Community Mental Health Settings Research Articles

Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children's Mental Health Settings.

The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children's community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children's community mental health settings.

Integrating Board-Certified Psychiatric Pharmacists in a Certified Community Behavioral Health Clinic.

Demand for mental health services has dramatically increased in recent years, raising concerns about the availability of service providers to meet these increased needs. One approach to expanding access to care is the use of highly qualified board-certified psychiatric pharmacists (BCPPs). However, the implementation of programs for integrating BCPPs has not been well characterized in community mental health settings. This column describes the development and implementation of a comprehensive practice model to incorporate BCPPs in a certified community behavioral health clinic. The authors report the results from the first 14 months of BCPP integration (based on 3,221 direct patient care interventions), offer recommendations, and highlight lessons learned.

Trauma in the lives of parents experiencing severe perinatal mental illness.

The perinatal period is a time of 'high risk' for new and recurrent episodes of mental illness with 0.1-0.2% of birthing parents requiring admission to specialist mental health units in the months after birth. The prevalence and role of trauma in the lives of birthing parents (most commonly mothers) experiencing severe perinatal mental illness is not well known. In a new perinatal mental health unit in Sydney Australia, a retrospective audit of trauma prevalence was undertaken using patient completed questionnaires and electronic medical record data. Descriptive analysis was undertaken. Prevalence of trauma in the lives of mothers with severe mental illness was found to be higher than that reported in general or community mental health settings, with 76% of mothers reporting lifetime trauma exposure and 24% meeting criteria for complex PTSD. The majority reported trauma experiences likely to impact attachment and also reported difficulties in responding to their infants' cues and needs. The findings suggest a need for more research, awareness, and consideration of the role of trauma in experiences of perinatal mental illness, with implications for developing trauma informed models for responding to parental mental illness.

Strengths Model for Youth (SM-Y) Case Management: Initial Findings on Youth Outcomes.

Case management is a widely utilized service in both youth and adult outpatient community mental health settings. Despite its widespread use, previous findings suggest that youth case management often lacks empirically tested models or frameworks. This article presents the results of a pilot study that involved adapting the Strengths Model, an adult case management model, for the child and adolescent outpatient community mental health population. The newly adapted model, known as the Strengths Model for Youth (SM-Y), was implemented in an urban community mental health center across five different youth case management teams. To assess changes over time in youth receiving SM-Y case management, marginal maximum likelihood multilevel modeling with adaptive Gaussian quadrature methods was applied. The study focused on three domains: socialization, education, and hospitalization. Utilizing the logit link function and Bernoulli conditional distribution due to the binary nature of the outcome data, three individual trajectories were drawn for socialization, education, and hospitalization. Positive findings indicated increases in socialization and educational performance among children and adolescents.

Tobacco, Alcohol, and Drug Use Among Young Adults with Serious Mental Illness.

To inform early intervention, this study describes correlates of substance use among young people with serious mental illness (SMI) enrolled in integrated care in community mental health settings. 227 adults ages 18-35 were assessed for clinical characteristics and substance use. Logistic regressions were used to describe relationships between substance use and participant characteristics. Over a third (38.9%) reported daily cannabis, 15.9% past month other illicit drug, 13.5% frequent/heavy alcohol and 47.4% any of these; 50.2% reported daily tobacco smoking and 23.3% current vaping. Daily cannabis and tobacco were the most common combination. Alcohol, drug, and cannabis with tobacco were associated with higher mental health symptoms but not with emergency room or hospital utilization. Cannabis and other substance use was common and associated with higher symptoms but not with greater hospital utilization, suggesting that early intervention could prevent long-term negative consequences.

Preoperative diagnosis of mental health disorder and dysphagia following anterior cervical spine surgery.

Mental health disorders (MHDs) have been linked to worse postoperative outcomes after various surgical procedures. Past studies have also demonstrated a higher prevalence of dysphagia in both acute and community mental health settings. Dysphagia is among the most common complications following anterior cervical spine surgery (ACSS); however, current literature describing the association between an established diagnosis of an MHD and the rate of dysphagia after ACSS is sparse. All patients who underwent ACSS between 2014 and 2020 with a minimum of 6 months of follow-up were retrospectively evaluated at a single institution. Patients were divided into cohorts depending on an established diagnosis of an MHD: the first had no established MHD (non-MHD); the second included patients with a diagnosed MHD. Outcomes were measured using pre- and postoperative patient-reported outcome scores, which included the Swallowing Quality of Life survey for dysphagia, as well as physical and mental health questionnaires. Postoperative dysphagia surveys were obtained at final follow-up for both patient cohorts. A total of 68 and 124 patients with and without a diagnosis of a MHD were assessed. The MHD group reported significantly worse baseline Patient-Reported Outcomes Measurement Information System depression scale scores (p < 0.001), 12-Item Short-Form Health Survey (p < 0.001), and Veterans RAND 12-Item Health Survey (p = 0.001) mental health components compared to non-MHD group. This group continued to have worse mental health status in the postoperative period, as reported by Patient-Reported Outcomes Measurement Information System depression scale scores (p = 0.024), 12-Item Short-Form Health Survey (p = 0.019), and Veterans RAND 12-Item Health Survey (p = 0.027). Postoperative assessment of Swallowing Quality of Life scores (expressed as the mean ± SD) also showed worse dysphagia outcomes in the MHD cohort (80.1 ± 12.2) than in the non-MHD cohort (86.0 ± 12.1, p = 0.001). ACSS is associated with significantly higher postoperative dysphagia in patients diagnosed with an MHD when compared to patients without an established mental health diagnosis. Given the high prevalence of MHDs in patients with spinal pathology, it is important for spine surgeons to take note of the increased incidence of dysphagia faced by this patient population.

Relational Complexity of the Near-Age Peer Support Provider Role in Youth and Young Adult Community Mental Health Settings.

Increasingly, US community mental health settings are integrating professional near-age youth peer support providers to improve youth service engagement and outcomes. Youth peer specialists (YPS) use their lived and living experiences with a mental health diagnosis to validate, empathize, and provide individualized support, while also improving their program's overall responsiveness to young people's needs. Although promising, these roles tend to lack clarity-responsibilities vary immensely, and turnover is high. Examining near-age youth peer on-the-job experiences is needed to design effective on-the-job supports. Using community-based participatory action research methods, young adults with lived experience worked in partnership with a PhD-level qualitative researcher to design, recruit, conduct, and analyze in-depth-interviews with current and former near-age youth peer providers. Ten young adult peer mentors in Massachusetts completed interviews that revealed near-age youth peer role relational complexity. Five relational aspects were identified requiring relational practice skills and self-awareness, including relationships with (1) self, (2) clients, (3) supervisors, (4) non-peer colleagues, and (5) other near-age peer providers. Near-age peers experience relationship-related struggles with non-peer identified colleagues who do not understand nor value the near-age peer role. Findings expand on current near-age peer practice and associated on-the-job challenges. Training, supervision, and professional development activities that target these five relational areas may improve YPS on-the-job wellbeing, decrease YPS turnover, and improve youth client outcomes.

[Knowledge, competence and educational needs of mental health staff on palliative care for the elderly with dementia].

Dementia is a clinical syndrome for which the benefits of palliative care have been recognized. The aim of this study was to investigate the knowledge and educational needs of mental health physicians and nurses and also their perceptions of their competence regarding palliative care for the elderly with dementia. A total of 96 mental health professionals (doctors, nurses) working in a public psychiatric hospital and its allied community mental health settings participated in the study. The Palliative Care Quiz for Nursing (PCQN) was used to detect their knowledge on palliative care as well as a questionnaire to collect participants' demographics, their perceptions about their competence on palliative care provision and their educational needs on the basics domains of palliative care for the elderly with dementia. Results revealed participants' significant lack of knowledge (PCQN =7.79/20) and low perception of competence regarding palliative care for aged persons with dementia. Participants who were psychiatrists, who had work experience between 16-20 years and provided care to more than ten patients with terminal dementia per year, showed higher PCQN scores in statistically significant level (p=0.001). The majority (93.6%) of participants considered training in palliative care for dementia patients as necessary, particularly in providing information to family/carers, relieving the psychosocial burden of family/carers, managing the terminal stage of dementia, providing information to dementia patients and planning their advanced care. Findings of this study could inform the design of training programs on palliative care for the elderly with dementia in Greece.

Investigating a multi-session virtual reality relaxation intervention for mental health staff: protocol for a feasibility and acceptability study

Purpose Clinical staff working in mental health services experience high levels of work-related stress, burnout and poor well-being. Increased levels of stress, burnout, depression and anxiety and poorer mental well-being among health-care workers are associated with more sick days, absenteeism, lower work satisfaction, increased staff turnover and reduced quality of patient care. Virtual reality (VR) relaxation is a technique whereby experiences of pleasant and calming environments are accessed through a head-mounted display to promote relaxation. The purpose of this paper is to describe the design of a study that assesses the feasibility and acceptability of implementing a multi-session VR relaxation intervention amongst mental health professionals, to improve their relaxation levels and mental well-being. Design/methodology/approach The study follows a pre–post-test design. Mental health staff will be recruited for five weeks of VR relaxation. The authors will measure the feasibility and acceptability of the VR relaxation intervention as primary outcomes, alongside secondary outcomes evaluating the benefits of VR relaxation for mental well-being. Findings The study aims to recruit 20–25 health-care professionals working in both inpatient and specialist community mental health settings. Originality/value Research indicates the potential of VR relaxation as a low-intensity intervention to promote relaxation and reduce stress in the workplace. If VR relaxation is shown to be feasible and acceptable, when delivered across multiple sessions, there would be scope for large-scale work to investigate its effectiveness as an approach to enable health-care professionals to de-stress, relax and optimise their mental well-being. In turn, this may consequently reduce turnover and improve stress-related sick leave across health-care services.

Experiences of a peer group for people diagnosed with borderline personality disorder: A qualitative interview study.

There is a notable lack of literature evaluating peer support for people with a diagnosis of borderline personality disorder (BPD). Peer-led groups have been shown to positively impact outcomes related to empowerment, hope, and self-efficacy beliefs for consumers diagnosed with serious mental illness and may also be a helpful option for those experiencing personality disorder symptoms. We outline the coproduction of a peer group for people with a lived experience of BPD and a qualitative analysis of feedback post-group participation. Twenty-two consumers participated in post-group interviews and described their experiences of peer support. Interview transcripts were coded, and three main themes were identified: growth and change, connection and feeling understood, and creating safety. The findings suggested that participation in a coproduced peer support group for people with a diagnosis of BPD facilitated positive personal transformation as well as opportunities to develop connection through shared experiences in a safe environment grounded in mutuality. These themes were particularly powerful for participants because they countered previous experiences of not feeling safe, understood, or equal when seeking treatment. These findings support the acceptability of implementing a coproduced group for people diagnosed with BPD in a community mental health setting.

Influence of Lifestyle Factors on Metabolic Syndrome in Psychiatric Patients Attending a Community Mental Health Setting: A Cross-sectional Study

Background: Metabolic syndrome (MetS) is a concern in psychiatric patients. We aimed to study the influence of the modifiable lifestyle factors on MetS in adult psychiatric patients along with associated clinical factors and quality of life. Methods: Factors such as diet (Healthy Eating Index), exercise, substance use, cardiovascular risk (QRISK), illness severity (Clinical Global Impression), medications, adverse events (Systematic Monitoring of Adverse Events Related to Treatments), and quality of life (Recovering Quality of Life Scale) were assessed along with clinical components for MetS in 323 psychiatric patients receiving routine care and monitoring in a Community Mental Health Team. Results: MetS was present in 50.5% (95% CI: 45.0–55.9). It was significantly associated with higher age, duration of mental illness, body mass index (BMI), QTc, QRISK, and antipsychotic drugs. In logistic regression, age, QTc, QRISK, and BMI remained significantly linked to MetS. Patients with or without MetS were comparable in their lifestyle factors such as diet, exercise, and substance use, along with the family history of metabolic disorders, age at onset of mental illness, duration of antipsychotic medication, side effects, psychiatric diagnoses, and quality of life. However, many patients with or without MetS had poorer diet and physical inactivity, indicating scope for interventions. Conclusions: Around half of the psychiatric patients had MetS, and modifiable lifestyle factors did not differentiate individuals with or without MetS. The need for further research on the prevention and management of MetS in psychiatric patients is highlighted.

Ethical challenges for nurses delivering coercive interventions in community mental health settings: A scoping review.

The number of Australians subject to coercive interventions in community mental health services continues to increase. This is in the context of a growing awareness of the harms from coercion, increasing concerns about potential breaches of human rights and an ongoing uncertainty regarding the clinical benefits of community treatment orders, the primary instrument of legislated coercion in community mental health services. Nurses in community mental health services are on the frontline with regard to coercion. They police the requirements of the community treatment order, administer medication to people in community settings without their consent and facilitate re-hospitalisation if indicated. Coercive practice contradicts the person-centred, recovery-oriented and trauma-informed care principles that inform contemporary mental health nursing. This contradiction may generate ethical challenges for nurses and result in ethical distress. The aim of this scoping review was to map the research literature on how nurses in community mental health settings recognise and manage the harm associated with the administration of coercive interventions and consider the ethical challenges that may arise within this practice. The search strategy yielded 562 studies with author consensus determining a total of three articles as meeting the inclusion criteria. The resulting literature identified three themes: (1) maintaining the therapeutic relationship, (2) promoting autonomy and (3) using subtle forms of control. This review demonstrated that there is minimal research that has considered the ethical challenges related to the use of coercion by nurses in community mental health settings.

How to achieve delivery of a cardiovascular health intervention in community mental health settings: a process evaluation of Flinders Program using RE-AIM framework

Background, research problem &amp; context: Globally, it is well recorded that adults with severe mental illness (SMI) die 10-20 years earlier than the general population, with cardiovascular disease being recorded as the key contributor to this health inequity. To address this health gap, the Flinders Chronic Condition Self-Management Program (will be referred to as Flinders Programme from here onward) was delivered within an NHMRC-funded randomised controlled trial (RCT) during 2018-2020 among 130 South Australian community-living adults diagnosed with SMI and CVD risk factors. Intervention design: The Flinders Programme is a person-centred care planning approach designed by Flinders University Behavioural Health Unit’s researchers. For this study, the programme aimed to improve the heart health and quality of life of the study participants. Intervention evaluation methods: This study sat alongside the RCT research and employed a longitudinal qualitative methodology underpinned by Roy Bhaskar’s Critical Realism philosophy and ontology. The aim was to understand why, how, and under which contexts the Flinders Program worked (or not). Alongside an outcome evaluation, this study also investigated how the Flinders Programme was delivered. Reach (R), Effectiveness/Efficacy (E), Adoption (A), Implementation/Delivery (I), Maintenance (M) or RE-AIM framework was used to conduct this qualitative process evaluation. Data were collected from 19 trial team members at multiple time points using multiple methods. In total, ten in-depth interviews, two focus group discussions, ten meeting minutes, and five reflective journals were analysed. Data analysis involved a Critical Realist Analysis (CRA) approach. Results &amp; impact: The key findings were organised within the RE-AIM framework: Reach (low recruitment, strategies taken to increase recruitment), Effectiveness (non-specific effects, ‘invisible’ changes such as enhanced awareness, motivation, hope), Adoption (model of care, work atmosphere, the physical structure of the setting), Implementation (preparation, pilot survey, revising study design, actual trial and adaptations, fidelity), Maintenance (self-management capacity, resources, care continuity). Learning for the international audience: This study described the steps taken in delivering the Flinders Programme within a few South Australian metropolitan community mental health settings between the period November 2017 – September 2020. The trial team faced difficulties in fulfilling the recruitment target for the trial. There were a few critical reasons identified- the South Australian community mental health system went through a significant restructuring during the same time, resulting in enormous workload increases in an already resource-scarce sector. Health system-level politics had a direct negative effect on the trial. Besides, improving the cardiovascular health of SMI was not deemed a priority in a system that was struggling to deal with acute mentally ill patients within a crisis-driven system. There was a clear indication that most sites did not have enough clear communication from the trial team before recruitment and throughout the trial period. The next steps: In the future, more preparation, including education sessions among clinicians, are required before delivering such physical health interventions within mental health settings. &#x0D;  

From Pathways to Partnerships: Building Patient-Centered Clinical Tracks (PCCT) in Outpatient Community Mental Health Settings.

Clinical pathways are structured multidisciplinary care plans used by treatment providers to detail essential steps in the care of patients based on assessment of their current health care needs and motivation and commitment for treatment. Reducing unnecessary variations in care and streamlining treatment processes in mental health settings may promote efficiency and help support quality improvement efforts. (Rotter et al., 2019) In this article we will describe the development of clinical pathways, coined Patient Centered Clinical Tracks (PCCT) in an outpatient community mental health clinic in an academic medical center in New York City. PCCT is comprised of six different clinical pathways that include: Medication & Engagement, Supportive Therapy, Dialectal-Behavior Therapy, Cognitive-Behavioral Therapy/Acceptance Commitment-Therapy, Relational Therapy and THRIVE (a Trauma Specialty Program). We will present the six Clinical Tracks and describe the early implementation of this model. We will explore how this programmatic infrastructure can connect evidence to practice and address multiple systemic challenges faced in a community mental healthsetting with a strong emphasis on training.

Core Components and Implementation Determinants of Multilevel Service Delivery Frameworks Across Child Mental Health Service Settings.

Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.

Physical activity following discharge from inpatient adult mental health settings

BackgroundPeople with severe mental illness are considerably less physically active than the general population and experience a premature mortality of 10–20 years, often attributed to modifiable behaviours, including physical activity. Inpatient environments provide opportunities for people with SMI to become more physically active, however evidence is limited on its sustainability following discharge to community settings. ObjectiveThis review aimed to summarise the published evidence relating to physical activity interventions following discharge from inpatient adult mental health settings. DesignMEDLINE, CINAHL, PsycINFO and AMED databases were searched to identify articles considering physical activity interventions taking place following discharge from an adult (>18) inpatient mental health setting, published after 2007. ResultsOf 3412 unique results, 5 studies were eligible for inclusion. Despite all included studies involving some transition between inpatient and community mental health settings, to-date no study has focused exclusively on physical activity interventions delivered following discharge from inpatient mental health settings. ConclusionsThis review has found insufficient evidence to guide the delivery of physical activity following discharge from inpatient mental health services. Future research is required to improve our knowledge of the optimal forms and delivery of physical activity interventions during this time, alongside quantifying the impact on readmission rates and clinical presentation.

Consultation as an Implementation Strategy to Increase Fidelity of Measurement-Based Care Delivery in Community Mental Health Settings: An Observational Study.

Regularly administering outcome measures to clients to inform clinical decision making, referred to as measurement-based care (MBC), has the potential to improve mental health treatment due to its applicability across disorders and treatment settings. Given the utility of MBC, understanding predictors of high-fidelity MBC implementation is important. Training and consultation are widely used implementation strategies to increase the fidelity of evidence-based practice delivery but have rarely been studied with MBC. The current study will examine the relationship between time clinicians spent discussing a casein consultation ("dosage") and MBC fidelity. Thirty clinicians and 56 youth were in the MBC condition of a randomized controlled trial and completed baseline questionnaires. Consultation dosage was extracted from call notes. MBC fidelity was measured using the implementation index, which combines rates of administering and viewing questionnaires, using objective data from the online MBC system. Multi-level modeling was used. Greater consultation dosage significantly predicted a higher implementation index (ß = 0.27, SE = 0.06, p < .001). For every 30min spent discussing a case in consultation, the case's MBC fidelity increased by 8.1%. Greater consultation dosage significantly predicted higher rates of administration (ß = 0.07, SE = 0.03, p = 0.033) and feedback report viewing (ß = 0.24, SE = 0.06, p < .001). More consultation at the case level predicts greater MBC fidelity using objective measures. The greatest impact was increasing the clinician feedback report viewing rate. The results of this study can help inform future efforts to increase the fidelity with which MBC is delivered and to make consultation as efficient and effective as possible.

Technologic and Nontechnologic Barriers to Implementing Behavioral Health Homes in Community Mental Health Settings During the COVID-19 Pandemic

Background Persons with serious mental illnesses (SMIs) experience disparities in health care and are more likely to die from physical health conditions than the general population. Behavioral health homes are used in public sector mental health programs to deploy collaborative care to improve physical health for those with SMIs. During the COVID-19 pandemic, these programs faced new challenges in delivering care to this vulnerable group. Purpose To describe barriers to implementing or sustaining behavioral health homes, experienced by community mental health workers during the COVID-19 pandemic, and the strategies used to address these challenges. Methods In-depth qualitative interviews were conducted among the behavioral health workforce in Maryland and Michigan community mental health programs. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR), and responses related to implementing and sustaining health homes during the pandemic were coded and themes were analyzed by using an inductive approach. Results Overall, 72 staff members across 21 sites in Maryland and Michigan were interviewed. Implementation barriers/strategies identified occurred across multiple CFIR domains (client, mental health system, physical health system). Interviewees discussed technologic and nontechnologic challenges as well as strategies to address technology issues. Strategies were more frequently discussed by providers when the barrier was viewed at the client level (eg, low technology literacy) versus the broader system (eg, canceled primary care visits). Conclusions Community mental health staff described barriers beyond technology in caring for individuals with SMIs and physical health conditions. Further research should examine how implementation strategies address both technologic and nontechnologic barriers to collaborative care.

Predictors of improved clinician screening, assessment, and treatment for tobacco use for clients in community mental healthcare following training

IntroductionPeople with mental illness (MI) are more likely to smoke cigarettes and less likely to receive treatment for tobacco use than the general population. Understanding factors associated with improved staff treatment of tobacco use in community mental health settings has received limited study. MethodsWe used data from a completed cluster-randomized clinical trial that tested two interventions designed to increase treatment for tobacco use in mental health clinics. Among 222 clinic staff, we examined demographic and employment characteristics, changes in perceived skills, knowledge, and beliefs using the S-KAP (i.e., perceptions of staff responsibility to treat tobacco use; client quit motivation; client outcomes; and barriers) as predictors of change in clinician reported delivery of tobacco use treatment following training. ResultsClinician reported treatment of client tobacco use significantly increased from baseline to week 52 across both study arms (p<0.001). This increase in reported treatment for tobacco use was associated with increases from baseline to week 52 in clinician reported skills to treat tobacco use, perceptions of responsibility to treat client tobacco use, and perceptions about client motivation to quit smoking (p's<0.05). ConclusionsTraining clinicians in community mental healthcare to address client tobacco use may improve outcomes by helping them to develop the needed skills, convincing them that treating tobacco use is part of their role as clinicians, and by helping clinicians to recognize that clients are motivated to quit smoking. These may be targets to improve how clinicians in community health settings address client tobacco use.

Implementation of evidence-based group interventions in a community-based mental health service for self-harming and suicidal youth

ABSTRACT Objective Suicide and self-harm have significant health, economic and social costs. Group-based interventions can be an effective and advantageous treatment approach; however, there is little evidence on the application of these groups in youth community mental health settings in Australia. Using the RE-AIM framework, we explore the feasibility and implementation of two group programmes in a youth-focussed community-based mental health service: dialectical behaviour therapy-adolescent (DBT-A) and cognitive behavioural Self and Strength (S&S). Method Data were collected from an Australian community mental health service that implemented two group therapy treatments over 12 months. RE-AIM implementation framework outcomes included programme reach (patient flow, group uptake, treatment completion), effectiveness (youth and care clinical outcomes), adoption (staff perception), implementation (barriers), and maintenance (service commitment and acceptability). Results Groups were considered for all eligible clients (61% of referrals), of these 36% accepted treatment and of those who commenced, 71% completed DBT-A and 82% completed S&S. DBT-A participants reported improved suicidality, emotion dysregulation, self-harm and quality of life (QoL). S&S participants reported improved QoL. Despite small sample size, treatment was acceptable to participants, with high retention and adherence across both groups. Clinicians involved in facilitation noted positive clinical impacts. Conclusions Group-based interventions have the potential to reduce emotion dysregulation difficulties for youth. Understanding barriers to uptake of group programmes in community-based mental health settings is essential to improve the reach and implementation of group programmes.