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

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.

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.