Community Mental Health Providers Research Articles

Transitions Between Jail and Community-Based Treatment for Individuals With Co-occurring Disorders

This study assessed transitions to community mental health services among individuals with co-occurring disorders upon release from jail.Data from jail and public mental health systems in Wayne County, Michigan, were merged to identify 677 individuals diagnosed as having a serious mental illness and substance use disorder who had been jailed a total of 1,774 times over 48 months starting in 2003.Only 33% of incarcerations (N=573) were followed by community-based treatment; 44% (N=803) were followed by treatment during a subsequent incarceration, and 23% (N=398) by no treatment. Generalized estimating equations found that individuals with schizophrenia and substance dependence were the most likely to obtain community treatment.By integrating discharge planning, community mental health providers and jails may ensure a continuum of care that facilitates treatment engagement, limits repeated incarcerations, and improves well-being.

A Family Group Work Application of Cognitive Behavioral Therapy of Psychosis for Community Mental Health Settings

Recent interest in a recovery model for severe and persistent mental illness (SPMI) has opened doors for implementing psychosocial interventions with this population and their families. Cognitive behavioral therapy of psychosis (CBTp) is one such intervention that has extensive empirical support. Community mental health (CMH) providers offer a potential venue for incorporating aspects of CBTp into treatment planning for adults with SPMI diagnoses. Including a family-oriented group work component of CPTp in CMH settings could both reduce family stress and simultaneously enhance available support for clients. This article reviews relevant psychosis-specific strategies of CBTp and describes how these might be combined to develop a psychoeducational program for adults with SPMI diagnoses and their family members.

BREATHE: A Pilot Study of a One-Day Retreat to Reduce Burnout Among Mental Health Professionals

Objective: Staff burnout is a frequent problem for mental health providers and may be associated with negative outcomes for providers, consumers, and organizations. This study tested an intervention to reduce staff burnout. Methods: Community mental health providers were invited to participate in a day-long training session to learn methods to reduce burnout. A Web-based survey was given at time of registration, before the intervention, and again six weeks later. Results: Eighty-four providers participated in the training, and follow-up data were available for 74. Six weeks after the day-long training, staff reported significant decreases in emotional exhaustion and depersonalization and significant increases in positive views toward consumers. There were no significant changes in providers' sense of personal accomplishment, job satisfaction, or intention to leave their position. Ninety-one percent of the staff reported the training to be helpful. Conclusions: This brief intervention is feasible, is acceptable to staff, and may improve burnout and staff attitudes. (Psychiatric Services 62:214–217, 2011)

Can Dialectical Behavior Therapy Be Learned in Highly Structured Learning Environments? Results From a Randomized Controlled Dissemination Trial

This study evaluated the efficacy of methods of training community mental health providers ( N = 132) in dialectical behavior therapy (DBT) distress tolerance skills, including (a) Linehan's (1993a) Skills Training Manual for Borderline Personality Disorder (Manual), (b) a multimedia e-Learning course covering the same content (e-DBT), and (c) a placebo control e-Learning course (e-Control). Participants were randomized to a condition, and the training took place in a highly structured and controlled learning environment. Assessments were completed at baseline, post-training, and 2, 7, 11, and 15 weeks following training. The results indicate that one or both of the active DBT conditions outperformed the control condition on all outcomes except motivation to learn and use the treatment. While clinicians preferred e-DBT over the Manual and found it more helpful and engaging, the active DBT conditions generally did not differ on the primary outcomes of knowledge and self-efficacy, with the exception that e-DBT significantly outperformed the Manual on knowledge at the 15-week follow-up. E-DBT also produced the highest rate of applying and teaching the newly learned skills in clinical practice. Overall, results from this study support the efficacy of e-Learning in disseminating knowledge of empirically supported treatments to clinicians, while also indicating that treatment manuals can be effective training tools.

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

General Medical Problems of Incarcerated Persons With Severe and Persistent Mental Illness: A Population-Based Study

Persons with severe mental illness have higher rates of chronic general medical illness compared with the general population. Similarly, compared with the general population, incarcerated persons have higher rates of chronic medical illness; however, there is little information about the synergy between severe mental illness and incarceration and the general medical problems of consumers. To address this gap in the literature this study addressed the following question: are consumers with a history of incarceration at greater risk of general medical problems compared with consumers without such a history? Administrative data were used to compare the medical problems of 3,690 persons with severe mental illness with a history of incarceration and 2,042 persons with severe mental illness with no such history. Consumers with a history of incarceration were more likely than those with no such history to have infectious, blood, and skin diseases and a history of injury. Furthermore, when analyses controlled for gender, race, age, and substance use disorders, consumers with an incarceration history were 40% more likely to have any general medical problem and 30% more likely to have multiple medical problems. The findings presented here call for better communication among local public health and mental health providers and jails and better integration of primary care and behavioral health care among community mental health providers. Also, research should be accelerated on evidence-based interventions designed to divert persons with severe mental illness from the criminal justice system and facilitate community reentry for persons with severe mental illness who are released from jails and prisons.

Community-Based Mental Health Service Utilization Among Low-Income Latina Immigrants

Latina immigrants may be at increased risk for mental illnesses, but have less access to and seek mental health services less often than Black and White counterparts. Guided by the Andersen Behavioral Model of service utilization, the current study employed a medical chart review to elucidate factors associated with use of mental health services at a community health center. Of the clients referred for mental health services, only 36% followed through on the referral. Older age, use of case management services, and depressive symptomatology were predictors of attending mental health services. These findings have implications for community health and mental health providers.

Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills

This study evaluated the efficacy of three methods of training community mental health providers (N = 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satisfaction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians' ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods.

Understanding Community Mental Health Administrators' Perspectives on Dialectical Behavior Therapy Implementation

In this study, key informant interviews were conducted with 13 administrators from nine community-based mental health agencies implementing dialectical behavior therapy in order to assess their perspectives on implementation. Four major themes were identified. They include opinions about dialectical behavior therapy and its fit with existing practices, resource concerns (for example, reimbursement issues, time commitment, and staff training), staff selection for training and staff turnover, and ongoing client referrals. Understanding agency administrators' unique perspectives and addressing their concerns is critical to treatment implementation given administrators' role in determining whether and how a treatment will be implemented. Better understanding of the fit between dialectical behavior therapy and existing service structures, the impact of staff turnover on implementation, and the resources required for implementation are all needed to ensure successful implementation and sustainability.

Implementation Practice and Implementation Research

The Interventions and Practice Research Infrastructure Program (IPRISP) funding mechanism was introduced by the National Institute of Mental Health (NIMH) to bridge the gap between the worlds of services research and the usual care practice in the community. The goal was to build infrastructure that would provide a platform for research to establish the evidence base for improving mental health care available in diverse communities. This is done by providing support for researchers and community mental health providers to establish working and sustainable partnerships to make evidence-based mental health services available and acceptable for people in need of mental health care. In this article, we (a) present the nature of one IPRISP and its attempt to foster science-to-service and service-to-science interchange; (b) discuss two models of implementation practice for human service agencies, the more common ‘‘external specialist purveyor model’’ and the ‘‘embedded generalist purveyor model’’ that is emerging from our IPRISP experience; and (c) we address our emerging practice approach to two issues that are critical in implementation practice and research: local adaptation of evidence-based interventions, and the use of client outcome data in usual care environments to inform clinical practice decisions.

A Fine Line to Walk: Case Managers' Perspectives on Sharing Information With Families

In the United States, sharing information with families in health care involves competing demands between clients' rights to confidentiality and families' wishes to know. In this article, I explore how community mental health providers share information with families of clients with severe mental illness. I interviewed 24 case managers in assertive community treatment programs. Results show that case managers share information with families to attain treatment goals rather than to support families in providing care. Case managers respect clients' confidentiality and do not release information without client consent. However, the absence of client consent posts an ethical dilemma when families provide helpful information for clients' treatment. Case managers find themselves walking a fine line between adhering to confidentiality guidelines and working for the clients' best interests. The findings suggest the need to expand confidentiality laws to the exchange of information and to develop guidelines for working with families in community settings.

Mental Health Providers' Involvement in Diabetes Management

Back to table of contents Previous article Next article LetterFull AccessLetterRichard W. Goldberg Ph.D.Brian Cooke Ph.D.Ann Hackman M.D.Richard W. Goldberg Ph.D.Search for more papers by this authorBrian Cooke Ph.D.Search for more papers by this authorAnn Hackman M.D.Search for more papers by this authorPublished Online:1 Nov 2007https://doi.org/10.1176/ps.2007.58.11.1501AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Mental Health Providers' Involvement in Diabetes ManagementTo the Editor: Recent policy recommendations and practice guidelines call for improved integration and coordination of psychiatric and medical care. The extent to which psychiatrists and other mental health providers should assume responsibility for mental health consumers' medical conditions requires further consideration, particularly for medical conditions that occur as a result of psychiatric interventions and perhaps also for preventive monitoring, screening, and education in regard to medical conditions that disproportionately affect psychiatric consumers. Individuals with schizophrenia and other serious mental illnesses have rates of type 2 diabetes more than four times higher than the rate in the general population ( 1 ). The higher rates are likely attributable to a combination of lifestyle issues (including physical inactivity, poor nutrition, use of illicit substances, and smoking) and use of second-generation antipsychotic medications. We previously found that consumers with serious mental illness and diabetes had glycosylated hemoglobin (HbA1c) values that exceed those recommended by the American Diabetes Association; consumers for whom olanzapine was prescribed had higher HbA1c levels than those for whom other antipsychotic agents were prescribed ( 2 ). We also found that consumers in this cohort fell short of recommended goals for cholesterol levels and blood pressure control and evidenced lower quality of diabetes care as reflected by receipt of fewer recommended preventive and educational services ( 3 , 4 ). More effort may thus be required to provide optimal diabetes care to this vulnerable population. To address this issue we examined involvement of community mental health providers in diabetes care in a cohort of 201 adults with type 2 diabetes and serious mental illness. Study participants were asked four questions that focused on the coordination of medical and psychiatric care during the past six months regarding whether or not their mental health providers asked about diabetes medications and behaviors, provided them with diabetes-related education, and asked to speak directly to their diabetes doctor.Results indicate that mental health providers were engaged in some related care coordination. A total of 112 study participants (56%) reported at least one diabetes-related intervention by their mental health provider. Of these, 96 (48%) reported that mental health providers asked about diabetes behaviors and 78 (39%) reported being asked about diabetes medication. Given the poor diabetes outcomes related to HbA1C and the poor quality of care noted in this cohort, however, it is problematic that only 34 participants (17%) reported that their provider asked to speak with their diabetes doctor and 28 (14%) reported receiving any diabetes education. Although these self-reported findings are limited by the absence of chart verification, they nonetheless suggest that mental health providers fall short of providing basic care coordination and counseling for consumers living with both serious mental illness and diabetes. Therefore, we strongly support efforts to increase mental health providers' involvement in the coordination of the medical and psychiatric care of consumers. Such efforts are squarely in line with recent calls to integrate health promotion services into the mental health system ( 5 ). Acknowledgments and disclosuresThe authors report no competing interests.The authors are affiliated with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Goldberg is also affiliated with the Mental Illness Research, Education, and Clinical Center, Veterans Affairs Capitol Health Care Network, Baltimore.

Humanistic Wellness Services for Community Mental Health Providers

The author examines the unique ability of mental health providers to offer humanistic services in a highly competitive atmosphere by using a wellness approach. J. E. Myers and T. J. Sweeney's (2005) 5 second‐order factors are offered as a conceptual model. Therapeutic techniques and humanizing benefits for individuals, families, and communities are provided.

Confirmatory Factor Analysis of the Evidence-based Practice Attitude Scale (EBPAS) in a Geographically Diverse Sample of Community Mental Health Providers

The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health service provider attitudes toward adopting evidence-based practices. The original scale development was done in one large California County using paper/pencil surveys. The present study examined the factor structure and internal consistency of the EBPAS in a sample of service providers from 17 states. Participants were mental health workers from agencies affiliated with communities funded under the federal Comprehensive Community Mental Health Services for Children and Their Families Program. A confirmatory factor analysis supported the originally derived a priori factor structure of the EBPAS in this new more geographically diverse sample and with a different data collection method. Analyses also demonstrated better internal consistency than in the original psychometric analyses. This study supports the factor structure and reliability of the EBPAS.

Elders and the Courts

This article examines how trial courts should address complex issues of an aging society. More older people, living longer, will enter courthouses with underlying problems that will impede effective access and court processes and will require judges to enhance linkages with community health, mental health, and social services providers. The article analyzes how court systems perceive these issues and explores how they have begun to address them. It concludes with an argument in support of innovative new approaches to assist courts in responding to emerging issues of older adults.

Universal Perinatal Depression Screening in an Academic Medical Center

To develop a department-based program to identify and treat women at risk for perinatal depression. Private and employed physician groups were engaged to conduct antepartum maternal depression screening using the Edinburgh Postnatal Depression Scale. A comprehensive program was established to ensure that patients identified as being at risk would receive appropriate care. The program 1) developed a network of existing community mental health providers to accommodate screen-positive referrals, 2) created a 24/7 hotline staffed by mental health workers to respond to urgent/emergent patient needs, 3) provided nursing and physician education via a comprehensive curriculum on perinatal depression, and 4) facilitated outpatient depression screening that included a centralized scoring and referral system. A total of 4,322 women completed 4,558 screens during the initial 24 months (June 2003-May 2005). Although initial uptake of the screening program was gradual, all 20 departmental obstetric practices were screening their patients at the end of the first year. Depression screening was accomplished between 28-32 weeks of gestation, and postpartum screening (during the 6-week postpartum visit) was subsequently added. Overall, 11.1% of women screened positive in the antenatal period, and 7.3% screened positive in the postnatal period. Three hundred three women were referred for evaluation and care. Department-based, perinatal depression screening was feasible when individual physician practices were not required to develop the infrastructure necessary to respond to at-risk patients. We believe that the provision of clinical safety nets (mental health provider network and the hotline) were essential to the universal acceptance of this program by practitioners. III.

Improving Mental Health Assessment and Service Planning Practices for Older Adults: A Controlled Comparison Study

This study evaluated the effectiveness of a guided assessment and service planning intervention in improving the clinical practices of non-physician community mental health providers caring for older persons. Thirteen agencies, 44 clinicians, and 100 consumers (age 60 and older) were assigned to the intervention or a comparison group receiving usual care. Baseline interviews of clinicians and chart reviews found that clinicians' routine evaluation and service planning practices showed inattention to key domains such as substance abuse (over 33% of clinicians), suicide risk and dangerous behaviors (over 40%), and caregiver burden and risk of neglect or abuse (over 75%). At 1-year follow-up, the intervention was associated with increased rates of routine assessments of major symptom, functioning, and support domains. There was also significant improvement in the specificity of treatment planning within the intervention condition. Implications for quality improvement are discussed.

The Longitudinal Discharge Planning and Treatment Model (LDPTM)

A longitudinally based discharge planning and treatment model that integrates essential components of other successful approaches (PACT, PACED, and Bridge to Discharge) is described. The development of linkages between the inpatient and community mental health providers during the early stages of hospitalization could improve the continuity of care and establish an aftercare plan rooted in existing community resources. Placing the client's need first will ensure a smoother transition from the structure of the inpatient ward to the community while maintaining continuity of care and reducing potential re-admissions to the hospital. Potential barriers that may prevent the adoption and implementation of such a system are discussed. Belcher and DeForge (2005) in Part 1 provided a review of case management and discharge planning, as well as a critique of case management models. In Part 2, DeForge and Belcher (2005) present and describe the components of the longitudinally based discharge planning and treatment model (LDPTM).

The Longitudinal Discharge Planning and Treatment Model (LDPTM)

This paper describes a longitudinally based discharge planning and treatment model. The model proposes to develop linkages between inpatient and community mental health providers during the early stages of hospitalization. The goal is to put the client's need first to ensure a smooth transition from the structure of the inpatient ward to the community, while maintaining continuity of care and reducing potential re-admissions to the hospital. The barriers that prevent such an adoption and implementation of such a system are discussed. Both clinical and policy issues are examined. Part 1 focuses on the background of case management and discharge planning and provides a critique of case management models (Belcher & DeForge, 2005). Part 2 presents and describes the components of the longitudinally based discharge planning and treatment model (LDPTM) (DeForge & Belcher, 2005).

Use of a Consumer-Led Intervention to Improve Provider Competencies

Client-centered care is a major aim of health care. In mental health, new client-centered treatment approaches that emphasize recovery, rehabilitation, and empowerment can improve outcomes for people with severe and persistent mental illness. However, these approaches are not widely used, in part because many clinicians lack the necessary competencies. The objective of this study was to evaluate the effectiveness of an innovative, consumer-led intervention, Staff Supporting Skills for Self-Help, which was designed to improve provider quality, empower mental health consumers, and promote mutual support. The study was conducted at five large community mental health provider organizations in two western states. One organization in each state received the intervention. The intervention included education, clinician-client dialogues, ongoing technical assistance, and support of self-help. It focused on client-centered care, rehabilitation, and recovery. A one-year controlled trial evaluated the effect of the intervention on clinicians' competencies, care processes, and the formation of mutual support groups. Outcomes were assessed by using competency assessment survey instruments and semistructured interviews with clinicians and managers. A total of 269 clinicians participated in the study: 151 in the intervention group and 118 in the control group. Compared with clinicians at the control organizations, clinicians at intervention organizations showed significantly greater improvement in education about care, rehabilitation methods, natural supports, holistic approaches, teamwork, overall competency, and recovery orientation. A feasible, consumer-led intervention improves provider competencies in domains that are necessary for the provision of high-quality care.