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Andreasen Werner posted an update 2 months ago
Collaborative chronic care models (CCMs) were established with implementation support in nine mental health clinics. This study sought to determine whether their clinical impact was maintained after implementation support ceased.
Posttrial data were analyzed from a randomized stepped-wedge CCM implementation trial in general mental health clinics in nine Department of Veterans Affairs medical centers. Sites received 1 year of implementation support, which was associated with reduced mental health hospitalization rates compared with non-CCM clinics in the same medical centers. Hospitalization rates for the year after implementation support were analyzed by using repeated measures logistic regression comparing the same clinics.
Hospitalization rates for the postsupport year did not differ from comparison clinics either in the population that initially showed the difference or the population active in the clinics at the end of the year of implementation support.
Clinical effects of the CCM may wane after cessation of active implementation support.
Clinical effects of the CCM may wane after cessation of active implementation support.
The authors examined how individual placement and support (IPS), an evidence-based model of supported employment, has been successfully adapted in rural communities across the United States.
Interviews with 27 key informants in 15 states with successful IPS programs in rural communities identified challenges that IPS workers faced because of rurality and the work-around methods they used to overcome these challenges. IMD 0354 chemical structure The authors conducted a thematic analysis of interviews.
Significant challenges to implementing IPS in rural areas included limited availability of public transportation, Internet connectivity, employment opportunities, and workforce. The work-around strategies used by IPS teams differed in relation to local circumstances and cultures, but effective services generally used natural supports for transportation, provided computer access for job applicants, developed relationships with local employers, and hired IPS workers with local knowledge.
The adaptations made to IPS in rural areas are specific to local communities but retain core IPS principles.
The adaptations made to IPS in rural areas are specific to local communities but retain core IPS principles.
The Recovery Assessment Scale (RAS) is one of the most used recovery measures in recovery-oriented practice evaluation of people with mental health conditions. Although its psychometric properties have been extensively studied, one critical piece of information that is missing from the literature is evidence of its longitudinal factorial invariance-that is, whether the RAS measures the same recovery construct across time. The authors empirically tested the longitudinal factorial invariance assumption for the RAS.
Structural equation modeling was used to test the longitudinal factorial invariance of the RAS with data longitudinally obtained at three time points from 167 people with severe mental illness.
The longitudinal factorial invariance assumption was supported (i.e., configural, metric, partial scalar, factor variance and covariance invariance).
This study found empirical evidence that the RAS can measure the same recovery construct over time and thus meets one of the important prerequisites for longitudinal assessment.
This study found empirical evidence that the RAS can measure the same recovery construct over time and thus meets one of the important prerequisites for longitudinal assessment.The behavioral health care transformation in Virginia resulted not from one policy change but from multiple changes prior to Medicaid expansion. These changes combined to shape a new behavioral health landscape, with more providers and more treated patients. Virginia’s layered approach may inform other states seeking to strengthen their capacity to fight the substance use epidemic, even as new epidemics emerge. The recent policy changes to procedures, outreach, eligibility, coverage, the workforce, and payment have laid the foundation for additional steps in the transformation of behavioral health care, including incorporating improvement in social determinants and addressing disparities.
This study aimed to examine differences in completion rates between telepsychiatry and in-person visits during the COVID-19 pandemic and a prior reference period.
The authors used electronic medical record data along with chi-squared or t tests to compare patients’ demographic characteristics. Generalized estimating equations for estimating the odds of primary and secondary outcomes were used, controlling for demographic characteristics.
During COVID-19, the odds of completing a telepsychiatry visit (N=26,715) were 6.68 times the odds of completing an in-person visit (N=11,094). The odds of completing a telepsychiatry visit during COVID-19 were 3.00 times the odds of completing an in-person visit during the pre-COVID-19 reference period (N=40,318).
In this cross-sectional study, outpatient adult mental health clinic telepsychiatry appointments, largely by telephone, were strongly associated with a higher rate of visit completion compared with in-person visits during and prior to the COVID-19 pandemic. Regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.
In this cross-sectional study, outpatient adult mental health clinic telepsychiatry appointments, largely by telephone, were strongly associated with a higher rate of visit completion compared with in-person visits during and prior to the COVID-19 pandemic. Regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.Patients from racial-ethnic minority groups undergo disparate electroconvulsive therapy (ECT) treatment compared with Caucasian peers. One leading hypothesis is that clinicians may unknowingly display racial bias when considering ECT for patients of color. Studies have consistently shown that patients of color face numerous racially driven, provider-level interpersonal and perceptual biases that contribute to clinicians incorrectly overdiagnosing them as having a psychotic-spectrum illness rather than correctly diagnosing a severe affective disorder. A patient’s diagnosis marks the entry to evidence-based service delivery, and ECT is best indicated for severe affective disorders rather than for psychotic disorders. As a consequence of racially influenced clinician misdiagnosis, patients from racial-ethnic minority groups are underrepresented among those given severe affective diagnoses, which are most indicated for ECT referral. Evidence also suggests that clinicians may use racially biased treatment rationales when considering ECT after they have given a diagnosis of a severe affective or psychotic disorder, thereby producing secondary inequities in ECT referral.
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