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

Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color.

There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all.

Objective and Aim

This study aimed to assess the impact of switching from face-to-face (f2f) psychotherapy to video therapy (VT) due to the COVID-19 pandemic on in-session processes, i.e., the therapeutic alliance, coping skills, and emotional involvement, as rated by both patients and therapists.

Methods

A total of N = 454 patients with mood or anxiety disorders were examined. The intervention group (IG) consisted of n = 227 patient-therapist dyads, who switched from f2f to VT, while the control group (CG) consisted of n = 227 patient-therapist dyads, who were treated f2f before the pandemic. To evaluate the effects of switching to VT on in-session processes, three longitudinal piecewise multilevel models, one per process variable, were fitted. Each process variable was regressed on the session number with a slope for the three sessions before switching to VT and a second slope for up to six VT sessions afterwards.

Results

The therapeutic alliance significantly increased after switching from f2f to VT across the two groups (IG and CG) and raters (patients and therapists) with no differences between IG and CG. On average, patients rated the therapeutic alliance better than therapists. Coping skills significantly increased after switching from f2f to VT across the two groups and raters, but the CG rated coping skills higher than the IG after the switch. Overall, therapists rated coping skills higher than patients. Emotional involvement did not significantly increase after switching to VT across the two groups and raters and there was no significant difference between patient and therapist ratings.

Discussion

In conclusion, the switch to VT had no negative impact on the therapeutic alliance and emotional involvement. However, more coping skills were reported in the CG than in the IG after the switch to VT, which was mainly due to a stagnation in patient-rated coping skills in the IG.

Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined.

Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system’s infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state’s interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers’ implementation of autism EBPs within EI systems.

Previous research indicates that youth exhibiting antisocial behavior are at risk for utilizing a disproportionate amount of health services compared to youth without these problems. The present study investigates whether being processed by the juvenile justice system and showing callous-unemotional (CU) traits independently predict health service utilization (medical and mental health service use and out-of-home placement) over and above the severity of antisocial behavior across adolescence. A total of 766 participants who had been arrested for the first time in adolescence provided data at ten appointments over a period of seven years. Results showed that self-reported antisocial behavior at the time of arrest predicted increased use of most health service use types over the next seven years (i.e. medicine prescriptions, tests for sexually transmitted infections, mental health service appointments, and out-of-home placements). All except prescription medication use remained significant when controlling for justice system processing and CU traits. Further, justice system processing added significantly to the prediction of medical service appointments. Whereas CU traits were associated with mental health service appointments and out-of-home placements, these did not remain significant when controlling for severity of antisocial behavior. These findings are consistent with prior research documenting the health care costs of antisocial behavior.

Burnout is a syndrome characterized by mental and emotional fatigue or exhaustion, depersonalization, and a lessened sense of personal accomplishment and efficacy. Burnout leads to negative consequences for mental health clinicians and for mental health care organizations. Measurement-based care (MBC) is a clinical process in which clinicians and clients use patient-generated data, also called treatment feedback, to collaboratively monitor mental health care and to inform goal-setting and treatment planning. We propose that MBC may improve the experience of care for both clients and clinicians, and ultimately protect against each of the three components of burnout. When combined with other organizational changes, adoption of MBC may support organizational level efforts to reduce burnout in mental health services.

A growing body of evidence demonstrates potential adverse mental health outcomes associated with exposure to occupational trauma among first responders. In response, policymakers nationwide are eager to work on these issues as evidenced by the number of states covering or considering laws for mental health conditions for first responders. Yet, little information exists to facilitate understanding of the impact of mental health-related policies in the United States on this important population. This study aims to identify and synthesize relevant state-level policies and related research on first responder mental health in the United States. Using a scoping review framework, authors searched the empirical and policy literature. State level policies were identified and grouped into two categories: (1) Workers’ Compensation-related policies and (2) non-Workers’ Compensation (WC) related policies. While benefits levels and other specifics vary greatly by state, 28 states cover certain first responder mental health claims under WC statutes. In addition, at the time of this study, 28 states have policies governing first responder mental health outside of WC. Policies include requiring mental health assessments, provisions for counseling and critical incident management, requiring education and training, providing funding to localities for program development, bolstering peer support initiatives and confidentiality measures, and establishing statewide offices of responder wellness, among others. Authors found a dearth of outcomes research on the impact of state level policies on first responder mental health. Consequently, more research is needed to learn about the direct impact of legislation and establish best practice guidelines for implementing state policy on first responder mental health. By conducting systematic evaluations, researchers can lay the foundation for an evidence-based approach to develop more integrated systems that effectively deliver and finance mental health care for first responders who experience work-related trauma. Such evaluations are crucial for building an understanding of the impact of policies and facilitating improvements in the support provided to first responders in managing mental health challenges arising from their work.

Psychotherapists’ attitudes and expectations towards routine outcome monitoring can impact the likelihood of its fruitful implementation. While existing studies have predominantly focused on Europe and North America, research in Latin America remains limited. The aim of this study is to explore therapists’ expected benefits and difficulties prior to implementing a routine outcome monitoring system in a university psychotherapy service in Ecuador. An exploratory and descriptive cross-sectional qualitative study was carried out with 20 participants aged 21 to 47. Semi-structured interviews were conducted to explore participants’ knowledge about routine outcome monitoring, their expectations of the difficulties, benefits, usability and risks of using a monitoring system, as well as their expectations about their role in the process. The data analysis adhered to the framework analysis methodology, leading to the identification of six overarching themes, 36 specific themes and 82 subthemes. The interviews highlighted a spectrum of positive and negative expectations at several levels: institutional/general, therapeutic process, therapists, and clients. Perceived benefits encompassed various aspects, including the availability of supplementary information, continuous adaptation of the therapeutic process, facilitation of organization and treatment planning, opportunities for professional development, and fostering patient trust and empowerment. On the other hand, anticipated difficulties comprised concerns such as discomfort among therapists and clients, increased workload, system usage and technical difficulties, and the risk of excessive quantification. Overall, participants expressed more anticipated benefits than difficulties. We present recommendations that can support and optimize the current local implementation efforts of routine outcome monitoring, both within this service and in other settings. These recommendations consider ways to meet positive expectations and address or mitigate negative ones.