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

The interpretation of effectiveness research can be enhanced by understanding what prescribed (i.e., adherence) and non-prescribed (i.e., differentiation) techniques were delivered. However, few measures exist that can assess both adherence and differentiation. The current study examined how the Therapy Process Observational Coding System for Child Psychotherapy Revised Strategies Scale (TPOCS-RS) can assess adherence to and differentiation from family therapy for youth with externalizing problems. Treatment sessions (N = 103) from 42 adolescents (M age = 15.0, SD = 1.4; 47.6% female; 59.5% Hispanic/Latinx/e, 19.0% Black, 11.9% multiracial, 4.8% other race) with primary externalizing problems treated by 24 clinicians (M age = 33.2, SD = 8.3; 66.7% female; 33.3% Hispanic/Latinx/e, 20.8% White, 12.5% Asian, 8.3% multiracial, 8.3% other race) in routine practice settings were coded with the TPOCS-RS. Treatment sessions were from three groups: (a) routine family therapy, (b) routine family therapy plus the medication integration protocol, or (c) usual care. Interrater reliability for the TPOCS-RS Family Therapy subscale was ICC = 0.90, and scores demonstrated evidence of convergent and discriminant validity via associations with treatment integrity and alliance measures. The TPOCS-RS Family Therapy subscale also demonstrated evidence of discriminative validity by identifying expected group differences. Results provide preliminary evidence that the TPOCS-RS can measure adherence to and differentiation from family therapy.

Designing mental health services that align with individual preferences is a cornerstone of patient-centered care, enhancing both service utilization and treatment outcomes. This study applied the precision framework of mental healthcare to explore preferences for first-contact mental health services among community residents and family members with mild psychiatric symptoms in Chinese megacities. Using a discrete choice experiment, an online survey was conducted with 4,057 participants from Beijing, Shanghai, Guangzhou, and Shenzhen. Mixed logit analysis identified service providers as a key determinant of mental health service utilization across cities. While both potential patients and family members favored lower-cost public services, notable variations emerged in preferences for psychological counseling/therapy across cities and between patient and family contexts. Latent class analysis further revealed four distinct preference groups among potential patients. Psychological distress levels and hukou type were significantly associated with preferences. These findings highlight the importance of tailored interventions that accommodate patient and family needs, leveraging the unique features of China’s mental healthcare system to improve access, quality, and equity in mental health services.

Peers are individuals with lived experience of mental health challenges trained to provide support to others with similar challenges. Help@Hand was a multi-site project that integrated peers into digital mental health intervention (DMHI) implementation. This study uses the Consolidated Framework for Implementation Research (CFIR) to frame challenges reported by peers when implementing DMHIs. Individuals leading the local peer workforce completed quarterly online surveys about perceived challenges to DMHI implementation. Biannual interviews probed for details on survey-reported challenges. 103 quarterly surveys and 39 bi-annual interviews were collected from key informants at 11 Help@Hand sites between Summer 2020 and Fall 2022. One challenge was tied directly to DMHIs; namely, device distribution. Several related to the Implementation Process, including challenges with recruiting qualified peers and integrating peers into DMHI implementations; communication and collaboration; and translation. Challenges in the Individual domain included unclear peer roles and multi-tasking across various projects. Inner Setting challenges included structural barriers to hiring peers, issues with communication and project management, and workforce turnover. Outer Setting challenges related to environmental technology readiness, COVID-19, unclear decision-making processes across the collaborative, and uneven communication between sites’ peers. Funding uncertainty bridged the Inner and Outer Settings. Using the CFIR model to frame challenges to DMHI implementation yielded useful lessons, especially when peers are engaged as partners in planning and implementation process. Successful implementation will be enhanced by ensuring adequate environmental readiness for tech-based interventions, clear role definition, streamlined peer hiring processes, and well-delineated lines of communication locally and across sites.

The goal of this paper is to explore the experiences of formerly incarcerated people navigating mental health care post-release and understand how mistrust of mental health services and providers is manifested among this population. Interviews were conducted between 2021 and 2022 with 25 people released from incarceration within the past five years. We partnered with community organizations to recruit a diverse sample of participants, using voluntary response and purposive sampling. The interview transcripts were coded using a modified grounded theory approach and the analysis further guided by critical phenomenology in order to center silenced or marginalized perspectives. Mistrust of mental health care was a prominent theme across interviews. Overall, participants felt that they did not have autonomy over their treatment planning and management. Participants described experiencing stigmatizing treatment from providers, suspicion of mandated mental health treatment, and believing that profit over patients was prioritized in the industry–all of which contributed to growing mistrust of the larger mental health system. The participants’ experiences of losing control over their lives and treatment, compounded by a perceived complicity between mental health and carceral systems, shaped their mistrust toward mental health care. Nevertheless, many demonstrated remarkable persistence in seeking care and engaging with multiple providers, while also actively seeking to reclaim their autonomy.

Maternal depression has been associated with negative parenting behaviors and poor developmental outcomes in children. Home visiting programs have positively impacted parenting behaviors and child outcomes; however, such programs often require specialized, highly trained professionals, resulting in a limited number of home visiting providers. One home visiting parenting program, Attachment and Biobehavioral Catch-up (ABC), does not have requirements regarding experience or background to become an ABC parent coach and deliver the intervention. ABC consists of ten 1-hour weekly sessions for parents of children between 0 and 6 months (ABC-Newborn), 6–24 months (ABC-Infant) or 24–48 months (ABC-Early Childhood). ABC has demonstrated efficacy in improving parental sensitivity and children’s developmental outcomes. A randomized clinical trial in one community implementation setting showed that ABC decreased maternal depressive symptoms. The current study aimed to replicate this finding across multiple implementation sites and expand on it by exploring if the effect differed by ABC model. Data included a community sample of 163 families from six countries who completed ABC. Maternal reports of depressive symptoms were collected prior to and after receiving ABC. Results showed a significant decrease in maternal depressive symptoms scores from pre-intervention to post-intervention regardless of ABC model. Findings demonstrate that a home visiting parenting intervention program can successfully leverage non-traditional mental health providers to ensure that mothers and children receive necessary resources and support.

Community Health Workers (CHW) are part of an emerging workforce in the field of mental health, but few studies have examined their training, supervision, and service delivery needs in the United States. Individual semi-structured interviews were conducted with CHWs (n = 9) and their administrators (n = 6) affiliated with a medical center and school districts in Southern California. Guiding questions focused on CHW roles, work-related stress, clinical decision making, and professional development. Findings pointed to high rates of stress, primarily attributed to role ambiguity, and need (and desire) for more training and supervision related to mental health interventions, and more systematic structures for data-informed decision-making. Discussion provides reflections and recommendations to the field about ways to support this growing and critical workforce.

Background

Child and Adolescent Mental Health Services (CAMHS) are expected to track user satisfaction routinely, and to this end, the Experience of Service Questionnaire (ESQ) is increasingly being adopted worldwide. The literature is inconsistent concerning the underlying factor structure of satisfaction measures, and debate is ongoing regarding the evidence of a general satisfaction factor.

Aim

This study aimed to examine the factor structure and dimensionality of the parent/carer and adolescent versions of the ESQ in the UK and Norway.

Methods

Data were retrieved from routine CAMHS clinical practice in the UK and Norway. Three models suggested by the research group were tested through Confirmatory Factor Analysis (CFA) and reliability testing.

Results

A series of CFAs revealed sound psychometric properties of the ESQ in all samples. A bifactor model with a general satisfaction factor and two specific factors of Satisfaction with Care and Satisfaction with Environment fitted the data best, except for the Norwegian adolescent version where a unidimensional model was kept.

Conclusion

The results support the continued use of the ESQ in CAMHS in the UK and Norway and significantly contribute to the literature on user satisfaction by adding evidence of a general satisfaction factor.

Coordinated specialty care (CSC) is considered the gold-standard treatment for individuals experiencing first episode psychosis (FEP). However, CSC teams are resource-intensive, motivating the development of a hybrid delivery approach where community mental health centers (CMHCs) collaborate with an academic medical center to deliver a mix of in-person and virtual services. To inform the development of this hybrid approach, a needs assessment was conducted, evaluating the existing capacity of Ohio CMHCs to treat FEP and identifying barriers to expanded use of telemental health. CMHC administrators throughout Ohio whose agencies primarily provide mental health services were surveyed using a novel instrument. A concurrent mixed methods approach combined multivariable analysis of cross-sectional survey data with thematic coding of responses to open-ended questions. The 56 responding CMHCs on average offered 10.96 of 17 services associated with CSC for FEP. Agency size was positively associated with number of service offerings, but rurality was not. Most agencies perceived gaps in their care for patients with FEP, particularly rural CMHCs. 75% believed that telemental health service expansion would benefit patients. Thematic analysis revealed three success factors for expanded telemental health usage: adapting care to virtual assessment, ensuring patient access, and adjusting workflows for virtual delivery. Responding CMHCs generally agreed that care for individuals with FEP could be improved and saw potential in expanded use of virtual services. Hybrid models may represent a valuable opportunity to overcome conventional barriers to CSC availability, but their development must account for current CMHC resource infrastructure and workflows.

Understanding the perspectives of individuals with mental health concerns and the influence of barriers and facilitators on treatment access can help mental health professionals ensure that those they serve receive needed care. The current study examined these factors in an online survey among 295 adults self-identifying as diagnosed with a mental health condition, which they felt was uncontrolled by intervention or psychiatric medication and impacted their daily lives. Most participants were not receiving psychotherapy or psychiatric medication, although some were accessing care and indicating unmet needs. A majority expressed a desire for more specialized care. Positive perception of providers, higher distress, and greater stigma tolerance were related to greater openness towards receiving psychotherapy and greater openness to psychotherapy, higher distress, and lower perceived barriers were associated with psychotherapy receipt. The relationship between openness towards psychotherapy and receipt was also stronger for those who perceived lower barriers to care. Advocacy and efforts to promote positive attitudes and reduce barriers by mental health practitioners and professional organizations may help support treatment access.