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

Routine outcome monitoring (ROM) involves the systematic recording of patient-reported outcome measures to monitor treatment progress and outcomes within psychotherapy. It represents an evidence-based approach to enhance psychotherapeutic treatment outcomes. However, it remains a rather controversial topic among mental health care professionals (MHP), resulting in its limited use in clinical practice, especially in inpatient settings. This qualitative interview study aimed to gain a comprehensive understanding of MHP attitudes towards ROM and its implementation within psychotherapeutic inpatient settings in Germany. In this study, semi-structured interviews were conducted with MHP working in the psychotherapeutic inpatient setting in the German healthcare system. Three independent researchers inductively coded the data, and thematic codebook analysis was used to evaluate the data iteratively. In total, 20 participants (14 medical doctors, and 6 clinical psychologists) with varying levels of working experience participated in the present study. The general attitude towards ROM and its implementation was predominantly positive, with ROM being perceived as a helpful feature to support psychotherapeutic inpatient treatment. However, possible pitfalls requiring careful consideration were highlighted, such as the risk of potential misuse and additional workload. The insights of the present study contribute to the ongoing discourse of ROM in mental health care. The study highlights the importance of proper implementation strategies and transparent communication regarding the relevance, aims, and use of ROM. Moreover, it highlights potential risks and perceived disadvantages associated with ROM, which may be related to implementation barriers and possible negative attitudes among MHP.

Strategies are urgently needed to address the mental health workforce crisis in the United States that threatens essential care for people living with psychiatric disabilities. Assertive Community Treatment (ACT) is a cornerstone of community mental health care and workforce turnover negatively impacts patient experiences and outcomes. The present study aims to examine malleable supervisory strategies for reducing the intention to leave among the ACT workforce in order to reduce voluntary turnover. A cross-sectional observational survey of the largest sample yet of ACT team members (N = 334) from 80 ACT teams working in four States assessed team-level and team members’ supervision characteristics theorized to predict supervisory working relationships and team members’ intention to leave their positions. Unadjusted and adjusted hierarchical linear regression models examined factors at multiple levels (i.e., team member, team) in relation to team members’ intention to leave and accounted for the clustering of team members within teams. Adjusted models indicated that team member and team factors were negatively associated with team members’ intention to leave. Specifically, higher levels of transformational leadership and strong supervisory working alliances had a significant association with reduced intention to leave. Additionally, empirically supported supervision strategies and transformational leadership were significantly associated with stronger supervisory working alliances. Strategic workforce investment in the development of ACT team leaders and their use of transformational leadership and empirically supported supervision strategies may represent a promising pathway to promote strong supervisory working alliances and retention of essential ACT team members.

Feasibility, the degree to which an innovation is successfully carried out in a given setting, is key to whether an intervention will be implemented as planned and is connected to implementation success and service outcomes. In settings with limited resources, feasibility may be a particularly important determinant of whether an intervention is adopted and/or sustained over time. However, there is limited consensus on how to define, measure, and report feasibility in research conducted in community mental health settings. Following guidance from Arksey and O’Malley (2005), Levac et al. (2010), and Westphaln et al. (2021), the current scoping review aims to synthesize how trials conducted in community mental health settings describe the rationale, definition, measurement approach, and results of feasibility. The search included articles from Medline, PsycInfo, CENTRAL, Global Health, and Global Index Medicus and was conducted in September 2023. Included articles referenced feasibility and had each of the following: (1) delivery of an evidence-based psychotherapy (EBP) in a community mental health setting, (2) participants with elevated mental health symptomatology, and (3) implementation and/or clinical outcomes. Through data extraction, data synthesis, and qualitative content analysis, the authors identified feasibility definitions, measures, results, and explanations as well as intervention characteristics. Sixty-one articles across 20 countries were included. Articles included a wide range of EBPs delivered to individuals across the life span in community mental health settings. While all studies reported some level of feasibility of an intervention or trial, only 60.7% described a rationale for examining feasibility, 11.5% defined feasibility, 73.8% measured feasibility, and 67.2% reported descriptive statistics to accompany the level of feasibility found. Our results highlight the lack of clear and consistent rationales, definitions, measurement approaches, and results of feasibility in research conducted in community mental health settings. To improve the conceptualization and study of feasibility, we propose guidelines for future researchers to consider when examining feasibility. The guidelines include providing a clear definition of feasibility (i.e., the extent to which an EBP is possible in a certain context; Proctor et al., 2011), combining reflective and formative measures of feasibility to assess how feasible an intervention is and why it is deemed feasible (respectively), considering when in the implementation process researchers are engaged, involving multiple voices in the measures of feasibility, and exploring the impact of feasibility on other implementation outcomes as well as clinical outcomes.

Serious workforce shortages in youth mental health widen the gap between demand and use, and exacerbate health disparities. A strategy to address this is training and integrating youth and young adult (Y/YA) peers to deliver services. This paper reviews international scientific studies on Y/YA services targeting mental health conditions or health promotion. We applied systematic criteria including controlled designs (RCTs or quasi-experimental), active intervention delivered by a young person, key search terms, and peer-reviewed publication between 2012 and 2023. The review yielded 32 studies meeting criteria, encompassing six domains: eating disorders, health promotion, depression/anxiety, suicidal risk, serious mental illness (SMI) and “other.” The most consistent evidence for effectiveness was for eating disorders; findings in the other domains were mixed. Training manuals, fidelity measurement, reporting of demographic data, and consistency in outcome measurement were largely absent, limiting both replicability and generalizability. The acceleration of scientific attention to youth/young adult peer services over the past decade and emerging support for its effectiveness is encouraging, however, and it bodes well for mitigating workforce shortages and, more importantly, for improving the quality of services for young people.

Assessing client needs is integral to improving outcomes in community mental health services, yet tools to evaluate the extent to which needs are met remain underutilized. This study examines patterns of met needs and disparities across sociodemographic groups using the Ontario Common Assessment of Need (OCAN), a standardized tool adapted from the Camberwell Assessment of Need (CAN) and widely implemented in Ontario, Canada. Specifically, we applied the Ontario Modified Met Needs Index (OMMNI), a ratio-based metric, to measure the extent to which identified needs were addressed over the course of care. Using longitudinal OCAN data from 4,537 clients engaged in assertive community treatment, case management, early psychosis intervention, and supportive housing programs, we calculated OMMNI scores based on both staff- and client-completed assessments. Results showed that 74% of staff-identified needs and 72% of client-identified needs were met or remained met. At the domain level, safety-related needs had the highest rates of being met (≥ 85%), while sexual expression, intimate relationships, company, daytime activities and psychological distress were least consistently addressed (< 70%). Disparities in staff assessments were observed for younger clients and those with unspecified service languages, while disparities in client assessments were noted for clients identifying as transgender or non-binary. These findings underscore variability in addressing diverse client needs, highlighting opportunities to enhance person-centered care. The OMMNI holds potential as a practical tool for measuring met needs, identifying disparities, informing service planning, and supporting quality improvement. Further validation is needed to ensure its applicability across populations and service contexts.

Autistic youth often experience co-occurring mental health needs, yet they have multi-level barriers to accessing needed care. To address these barriers, the ATTAIN NAV (Access to Tailored Autism Integrated Care through Family Navigation) intervention was co-designed with caregiver and healthcare partners and delivered by lay health navigators to facilitate access to and engagement with mental health services for school-age autistic youth. This manuscript describes the multi-method, partner-engaged, longitudinal adaptation process to (1) identify intervention content and implementation refinements prior to the hybrid trial and (2) track ongoing research, intervention, and implementation adaptations during the trial and their impacts on study outcomes. The adaptation processes used the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (Miller et al., 2021) to guide data collection and evaluation approaches. From the qualitative co-design activities with caregivers (n = 5), primary care providers (n = 6), developmental care clinicians (n = 4), and health informatics staff (n = 3), several intervention content and implementation adaptations were identified and integrated prior to the trial. From the longitudinal adaptation tracking process during the trial, a total of 19 adaptations were documented throughout the implementation trial. The adaptations were related to maintaining the feasibility and acceptability of the study procedures (32%), increasing family recruitment/engagement (26%), increasing the acceptability of the intervention components (16%), increasing physician recruitment/engagement (11%), expanding mental health resources (5%), complying with partnered healthcare organization policy (5%), and increasing navigator workflow efficiency (5%). Findings offer a structured and replicable approach adoptable by non-traditional mental health intervention and implementation research.

Childhood anxiety imposes substantial economic burdens on families, schools, and medical services. Interventions to reduce anxiety may be economically valuable, particularly if they can be delivered at low cost. This study examined the cost-effectiveness of two school nurse-delivered anxiety interventions for elementary school children: CALM (Child Anxiety Learning Modules, cognitive behavioral skills) and CALM-R (relaxation skills). In this pilot randomized controlled trial (RCT) 30 school nurses delivered CALM or CALM-R to 54 children with elevated anxiety. CALM and CALM-R demonstrated intervention affordability, with nurse training and nurse delivery costs at $560 and $630 respectively per child. At baseline, we found significant economic resources used by school systems, families, and health systems to support students with anxiety ($3,660-$5,350 per child). At three-month follow-up, total resource use– including intervention costs and all other services -- was lower for children in CALM but higher for CALM-R. For CALM, the implementation cost was more than offset by subsequent resource savings. Moreover, at three month follow up, responder status per child was higher for CALM (60%) than for CALM-R (35%). Thus, CALM students required fewer resources and experienced greater clinical benefits than students in CALM-R. Incremental Cost-Effectiveness Analysis showed that CALM was more cost-effective than CALM-R: the cost per incremental responder student was $6,291 lower. CALM has a high probability of acceptance across all positive values of willingness to pay for anxiety reduction. Evidence from this study indicates that cognitive behavioral skills delivered by school nurses may offer a cost-effective response to childhood anxiety.

Trained non-specialist providers (NSPs), with no formal degree in mental healthcare, can deliver effective psychotherapies for task-sharing. Clinical supervision is important in this process to facilitate quality-assured psychotherapy. We explored three group supervision models within a large, multi-site trial that leveraged NSPs to deliver a brief psychotherapy. In-depth, semi-structured interviews with NSPs (n = 15) explored facilitators and barriers of group supervision models in a stepwise approach, that progressed from expert-led to peer-led, with monthly measurement-based supervision throughout. A focus group on measurement-based supervision was also conducted with clinical experts who provided supervision (n = 4). Qualitative data were analyzed using content and thematic analysis. In expert-led supervision, perceived facilitators among NSPs (n = 15) included educational and professional development (n = 14/15, 93.33%), emotional support (n = 11/15, 77.33%), and expert advice in specific delivery techniques (n = 4/15, 26.67%). A barrier was scheduling (n = 6/15, 40.00%). In peer-led supervision, perceived facilitators among participating NSPs (n = 12) included learning opportunities with peers from diverse backgrounds (n = 10/12, 83.33%), fostering peer connections (n = 9/12, 75.00%), and professional growth (n = 6/12, 50.00%). Barriers included reduced structure (n = 6/12, 50.00%) and attendance (n = 3/12, 25.00%). In measurement-based supervision, reported facilitators included listening to peer’s audio-recorded sessions (n = 14/15, 93.33%), receiving and providing feedback (n = 13/15, 86.67%), and the supervision model’s structure and tools (n = 5/15, 33.33%). Barriers included low self-ratings (n = 12/15, 80.00%) and initial uncertainty on how to provide constructive feedback (n = 6/15, 40.00%). These facilitators and barriers were also reported by the clinical experts (n = 4). Our results highlight the need to produce clear and concrete guidelines to facilitate peer-led and measurement-based supervision, which will support the implementation of task-sharing.

Autistic youth have a high co-occurrence of mental health challenges and a resultant high need for mental health treatment. However, they experience mental health service disparities compared to non-autistic youth. Social determinants of health (SDH) may contribute to mental health service disparities among autistic youth, yet this has not been previously examined. Therefore, the present study utilized a validated composite of children’s SDH to examine whether autistic youth with better SDH were more likely to use psychotherapy services compared to those with poor SDH using state-level records of insurance billing claims data (2019 All-Payer Claims Database). 700 autistic youth with a co-occurring mental health condition were included in analyses. One or more claim records for psychotherapy CPT codes were used as indicators of psychotherapy service use. SDH was assessed using the Childhood Opportunity Index, a continuous composite measure of neighborhood SDH. The predictive effect of SDH on psychotherapy use were examined, while examining covariates of insurance type and age. Approximately 70% of the sample did not use any psychotherapy services. Inconsistent with findings from non-autistic samples, autistic youth’s SDH did not predict their likelihood of using psychotherapy services; rather, those with low and high opportunity alike did not access psychotherapy. Age increased the likelihood, and using Medicaid decreased the likelihood of psychotherapy service use. These results may highlight the compounded barriers to psychotherapy that autistic youth may experience, including the paucity of mental health providers who accept Medicaid and accept autistic youth clients.

One school psychologist is recommended for every 500 students; in practice there is ~one school psychologist for every 1,500-2,000 students. Care extenders can help decrease the number of students needing one-on-one support by implementing universal mental health prevention and promotion practices. Their impact and success relies on empirically informed models for workforce support. The present study extends partnership with City Year Miami, an education non-profit that supports students in low-performing public schools to stay on-track and on-time to graduation. We delivered four weekly 1-hour sessions of Cognitive Triangle training (i.e., brief training applying the Triangle to promote staff and youth emotional well-being) to their AmeriCorps Members (ACMs, n = 19) and collected three sources of data: (1) pre-training quantitative survey data (n = 14 to inform qualitative inquiry), (2) training-generated data (e.g., attendance, text nudge replies), and (3) post-training semi-structured interviews with ACMs (n = 13, ~60 min). We used theoretical thematic analysis to explore, “What will it take to infuse mental health knowledge into routine practice?” informed by the Consolidated Framework for Implementation Research emphasis on provider characteristics and perceptions of mental health knowledge. Results illustrate the interplay between innovation and individual characteristics for infusing knowledge into student support routines. Discussion points to findings advancing the science of transportability and workforce support.