Mental Health Center Staff Research Articles

Organizational structure, climate, and collaboration between juvenile justice and community mental health centers: implications for evidence-based practice implementation for adolescent substance use disorder treatment

BackgroundSubstance use disorders are prevalent among youth involved with the criminal justice system, however, evidence-based substance use disorder treatment is often unavailable to this population. The goal of this study was to identify barriers to effective implementation of evidence-based practices among juvenile justice and community mental health organizations through the lens of an adopter-based innovation model.MethodsIn this mixed-methods study, qualitative interviews were conducted with n = 15 juvenile justice staff and n = 14 community mental health staff from two counties implementing substance use services for justice involved youth. In addition, n = 28 juvenile justice staff and n = 85 community mental health center staff also completed quantitative measures of organizational effectiveness including the implementation leadership scale (ILS), organizational readiness for change (ORIC), and the implementation climate scale (ICS).ResultsOrganizationally, staff from community mental health centers reported more “red tape” and formalized procedures around daily processes, while many juvenile justice staff reported a high degree of autonomy. Community mental health respondents also reported broad concern about their capacity for providing new interventions. Staff across the two different organizations expressed support for evidence-based practices, agreed with the importance of treating substance use disorders in this population, and were enthusiastic about implementing the interventions.ConclusionsWhile both community mental health and juvenile justice staff express commitment to implementing evidence-based practices, systems-level changes are needed to increase capacity for providing evidence-based services.

A proposed intervention to improve knowledge of self-management of hypertension for Kenneth Young and C4 community mental health center staff in Cook County, Illinois

Community mental health centers (CMHCs) provide psychiatric services and link Medicaid clients/members to both primary and specialty care within the community for people with serious mental illness (SMI), such as major depressive disorder, schizophrenia, and bipolar disorder. CMHCs help transition patients safely into the community from nursing facilities and rehabilitation centers. Patients diagnosed with an SMI have a higher incidence of cardiovascular diseases (CVDs), such as hypertension, and need management in the community to prevent further complications. CMHC staff lack knowledge to help their clients to manage medical conditions in the community, which can worsen hypertension management, potentially leading to complications for this population. The conceptual framework used to guide this project is the health belief model. The planning model used to guide the intervention is the PRECEDE-PROCEED model. Twenty-two staff from two CMHCs participated in a one-hour educational session on hypertension management and accurate blood pressure demonstration, with pre and post session measures of hypertension knowledge and blood pressure skills checklist. Staff were re-evaluated for hypertension and blood pressure monitoring skills 8 weeks from the implementation of the intervention with a 30-min booster session, completing an additional post intervention hypertension knowledge questionnaire and blood pressure skills checklist. A hypertension management tool was developed for staff to use as a resource in the community for clients with hypertension. The tool covered accurate blood pressure measurement and documentation, red flag symptoms, medication, and physician appointment adherence. Ordinal data were evaluated from the Likert scale to compare the percentage score from baseline to post intervention measuring hypertension knowledge. Twenty-two staff participated from both agencies, comprising 17 females and 5 males, of which 38% had their Bachelors of Science degree and 62% had their Master’s degree. The pre and post assessment of knowledge increased by 33% from baseline after the intervention. Nominal data were used to collect responses from staff based on pre and post intervention blood pressure demonstration checklist and to capture staff attendance through the sign-in sheets at the intervention training. The results showed an improvement of 133% from baseline with the blood pressure demonstration checklist after the intervention and demonstration. There was a 14% decrease of blood pressure skills checklist at the 8-week booster session compared to the post intervention results. The recommendations based on this project include addressing content missed from the knowledge test and the blood pressure skills checklist in the booster session, and reviewing the hypertension management information resource tool. Continually monitoring the use of the resource tools and incorporating booster sessions with the agencies can address any gaps in hypertension knowledge and changing guidelines in hypertension management. Recommendations to stakeholders of the agencies will include budgeting for training resources and participation incentives, monitoring sustainability of the intervention with use of the sustainability tool, and long-term monitoring of the impact of the intervention tool on blood pressure management outcomes in clients.

Rural faith community leaders and mental health center staff: Identifying opportunities for communication and cooperation.

Rural faith community leaders and mental health center staff: Identifying opportunities for communication and cooperation.

Community mental health center staff attitudes about employment for persons with serious mental illness.

To measure community mental health agency staff attitudes about employment for persons with serious mental illness. An online survey was developed and sent to 2,218 staff at 4 community mental health centers (CMHC) in 1 New England state. The survey collected quantitative and qualitative data about staff attitudes about employment for persons with serious mental illness. Descriptive statistics and qualitative results are provided. Results from analysis of variance are provided as well, assessing differences in staff views by staff characteristics. A mix of clinical and administrative staff participated in the survey (N = 221). Staff views on the benefits of work, the ability of clients to handle the demands of the worker role, and client motivation to work were mixed. Staff with higher levels of education held significantly more supportive views than those with less education. CMHC staff need to consistently convey supportive attitudes about employment to their clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Oriented mentalization-based treatment for borderline personality disorder patients: preliminary results at Camposampiero Mental Health Center.

This contribution presents two brief reports about preliminary results of 18 months of oriented Mentalization-Based Treatment (MBT), with Borderline Personality Disorder patients, recruited at the Camposampiero Mental Health Center. Following in large part Bateman and Fonagy guidelines for MBT in institutional settings, this paper presents preliminary results in two brief reports related to two cohorts of patient underwent to the oriented MBT in Camposampiero Mental Health Center (MHC). In the first study, we analyzed a group of 9 patients: an anamnestic schedule was administered; then, symptoms (SCL-90-R), psychodiagnostic scale and global health functioning (Health of the Nation Outcome Scale, Structured Clinical Interview for DSM-IV Axis II Disorder [SCID-II], Global Assessment of Functioning, [GAF]), data on service impact and service costs (Cassel Community Adjustment Questionnaire, Patient Evaluation Schedule and folder data) were provided at the beginning (T0), at the end of the treatment (T2) and 1 year after the end of the MBT project. The second study showed a micro-analytical change on a second patient cohort (n=6) at T0, 3, 6 and 9 months (T1) were presented considering specifically mentalization (Comparative Psychotherapy Process Scale, Modes of Mentalization Scale, Mentalization Imbalances Scale) and patienttherapist session evaluation trends (Session Evaluation Questionnaire) and patient reflective functioning at T0 and T2 (Reflective Functioning Questionnaire). Aims and hypotheses of the two studies pointed out how the oriented MBT bring to an improvement of the overall functioning of the patients, a reduction of the symptoms, a decrease of the diagnostic criteria for the Borderline Personality Disorder (BPD) and the other Axis II disorders, a reduction of the workload hours for the MHC staff and of the costs of the assistance. The analyses of both the studies were carried out using non-parametric statistics (Friedman test, Spearman correlation, Chi-square). Preliminary results confirmed the improvement in the overall functioning of patients (GAF), the reduction in BPD-related symptoms and in diagnostic criteria for BPD (SCID-II), the improvement of patients’ mentalization skills, and a significant reduction in workload for health staff. Standing the limits and the preliminary results, the two brief reports demonstrate the feasibility of an oriented MBT within an Italian Public Service and the effectiveness of this treatment pathway for patients with BPD, leaving some open questions to stimulate a fruitful clinical discussion.

Do Providers Know What They Do Not Know? A Correlational Study of Knowledge Acquisition and Person-Centered Care.

Person-centered care (PCC) is a central feature of health care reform, yet the tools needed to deliver this practice have not been implemented consistently. Person-centered care planning (PCCP) is a treatment planning approach operationalizing the values of recovery. To better understand PCCP implementation, this study examined the relationship between recovery knowledge and self-reported PCCP behaviors among 224 community mental health center staff. Results indicated that increased knowledge decreased the likelihood of endorsing non-recovery implementation barriers and self-reporting a high level of PCCP implementation. Findings suggest that individuals have difficulty assessing their performance, and point to the importance of objective fidelity measures.

Job Satisfaction and Burnout Among VA and Community Mental Health Workers

Building on two independent studies, we compared burnout and job satisfaction of 66 VA staff and 86 community mental health center staff in the same city. VA staff reported significantly greater job satisfaction and accomplishment, less emotional exhaustion and lower likelihood of leaving their job. Sources of work satisfaction were similar (primarily working with clients, helping/witnessing change). VA staff reported fewer challenges with job-related aspects (e.g. flexibility, pay) but more challenges with administration. Community mental health administrators and policymakers may need to address job-related concerns (e.g. pay) whereas VA administrators may focus on reducing, and helping workers navigate, administrative policies.

Community Mental Health Agency Views of Research

We examined community mental health center staff perceptions of ongoing research within their agency. We interviewed upper management and conducted focus groups with medical staff, non-medical clinicians, and administrative staff. Participants were asked about (1) their attitudes towards research in general, agency research and towards the principal academic institution doing research with clients, (2) their perceptions of the value of research and (3) ideas for improving the collaboration. We identified 5 overarching themes: inter-agency communication, shared goals and equality in research, researchers adding knowledge to the agency, improving attitudes toward research, and agency involvement in research. Under these domains, specific suggestions are made for how to improve the collaboration across all stakeholder groups. Lack of shared values and inadequate communication processes can negatively impact community-based research collaborations. However, clear strategies, and adequate resources have great potential to improve community mental health collaborations.

Psychiatrist Victimized by Rita Continues to Put Patients First

Back to table of contents Previous article Next article Community NewsFull AccessPsychiatrist Victimized by Rita Continues to Put Patients FirstAaron LevinAaron LevinSearch for more papers by this authorPublished Online:21 Oct 2005https://doi.org/10.1176/pn.40.20.00400005aPsychiatrist James B. Creed Jr., M.D., watched Beaumont, Texas, turn from sanctuary to target as Katrina gave way to Rita.Beaumont took in 4,000 evacuees from New Orleans after the first storm, then the entire town was itself evacuated before the second hurricane hit.Creed helped move patients from the 16 nursing homes he covers in his practice and managed to get to a friend's farm just 45 minutes before Rita struck. Directly in Rita's path, the farmhouse and one of his cars were destroyed, but Creed and his wife survived.“I've lived in this area all my life, and this is the closest I've come to death,” said Creed from his refuge at his sister's house in Houston. He is president of the Southeast Texas chapter of the Texas Society of Psychiatric Physicians.As he spoke at the end of September, word was that no one would be allowed back into Beaumont for 30 days. Two of the three power stations were destroyed and the third damaged. There was no water or sewage service in the city, and both hospitals were closed.Aside from being alive, Creed had two bits of good news, both technological. For one, he had switched to an electronic medical records system in 1993 and thus left Beaumont with all his patient records back to 1981 on his laptop. He also used a phone company voicemail system, which was soon accessible again by way of his cell phones. All of the other 10 or so psychiatrists in the Beaumont area depended on a live answering service whose operators had evacuated too. As a result, Creed not only began to hear from patients scattered across half a dozen states, but volunteered to be a contact person for his equally dispersed colleagues.He was soon inundated with phone calls from patients to renew prescriptions. Although many patients had relocated out of state, no pharmacy had refused to fill a prescription they had brought with them or for which they needed a refill, he said.As he filed insurance claims and bought new clothes late in September, his future seemed uncertain but not discouraging.“I'll be one of the first back into the city, and I'll be helping other people help themselves,” he vowed.Meanwhile, farther east, conditions remained primitive although there were some signs of recovery. Communication was still a problem, although cell-phone service and some utilities were coming back online in the Pascagoula/Biloxi area and much of Gulfport, Mississippi Psychiatric Association President Elizabeth Henderson, M.D., said in late September. Severe structural damage was widespread, and she feared the official death toll would rise. Some Gulfport mental health center staff had not returned by September's end, and many of those who were back were camping out in tents, with no running water or electricity.Communication and coordination continued to be extremely problematic. Although state health authorities were working on a master mental health plan, some key stake-holders had not yet been included, she said.“They have not reached out to the mental health center directors in the affected areas, and they have not taken into account wider psychiatric needs like helping local employers and human resources departments, coordinating with primary care doctors, and providing psychiatric support in the local hospitals and emergency rooms,” she said.If making the best of a bad situation was the prevailing attitude, she had also heard about fits of irritability, jumpiness, and total meltdowns, often due to evacuees' frustration after waiting for services and then being told they were in the wrong line or ineligible for a particular benefit. ▪ ISSUES NewArchived

CANDIDATES FOR RECORDER

CANDIDATES FOR RECORDER

Mental Health Services in Kentucky Jails: A Self-Report by Jail Administrators

This work examines jail mental health services in Kentucky, a rural state with relatively small jails. While mental health services in prisons and large jails have been studied extensively, little is known about smaller jails. Each of the 85 Kentucky jail administrators was mailed a survey regarding mental health services at their jail. The response rate was 70.6%. Jail administrators self-reported their information; no attempt was made to verify their data and therefore it may not reflect actual practices. Jail administrators relied on a variety of techniques to determine if an inmate was mentally ill. Jail staff members were most likely to administer medication, while community mental health center (CMHC) staff provided assessments, counseling/therapy, and psychiatric visits. Jail administrators were most likely to pay for services. Jail administrators preferred that the CMHC staff treat inmates, but that the inmate/family and the state mental health authority pay for the services.

A collaborative community-based treatment program for offenders with mental illness.

The paper describes initial results of collaboration between a mental health treatment program at a community mental health center in Baltimore and a probation officer of the U.S. federal prison system to serve the mental health needs of offenders on federal probation, parole, supervised release, or conditional release in the community. A forensic psychiatrist in the treatment program and a licensed social worker in the probation office facilitate the close working relationship between the agencies. Treatment services provided or brokered by the community mental health center staff include psychiatric and medical treatment, intensive case management, addictions treatment, urine toxicology screening, psychosocial or residential rehabilitation services, intensive outpatient care, partial hospitalization, and inpatient treatment. Among the 16 offenders referred for treatment during the first 24 months of the collaborative program, 14 were male and 14 were African American. Three of the 16 violated the terms of their release due to noncompliance with stipulated mental health treatment; only one of the three had been successfully engaged in treatment. One patient died, two completed their terms of supervision, and ten remained in treatment at the time of the report. The major strength of this collaboration is the cooperation of the treatment and monitoring agencies with the overall goal of maintaining the offender in the community. Further research is needed to confirm the effectiveness of the clinical model in reducing recidivism and retaining clients.

Capacity of rural community mental health centers to treat serious mental illness.

This study evaluates the capacity of rural community mental health center staff to treat persons with serious mental illness (SMI). A 20-item survey was mailed to 720 providers in 34 community mental health centers (CMHCs) in Iowa. Responses were received from 285/680 persons in 32/34 centers. The confidence and interest in receiving additional training in tasks necessary for the care of persons with SMI was assessed for staff members of various disciplines and both confidence and training interest was found to vary by discipline. Recommendations to enhance CMHC capacity to treat persons with SMI are discussed.

Student Mental Health and Funding Constraints: A Delicate Balance

A wide range of serious psychiatric disorders that would be progressive if untreated was observed during the first 9 months of a 1-year psychotherapy fellowship at the student health center of a major New England university. This finding underscores the cost benefits, in both human and financial terms, of having a multidisciplinary mental health center staff on campus to provide timely, intensive, and comprehensive interventions.

The 'consumer-as-provider' initiative.

The National Institute of Mental Health has provided funding in Region I (New England) to several technical assistance centers: the Center for Community Change through Housing and Supports (Vt.); the Human Resource Association of the Northeast (Mass.); and the recently funded National Empowerment Center (Mass.). These federally funded projects are focused on guiding the mental health field toward a more consumer-driven system. The authors have been involved with these organizations and also provide consultation along with Northern Rhode Island Community Mental Health Center (NRICMHC) staff and consumers to other counties and states on improving services for adults and children with longer-term psychiatric problems. The consulting team for NRICMHC has encountered some communities where the hiring of current or former consumers appeared to present a "quick fix" for system problems rather than a reflection of more fundamental changes in attitudes and programs. Based on the authors' personal and family experiences, as well as their work experiences, they have reexamined some of the conventional wisdoms in the rapidly evolving area of "consumers as providers."

Development of an innovative child and youth mental health training and services delivery project.

In 1989 North Carolina began funding a mental health demonstration training and services project to serve severely emotionally disturbed children and youth in the community. During the first two years of this state-university collaboration, consultation and direct services provided by faculty and student trainees have been linked to preexisting services at a mental health center serving three counties. The project has met initial goals of developing new and expanded services, building relationships with other agencies, and integrating university and mental health center staff. More formal process and outcome evaluations are under way. Areas of probable long-standing concern include the need for more cordial working relationships with other agencies and for more participation of parents in treatment and education programs.

Changing the Focus of Social Work Supervision: Effects on Client Satisfaction and Generalized Contentment

An experiment and three replications were conducted in which the focus of social work supervision was varied to compare client outcomes under two conditions. A social work supervisor gave two male and two female mental health center staff eight weeks of supervision with a mixed focus on administration, training, and clinical consultation. This was followed by eight weeks of client-focused supervision in which questions were asked about client problems and staff interventions in the context of client outcomes. The dependent variables were mean weekly caseload reports of generalized contentment and three dimensions of client satisfaction. Outcome data were plotted and examined with visual analysis for trend and aggregated for effect-size calculations. Adult outpatients reported significantly greater satisfaction under client-focused supervision. The findings suggest that social work supervision affects clients, and that client satisfaction improves if supervisors ask questions about client problems and staff interventions in the context of client outcomes.

Collaboration of a university and state mental health agency: Curriculum for improving services for children.

We describe the collaboration of a state university and a state mental health agency in implementing training to improve skills of community mental health center staff for working with children, adolescents, and their families. The project consisted of three phases: (a) a needs assessment survey was conducted, (b) a series of written instructional modules were developed, and (c) workshops were conducted in six locations across the state

Performance Feedback and Goal Setting to Improve Mental Health Center Staff Productivity

A multiple baseline across groups design was used to assess the effectiveness of first self-monitoring (feedback), then self-monitoring plus assigned goals (feedback and goal setting), on the proportion of work hours spent in direct client contact by 17 clinicians in a rural mental health center. Results for the first group (n = 6) showed that performance rose 59.8% between baseline and the final treatment phase. Corresponding increases for Group 2 (n = 6) and Group 3 (n = 5) were 29.1% and 19.8%, respectively. Most increases occurred during self-monitoring, but the combined treatment produced small additional increments. In the final treatment phase weekly goal attainment occurred at a 33% rate for Group 1, 14% rate for Group 2, and 10% rate for Group 3. Amounts billed for individual therapy and for all therapy increased for all groups.

A School Disaster—Intervention and Research Aspects

Various aspects of group, community, and individual interventions in a school pedestrian overpass accident are described and analyzed. A planning group of school personnel, parents, community mental health center staff and university child psychiatry faculty initiated a broad school based assessment and intervention program shortly after the accident occurred. The social dynamics of this collaborative effort involving different personalities, professional disciplines, and institutions were complex. Collaboration was sufficiently successful to achieve the primary goal of assisting a large population, assimilate an unpredictable catastrophic event and adapt again to a predictable world. A secondary research goal of studying the impact of the accident in depth on individuals was not sufficiently met.