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

Racial and ethnic minoritized (REM) youth are at greater risk for depression and suicide than their White peers. Despite this, REM youth are much more likely than their White peers to prematurely dropout of treatment. Culturally tailored and scalable engagement models to improve mental health treatment retention among REM youth with depressive symptoms and suicidal thoughts and behaviors (STB) are urgently needed. Strategic Treatment Assessment for Youth (STAY) is a theoretically-driven, culturally tailored measurement-based care (MBC) approach to treatment engagement for REM youth with depressive symptoms and suicide risk. Specifically, STAY uses MBC feedback processes to reduce perceptual barriers to treatment, thus improving treatment retention and ultimately, client outcomes among REM youth. In addition to standard MBC components, STAY includes a greater emphasis on providing a client-centered rationale for MBC which includes assessing and discussing treatment expectations, the use of individualized progress measures and alliance measures, and cultural competence training. The goal of this manuscript is to describe the STAY model based on initial theoretical development and preliminary clinician-informed refinements. Further, a case example of STAY is presented with a particular focus on the use of feedback processes. Finally, the current and future directions to empirically examine STAY as a treatment retention strategy with REM populations are provided.

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.

Measurement-based care (MBC) is an evidence-based practice (EBP) focused on regularly administering outcome measures to clients to inform clinical decision making. While MBC shows promise for improving youth treatment outcomes, therapist adoption remains low. Clinical consultation is one strategy that improves MBC implementation, but our limited understanding of consultation hinders the ability to optimize its impact. This research explored the content of, and techniques used during MBC consultation calls. Therapists (N = 55) in a randomized controlled trial treating adolescents with anxiety and/or depression were trained to utilize MBC with usual treatment using the Youth Outcome Questionnaire (YOQ) through an online measurement feedback system (MFS). Weekly ongoing consultation followed an initial workshop training in MBC. Case discussions (N = 294) during consultation calls were coded using a developed codebook, including 12 content and 10 consultant techniques. Results indicated that content focused predominantly on interpretation of client symptom and alliance report, planning for YOQ administration, and discussion of data with clients in session. Common consultant techniques included modeling and eliciting report viewing and interpretation, making clinical suggestions, and didactics about clinical and technical issues. Notably, role-play/behavioral rehearsal was not used. The prevalence of passive consultation techniques (suggestions, didactics) suggests a focus on teaching rather than active techniques (behavioral rehearsal, modeling), potentially influenced by the novelty of MBC and MFS. Technical aspects of MBC, such as measure administration and system usage, emerged as key consultation content, highlighting an unanticipated emphasis on logistics over clinical implementation. These findings underscore the evolving role of consultation in supporting MBC implementation and suggest that addressing technical challenges early in training might enhance adoption.

Individual Placement and Support (IPS), an evidence-based supported employment model for working-age adults with serious mental illness, also serves transition age adults (TAY; ages 16-24). The IPS-Y is a new IPS fidelity scale tailored to this younger population. Although adopted worldwide, it lacks research on the psychometric properties of its two components (employment and education). Six IPS programs serving TAY were assessed on IPS-Y (Employment) in an initial review (Time 1) and on both components in a second review one year later (Time 2). We examined scale calibration, reliability, and validity for the IPS-Y in this sample. Fidelity reviewers use the full range of ratings, from "not IPS" to "exemplary," on both IPS-Y components. On the employment component, item calibration was excellent; internal consistency reliability was good at Time 1 (r = .81) and test-retest reliability was fair (r = .63). The IPS-Y (Employment) showed excellent sensitivity to change, with the mean scale score increasing from 88.3 to 105.5. IPS-Y (Employment) item ratings at Time 2 were similar to corresponding items in a sample of conventional IPS programs using the standard IPS fidelity scale. Predictive validity was promising for both components, with fidelity scale ratings positively correlated with site-level competitive employment rates (r = .57) and education enrollment rates (r = .69). IPS can be implemented to good fidelity for programs serving TAY. Preliminary findings regarding the psychometric properties of the IPS-Y Employment are encouraging, but replication in larger samples is needed.

To identify patterns of medication adherence during the pandemic and factors associated with these patterns among Medicaid-enrolled individuals with schizophrenia who had highly adherent medication use prior to the COVID-19 pandemic. We used Medicaid claims from Philadelphia to identify individuals with schizophrenia ≥ 18 years of age, their demographic characteristics, and health service use. We used group trajectory models to identify adherence trends, and ANOVA to examine associations between adherence groups and demographic characteristics and service use. The sample included 1,622 individuals. A 4-group trajectory model best fit our data. Seventy percent of individuals averaged about 92% adherence throughout the study period; 10% experienced a pronounced decline when the pandemic started (pandemic non-adherers); 11% experienced a sharp decline mid-pandemic (late non-adherers); and 9% experienced a sharp decline at the beginning of the pandemic and returned to higher adherence after a year (disrupted adherers). Adherers were least likely to be diagnosed with a substance use disorder, and had more telehealth visits, mental health outpatient visits, and fewer emergency department visits on average. Late non-adherers were more likely than adherers to have substance use disorders and physical health conditions. Pandemic non-adherers had more co-occurring psychiatric disorders than adherers and had the lowest use of case management. Three in ten previously adherent individuals with schizophrenia became less adherent to antipsychotic medications, either at the onset or later in the pandemic. Our findings point to telehealth and case management as critical strategies for treatment engagement, especially during public health crises, and well as the need to address co-occurring conditions.

In recent years, there has been increased support for the use of coercive policies to address the seemingly intractable problem of homelessness among people with mental disorders in North America. Although these policy approaches respond to a critical issue, rising rates of unsheltered homelessness, low service engagement and concerns about disruptive behaviors in public settings, they are unlikely on their own to be successful. To avoid coercive practices, there is an urgent need to consider alternative, person-centred approaches to promote service engagement among people experiencing homelessness and mental disorders, with input from those with lived experience and frontline homeless service providers. Three person-centred approaches are proposed for consideration: (1) cross-sectoral service delivery models, (2) peer-led services, and (3) financial incentives. These approaches merit further study to support voluntary treatment engagement and exits from homelessness among people with mental and substance use disorders and safeguard the human rights of this population.

In response to the COVID-19 public health emergency, state and local mental health authorities rapidly developed and disseminated guidance to community mental health agencies. While tailored communication is effective to reach target audiences under usual circumstances, strategies to facilitate the implementation of guidance amidst a rapidly evolving public health emergency are not well understood. This project sought to understand factors informing decision-making about adaptations to guidance, and strategies used to disseminate and facilitate guidance implementation among system-level community partners in OnTrackNY Coordinated Specialty Care (CSC) programs for early psychosis. Semi-structured interviews were conducted with New York State Office of Mental Health (NYS OMH) state and local mental health authorities including state leaders (n = 3) and NYS OMH field office directors (n = 4), OnTrackNY program directors (n = 4), and leadership and trainers of an intermediary organization, OnTrack Central (n = 12). Interviews were analyzed using content analysis. Code reports relevant to guidance decision-making and dissemination were reviewed to identify emerging themes. For state and local mental health authorities, decision-making was influenced by changing COVID-19 risk levels, need for alignment between federal and local guidance, and balancing support for workforce capacity and mental health service continuity. For OnTrackNY program directors, decision-making was influenced by internal infrastructure and processes (e.g., program autonomy), availability of resources (e.g., technology), and perspective on managing risk and uncertainty (e.g., COVID-19, regulatory waiver expiration). For OnTrack Central, decision-making focused on balancing CSC model fidelity with OnTrackNY team capacity and resources. Dissemination of guidance consisted of mass and targeted strategies. Information flow was bidirectional such that top-down dissemination of guidance (e.g., from state mental health authorities to providers) was informed and refined with bottom-up feedback (e.g., from providers to state leadership) through surveys and professional forums (e.g., COVID-19 town halls, provider learning collaboratives). Unlike a planned approach to disseminate new policies, public health emergencies create variable landscapes that may warrant a deeper understanding of how guidance may be adapted to fit rapidly evolving community partner needs. Findings may inform efforts to identify processes that contribute to adaptation and dissemination of guidance for mental health during future public health emergencies.