening resources, low capacity and quality in psychiatric residential treatment facilities, workforce shortages, and ineffective assessment and referral processes exacerbate treatment delays and negatively affect child well-being. The system maps created in this study highlight the need to implement multipronged approaches that concurrently address system capacity and quality issues while also improving pathways to care for children with complex needs.

Psychological trauma is a prevalent mental health concern, with most individuals experiencing at least one traumatic event in their lifetime. Early leaves from inpatient settings are a pertinent challenge among persons who have experienced trauma and may reflect unmet care needs. This study examined patterns of early leaves among persons with trauma from inpatient care in Ontario, Canada. All records for individuals who have experienced trauma with an index admission of over 72 h between January 1, 2015 and December 31, 2019 were included (N = 11,043). Logistic regression using generalized equation estimation was used to assess the association between demographic and clinical characteristics, substance use, social relationships, staff dynamics, and control interventions with the outcome of early leaves. In the final model, alcohol (OR: 1.83, 95% CI: 1.27-2.64), other substances (OR: 2.15, 95% CI: 1.34-3.46), and poly substance use (OR: 2.46, 95% CI: 1.82-3.31) all increased the odds of early leaves after considering possible facility effects, and after adjusting for other demographic and clinical factors. Being older, employed, and having mood disorders reduced odds of early leaves. Early leaves are important within treatment planning, particularly in relation to addressing complex traumas. While challenges related to substance use may be driving some of the early leaves, there may also be challenges to providing complex care within acute mental health settings. Further exploration of policies and practices to prevent early leaves are necessary, including the potential need for longer-term specialized treatment programs.

The needs of youth at-risk and their families, facing multiple problems and serious mental health issues, exceed the expertise and possibilities of a single stakeholder (professional, organization, municipality). These youngsters require care in which the expertise of different professionals and organizations is integrated. However, combining various types of expertise to provide integrated care to youth at-risk is challenging. Therefore, this qualitative study aims to describe how stakeholders approach these challenges when combining different types of expertise to provide integrated care for youth at-risk. In total, 28 in-depth interviews were conducted with stakeholders working in various organizations or municipalities for youth at-risk in The Netherlands. Transcripts were analyzed through reflexive thematic analysis. Reflections from a youth representative were also incorporated. Results reveal challenges at four levels: youth and family, professional, organization, and system. At each level, challenges arise in addressing the exceptional needs and problems of youth at-risk, collaborating with multiple stakeholders, reluctance to apply or involve expertise, and finding sufficient resources to combine expertise. Professionals, organizations, and municipalities approach these challenges with a backward or forward approach: either they accept the situation, focus on their own expertise, leave responsibility to others; or they force their expertise on others, or seek collaboration to combine expertise. Overall, combining different types of expertise to provide integrated care to youth at-risk can be seen as an expertise in itself, and necessitates reflection, awareness, and careful consideration from all stakeholders.

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.