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

Mental health task sharing, which involves delegating select mental health tasks to non-licensed providers in social service settings, has been used globally and in the U.S. to improve access to and uptake of mental health care. This study aimed to identify barriers and facilitators to effective implementation of mental health task sharing in community-based organizations mainly serving older Chinese adults, a fast-growing older immigrant population with a high prevalence of unmet mental health needs. Semi-structured interviews were conducted in 2023 with 30 service providers from 17 community-based social service organizations in New York City that had implemented mental health task-sharing initiatives since 2016. Interview data were analyzed by two coders using the framework method, a systematic approach for managing and interpreting qualitative data through coding, charting, and thematic analysis, with codes reflecting key domains in the Consolidated Framework for Implementation Research (CFIR). Codes were further analyzed for the factors’ positive or negative influence on implementation. Key barriers to the implementation of mental health task sharing included limited mental health resources, varying levels of staff mental health competencies, and insufficient financial incentives for social service organizations to provide mental health care. Facilitators to mental health task sharing implementation included supportive leadership, training, cross-system collaborations between mental health specialists and social service providers, and close teamwork between administrators and frontline providers in social service organizations. Study findings highlight the importance of more systematically integrating mental health and social care and of using culturally tailored strategies to engage different populations in care.

To improve access to mental health care for children and adolescents, it is necessary to identify the barriers faced by their caregivers. The aim of this study is to identify these barriers in Greece and to investigate the reliability and validity of the modified version of the Barriers to Access to Care Evaluation scale (BACE) - the BACE Proxy Report (BACE-PR). A total of 265 caregivers who reported that their offspring had mental health difficulties completed the BACE-PR. Descriptive statistics were used to identify the major barriers to accessing care. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate the factor structure of the instrument. Item parameters were assessed via Item Response Theory. Interpretability was assessed by linking summed scores to IRT-based scores. Caregivers reported care costs, their willingness to resolve problems on their own, and their own concern that their children might be seen as weak, as the major barriers to services access. Obsessive compulsive symptoms and self-harm were the conditions for which caregivers reported the highest level of barriers. EFA and CFA suggested that a one-factor solution fit the data well (RMSEA = 0.048, CFI = 0.991, TLI = 0.990). Internal consistency was found to be high (ω = 0.96). Average z-scores provided five meaningful levels of caregivers’ perceived barriers compared to the national average. Caregivers face a variety of barriers to access mental health care for their children, and this could partly explain the treatment gap in the Greek mental health sector. Our study provides evidence for the reliability and validity of the BACE-PR scale, which can aid to identify caregiver-perceived barriers and to design interventions to improve access to mental health care.

Workforce shortages and other barriers have undermined efforts to address recent spikes in youth behavioral health problems. This study evaluates Washington State’s Behavioral Health Student Assistance Program (BH-SAP), a novel approach to addressing the youth behavioral health crisis by using paraprofessional-delivered services in schools to expand the continuum of services available to youth. During the 2022-23 school year, 60 Student Assistance Specialists (SASs) delivered 3,218 prevention activities, provided group interventions to 1,158 students, and served 2,532 students with individual interventions, though there was substantial variation in the relative rates of BH-SAP activities across Washington’s nine regional Educational Service Districts. Students receiving group and individual interventions reported significant improvements in hope, social connection, mental health agency, and reductions in internalizing symptoms and behavioral incidents, with small to moderate effect sizes (d = 0.23–0.39). Over 96% of N = 1,061 students who completed surveys reported the program was helpful. Students served by SASs who demonstrated greater adherence to the state’s BH-SAP fidelity rubric showed greater improvements than those from lower-adherence providers. Results show that paraprofessionals, when properly trained and supervised, can effectively expand the workforce and extend the reach of evidence-based interventions in schools, and that a consistently implemented student assistance program can provide a promising strategy to address the youth mental health crisis.

Peer recovery specialists (PRS) are increasingly recognized as key members of the substance use disorder (SUD) treatment workforce. Recent efforts have focused on expanding PRS roles to include the delivery of behavioral evidence-based interventions (EBIs), such as motivational interviewing, cognitive-behavioral therapy techniques, and brief interventions. This scoping review aims to identify the determinants that influence the implementation of PRS-delivered behavioral EBIs and the strategies used to optimize their delivery within diverse SUD treatment contexts. A systematic search was conducted in APA PsycINFO, Web of Science, Scopus, PubMed, and Google Scholar, following PRISMA-ScR guidelines. Studies were included if they examined PRS delivering behavioral EBIs for SUD and reported on at least one implementation outcome as defined by Proctor et al. (2011). Data extraction and thematic synthesis were conducted using a hybrid deductive-inductive coding framework. Twelve studies met inclusion criteria. The most commonly studied interventions included behavioral activation, motivational interviewing, and Screening, Brief Intervention, and Referral to Treatment (SBIRT). PRS-delivered behavioral EBIs demonstrated high acceptability, appropriateness, and feasibility, with strong participant engagement and satisfaction. Facilitators of implementation included the integration of PRS within existing service structures, the adaptability of interventions, and the unique relatability of PRS. Barriers included PRS role ambiguity, gaps in training, and systemic challenges such as lack of funding and limited access to adjunctive support services. Implementation outcomes such as adoption, sustainability, and cost were infrequently assessed, highlighting gaps in the current literature. The findings suggest that PRS-delivered behavioral EBIs hold promise in expanding access to evidence-based care for individuals with SUD. However, structured training, supervision, and organizational support are critical for successful implementation. Future research should prioritize evaluating long-term sustainability, supervision, and strategies to enhance the integration of PRS within healthcare systems. Incorporating methods to address systemic barriers faced by service recipients will be essential for maximizing the impact of PRS-delivered interventions in SUD treatment.

While treatment adherence is often considered necessary for optimal clinical outcomes, adherence to evidence-based practices (EBPs) may be poorer in usual care (UC) than in research settings. Practical, accurate adherence monitoring tools may enhance EBP delivery in UC. We examined the psychometric properties of the Cognitive and Behavioral Therapy Adherence Measure (CBTAM), a multi-informant (provider, caregiver, youth) measure of provider adherence to the core components of cognitive and behavioral therapy (CBT) for youth anxiety, depression, and behavior problems. Providers (N = 28, M 29.46 years old; 75% female; 82.14% White; 7.40% Latinx), youths (N = 46, M 11.34 years old, 54.35% male; 58.70% White; 6.52% Latinx) and their caregivers (N = 41, M 42.63 years old; 92.68% female; 73.17% White; 9.76% Latinx) rated provider adherence to CBT following each treatment session. Coders rated a subset of treatment sessions using the CBTAM and established observational coding systems for CBT adherence and alliance. Provider, caregiver, and youth CBTAM ratings evidenced full range, but were generally higher than coder ratings. Caregivers and youths were concordant with coders on a few items, while providers were concordant on most items. Provider CBTAM ratings were also correlated with similar items on observational measures, and these correlations were higher than correlations with dissimilar items, demonstrating convergent and discriminant validity. There is initial support for the provider CBTAM as a session-level measure of CBT adherence for common youth mental health problems. Further research is needed to evaluate the CBTAM’s reliability and clinical utility in community settings. 

Individuals from minoritized and under-resourced communities have significantly less access to specialized services from substance use disorder. Peer recovery specialists (PRSs) show promise for increasing access to services, especially in low-resource settings, but have not historically been trained to deliver evidence-based interventions (EBIs). While behavioral activation (BA) has shown promise as a PRS-delivered EBI, few studies have examined broader training efforts that may inform the scale-up of this model. This study describes the co-development (including PRSs and community-based treatment providers) and dissemination of a BA training for PRSs. The initial training was piloted with five PRSs, who provided qualitative feedback on training content and delivery. The revised training was then delivered to 168 PRSs. Post-training, participants completed implementation outcome measures assessing feasibility, acceptability, and appropriateness. A follow-up survey was sent within six months to assess continued use and perceptions of BA. Qualitative feedback identified BA as feasible for PRS delivery and appropriate for the PRS role, and identified ongoing supervision and experiential learning as key needs for PRS training. PRSs who received the revised training found it to be feasible, appropriate and acceptable. Follow-up surveys suggest PRSs continued to use BA skills and found it was a good fit to their role and feasible for their work situation. PRS-delivery of EBIs has the potential to increase access to treatment for individuals from low-resource communities. With appropriate modifications for the unique needs of this workforce, PRSs can be trained on a large-scale to deliver BA.

The United States (US) faces a mental health crisis characterized by persistent unmet mental health needs, provider shortages, and pronounced mental health inequities for systematically marginalized communities, including the Latine population. Integrating community health workers (CHWs) into mental healthcare delivery via task-shifting is one promising approach to address longstanding inequities in treatment access. Yet, most studies of CHW mental health models have been conducted outside of the US, necessitating an evaluation of the evidence base for these models domestically, and in particular, their use with Latines living in the US. This systematic review examines the evidence for CHW-delivered mental health interventions for US-based Latines. In total, 27 articles (25 trials) met the eligibility criteria. The majority of interventions were delivered in Spanish to immigrant populations. The most common mental health targets included depression, stress, and parenting or the parent–child relationship. Common intervention components included psychoeducation, general coping skills, behavior management, case management, communication skills, relaxation, and problem solving. The majority of studies found that CHW-delivered interventions led to significant mental health symptom improvements. However, there was a high risk of bias across studies. Thus, there is promising preliminary evidence supporting CHW-delivered mental health interventions for US Latines, but more rigorous evaluation of these models is needed.

Rural children in mainland China, particularly those whose parents migrate for economic opportunities, face distinct mental, emotional, and behavioral (MEB) challenges. With few mental health professionals available to address rural student’s MEB needs, task-shifting approaches that rely on teacher-led interventions, such as the evidence-based Social and Emotional Learning (SEL) program, are a promising alternative. However, little is known about the implementation determinants of teacher-led SEL programs in rural China, a key gap for sustaining and scaling effective programs. The present study qualitatively explored the contextual determinants of implementing the Positive Growth Curriculum (PGC), an efficacious, teacher-led SEL program delivered to 648 fifth graders in two rural schools in southwest China. We conducted in-depth interviews with all N = 15 schoolteachers and administrators who implemented PGC, with questions guided by the Consolidated Framework for Implementation Research. Interviews were audio recorded and two independent coders conducted Rapid Qualitative Analysis. Codes were organized into four major themes detailing how contextual determinants shaped the acceptability, appropriateness, feasibility, fidelity, and sustainability of PGC. Findings indicated that innovation facilitators, e.g., relative advantage, low complexity, intervention design, and perceived effectiveness, facilitated PGC acceptability and appropriateness (Theme 1) and implementation strategies, e.g., training, facilitation and champions, were vital for ensuring fidelity (Theme 2). However, despite high teacher motivation and buy-in, feasibility and sustainability were threatened by inner setting pressures and administrative burdens that prioritize student’s academic success over their SEL (Theme 3) and a lack of community buy-in and low governmental funding for SEL initiatives, two outer setting determinants (Theme 4). These barriers led some teachers to question if they are the optimal deliverers for SEL curricula. Potential PGC adaptations are discussed, as are possible implementation strategies and adjunctive interventions to sustain and scale effective teacher-led programs that can support rural students’ MEB health and academic success.

To develop screening guidelines, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) Evidence to Decision (EtD) framework recommends careful assessment of both test accuracy and the downstream consequences of screening. To tailor recommendations to a specific context, GRADE EtD recommends ensuring that all assumptions and inputs on which the original recommendations are based are appropriate to the novel setting. Perinatal depression screening offers a notable example where evidence-based screening guidelines are recommended at a national level, yet implementation necessarily occurs in specific contexts. Methods to examine the generalizability of assumptions underlying screening recommendations are needed. The GRADE EtD framework demonstrates how local prevalence can be combined with evidence on screening sensitivity and specificity to estimate the number of true positive, false positive, true negative, and false negative results. In turn, these estimates can be linked to evidence of benefit and harm, such as potential benefits from treatment or stigma from false positive identification. To estimate benefit at a local level, we developed a simulation model that expresses prevalence as a function of sensitivity, specificity, and the proportion of patients who screen positive. We then identified published systematic reviews and meta-analyses of (a) perinatal depression prevalence, (b) screening accuracy, (c) implementation of screening in clinical settings. We then used a participatory form of simulation modeling to estimate prevalence at a local level—a necessary first step to evaluation net benefit—and to explore alternative hypotheses through sensitivity analyses. We identified meta-analyses of prevalence and screening accuracy, as well as 14 screening studies with data sufficient to inform key questions. Simulation models estimated local prevalence as a function of positive screening rates and published estimates of sensitivity and specificity. These prevalence estimates displayed marked heterogeneity, including frequent implausible impossible values (e.g., prevalence < 0%). Findings suggest that screening data are insufficient to estimate local prevalence and that sensitivity and specificity are not stable properties of screening questionnaires. Instead, study-level differences in context may be influential, such as variation in patients’ willingness to disclose depression symptoms across settings. Results highlight the opportunity for simulation modeling to inform evidence synthesis and decision-making.