Behavioral Health Service Providers Research Articles

Native Hawaiians' Views on Depression and Preferred Behavioral Health Treatments: a Preliminary Qualitative Investigation.

Behavioral health issues, especially depression, are a major health disparity concern for Native Hawaiians in Hawai'i. Following the cultural safety framework and contextual behavioral science approach to intervention development, the present preliminary qualitative investigation aimed to gather better insight into Native Hawaiians' views of depression and its causes as well as their preferred forms of behavioral health services. Data were initially collected from a 2-hour virtual focus group with three behavioral health service providers working with Native Hawaiians, followed by a total of 38 online one-on-one in-depth interviews with Native Hawaiian clients with depression (n = 19), behavioral health service providers working with Native Hawaiian adults (n = 9), and Native Hawaiian cultural leaders (n = 10). Our qualitative data suggested that Native Hawaiians tend to view depression contextually and socioculturally as the manifestation of one's vital connection to the 'āina (land), 'ohana (family; continuity from ancestry and future generations), community, culture/spirituality, and one's authentic self being disrupted. Our findings also suggested that Native Hawaiians often attribute these disruptions to disparities due to the ongoing impact of colonization, historical trauma, and cultural loss. As a preferred form of treatment for depression, participants recommended various Hawaiian cultural practices to be integrated into existing behavioral health services to nurture the above-mentioned vital connection.

“It’s Stable but Not Stable”: A Conceptual Framework of Subjective Housing Stability Definition Among Individuals with Co-occurring Mental Health and Substance Use Disorders

Objective: Despite increasing efforts to improve housing stability, research has largely defined housing stability in a narrow sense and heavily relied on objective measures, such as housing types and housing duration. The present study constructed a conceptual framework for a subjective housing stability definition from the perspectives of individuals with co-occurring mental health and substance use disorders and their behavioral health service providers. Methods: Following the principles of grounded theory, we collected and analyzed qualitative data through semistructured interviews with 24 individuals with serious mental illness and substance use problems and three focus groups with 22 behavioral health service providers. Results: We developed a conceptual framework with two domains of subjective housing stability: functional stability and experiential stability. The functional stability domain includes four theoretical concepts: meeting basic needs, housing quality, housing affordability, and housing permanence. The experiential stability domain includes four theoretical concepts: autonomy and independence, connectedness, safety, and supportiveness. Conclusions: The conceptual framework can inform future research, practices, and policies to move beyond focusing on merely providing housing to consider the diverse and underlying needs in improving housing stability and well-being among those experiencing or at risk of housing instability.

Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults.

There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one's perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients' self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.

Advancing Health Equity: A Safety Net Hospital Perspective

Equitable care has been recognized as one of the six core components of quality for over two decades, yet scant attention has been paid to understand and address healthcare disparities in the US. There is long-standing evidence of substantial health disparities and poor health outcomes along race, ethnicity and income levels in the US. The COVID-19 pandemic both exacerbated and exposed these inequities and catalyzed a national imperative to achieve equitable healthcare. The objective of this article is to provide a case study of a resource-challenged safety net hospital’s journey to advance health equity in Chicago. Humboldt Park Health (HPH) is a 200-bed independent community teaching hospital located on the West side of Chicago serving a multiracial, multilingual and socioeconomically disadvantaged population. Our journey started with the formation of a multidisciplinary health equity committee in 2021, reporting to the Board of Trustees, that was charged with formulating a strategy, developing an evidence-based framework and priorities for action, and implementing the action plan. We addressed four groups of stakeholders: our patients, our people, our organization, and our community. Our actions to advance equity have included (a) collection of patients’ demographic data such as race, ethnicity, language, sexual orientation, and gender identity; (b) assessment of social determinants of health (SDOH) along with connecting patients with social services; (c) the development of health disparities dashboards for various ambulatory preventive measures for stratification of quality data along race, ethnicity and language; (d) focus on LGBTQ+ community’s access to well-informed and sensitivity-trained behavioral health service providers, and (e) organization-wide training to embed the concepts of diversity, equity and inclusivity in the fabric of the organization. Other initiatives include the building of a community wellness center and a 100-unit affordable housing complex in the community. Digital health equity is an important domain that is being addressed by the launch of a patient portal to empower patients by providing them access to their information, and remote patient monitoring solutions. The next phase of our work involves evaluation studies to understand the impact of our interventions on health disparities and outcomes in our community.

Montana County ends decade‐long contract with MH provider

One of Montana's leading providers of behavioral health services will no longer have an operating contract with Gallatin County as of Feb. 2, the Montana Free Press reported Jan.12. Citing several breaches of its agreement, Gallatin County commissioners and County Attorney Marty Lambert notified Western Montana Mental Health Center in a letter that the agreement would be terminated in 15 business days. “Gallatin County hereby advises all of you that the WMMHC has, on multiple occasions, breached its contractual obligations to the County, including but not limited to, the pro‐visions outlined below,” stated an accompanying Jan. 10 letter addressed to WMMHC Chairperson Levi Anderson. Gallatin County has been paying the WMMHC $29,417.50 monthly to provide a range of services. One is the provision of at least one bed for temporary, involuntary holds at the WMMHC's Hope House in Bozeman for people whose mental health crisis presents a danger to themselves or others. County officials say Hope House has been insufficiently operated at various times in recent years. Ending the more than 10‐year contract, Lambert said, “finally allows us to move forward with the provision of these very important crisis services which have only been sporadically met by Western for quite some time.” The WMMHC's Anderson attributes much of the difficulty at Hope House to low staffing levels exacerbated by the COVID‐19 pandemic — an issue he says is not unique to his organization. “The entire State of Montana is experiencing a drastic workforce shortage and behavioral health providers, WMMHC included, are struggling with workforce,” Anderson said in an email, adding that his organization has had to be “nimble” to modify services during the pandemic. “The Gallatin County Commission and County Attorney are alleging a breach of service based on these pandemic‐related operational challenges that have been experienced by many organizations, including the County themselves.” Lambert said the county does not expect to enter into a new contract with any other behavioral health care provider, which would require issuing a request for proposals to interested organizations, before the WMMHC's contract ends. The county's agreement with Bozeman Health, he said, will provide an emergency resource for people in crisis until the county can find new providers to work with long term.

Integrating primary, behavioral and spiritual health care to improve patient outcomes

Background: Residents of Webb County, Texas, along the U.S.-Mexico border suffer from health disparities which stem from extreme poverty, lower levels of educational attainment, and inadequate access to basic health care. The scarcity of primary care and behavioral health service providers is a key factor influencing higher-than-average disease prevalence and unfavorable disease management in the region. In 2015 Mercy Ministries of Laredo became one of eight subgrantees of a grant awarded by the Social Innovation Fund to Methodist Healthcare Ministries of San Antonio to enhance/expand integrated primary care and behavioral health care services in medically underserved areas of South Texas. Methods: Mercy’s project embodied a 3-dimensional model of health and healthcare, to include physical, behavioral and spiritual needs and interventions. With strong support from a research design and analysis group, this small clinic was able to demonstrate statistically significant improved health outcomes of several interventions. A non-randomized quasi experimental design (QED) was used and participants chose whether to participate in the intervention (207) or control (203) group. Common variables for all eight subgrantees included five overarching measures (HbA1C, blood pressure, BMI, PHQ-9 and quality of life score) and depression outcomes were used to statistically power all subgrantee studies. Results: Intervention group participants had significantly greater improvements in quality of life and anxiety symptoms when compared with comparison group participants. Intervention participants had a Duke General Health score 4.01 points higher and a GAD-7 score 0.79 points lower than those in the comparison group. There were also significant improvements for intervention participants over time for these two outcomes as well as depression symptoms. Conclusions: Grant funded resources enhanced health outcomes and prompted this small clinic to expand integrated primary and behavioral health services to serve the entire clinic population and promote integrated primary and behavioral health care for other underserved populations.

Conceptualizing Implementation Practice Capacity in Community-Based Organizations Delivering Evidence-Based Behavioral Health Services

Due to the significant prevalence of mental and substance use disorders in the United States, the push for the development and implementation of evidence-based practices (EBPs) in behavioral health has risen exponentially in the last 30 years. Community-based organizations (CBOs) (i.e., self-governing and/or not-for-profit) have been recognized as important providers of behavioral health services. However, there are gaps in the literature surrounding CBO implementation capacity—ability to adopt, implement, and sustain an EBP- and capacity training initiatives (e.g., training in data-based decision-making) that specifically target CBOs and implementation practice. The purpose of this exploratory study was to assess how individuals working within Florida CBOs conceptualize implementation practice capacity and what is needed to reach adequate capacity to utilize an EBP. This qualitative study consisted of semi-structured interviews with eight administrators and nine practitioners currently employed by CBOs who deliver evidence-based behavioral health services (N = 17). Results showed certain implementation practice characteristics such as leadership, culture/climate, collaboration/communication, data-based decision-making and evaluation, and funding were all important areas of implementation practice capacity. Implications for future research focused on conceptualizing and building implementation practice capacity within the context of community behavioral health settings will be discussed.

Bringing Evidence-Based Interventions into the Schools: An Examination of Organizational Factors and Implementation Outcomes

Although schools are one of the largest providers of behavioral health services for youth, many barriers exist to the implementation of evidence-based interventions in schools. This study used the Stages of Implementation Completion (SIC) to examine school-based implementation outcomes for a computer-assisted cognitive behavioral therapy intervention for anxious youth. Organizational factors and predictors of program startup also were examined. Results indicated that the SIC detected implementation variability in schools and suggested that spending more time completing pre-implementation activities may better prepare schools for active implementation of program delivery. Furthermore, proficiency emerged as a potentially important organizational factor to examine in future school-based implementation research.

Continuous quality improvement in measure development: Lessons from building a novel clinical feedback system

PurposeWhile the use of clinical feedback systems has become commonplace in psychological treatment, many of the most common instruments used for this purpose have not changed in decades. This paper describes the first four cycles of a measure development method designed to embrace continuous quality improvement.MethodsUsing techniques and philosophies developed in business management and academia—lean continuous quality improvement, action research, and practice research networks—we iterated through multiple cycles of development with the goal of creating an optimal clinical feedback system. These cycles emphasize building capacity to receive and implement feedback from a variety of stakeholders, especially patients and providers of behavioral health services, while also being responsive to quantitative findings from measure development.ResultsIterating measure development with stakeholder feedback over the course of 5 years has resulted in a novel measurement system with 19 subscales administered via branching logic, and a supporting practice research network to sustain development.ConclusionIn developing a new clinical feedback system, the less-frequently-discussed practical aspects of measure development require close attention. Specifically, being willing to embrace change, planning for iteration, and systematically seeking stakeholder feedback are identified as central methods for improving clinical feedback systems.

Bridges to Care and Recovery: Addressing Behavioral Health and Mental Health Needs Through the Faith Community.

The Bridges to Care and Recovery program supports the behavioral health assessment, treatment, and recovery of individuals through partnerships with the African-American faith community. Church members receive mental health training and skill building, so they can serve as personal mental health educators and advocates. A Community Connector provides guidance and referral to behavioral health services, including access to free counseling. The program reduces the perceived stigma of mental illness and strengthens partnerships between behavioral health service providers and the African-American community.

Examining links between cannabis potency and mental and physical health outcomes

Cannabis use is associated with unwanted health outcomes, including anxiety, depression, poor sleep hygiene, and disrupted cognitive functioning. However, research to date has not been able to disentangle the complexities of these relations, leaving behavioral health service providers lacking clear direction for treatment. A limiting factor may be the common practices for cannabis use assessment. Cannabis use is typically assessed by frequency, even though to estimate the amount of psychoactive compounds ingested potency, quantity, and route of administration should also be assessed. This study, one of the first of its kind, takes an important step in assessing cannabis use by studying the link between cannabis potency and behavioral health (i.e., physical and mental health) outcomes. Self-reported data were analyzed using the New Statistics, which focuses on effect sizes and confidence intervals, rather than null hypothesis significance testing. Findings were inconsistent, with some positive, some negative, and some trivial associations across four domains (i.e., demographic variables, cannabis use variables, mental health, and physical health). The most valuable discovery was the importance of method of administration in understanding the link between potency and health. We observed a “potency valley” (i.e., a range of potencies for which products were not available) between flower potencies and concentrate potencies. Further, collapsing potency data across flower and concentrated cannabis obscured important relations between cannabis potency and behavioral health outcomes. Findings suggest that to more fully understand the relation between cannabis potency and behavioral health outcomes, researchers should examine potency separately across routes of administration.

Can you hear me now? Teaching listening skills.

This column provides an overview of methods for training to improve service provider active listening and reflective responding skills. Basic skills in active listening and reflective responding allow service providers to gather information about and explore the needs, desires, concerns, and preference of people using their services-activities that are of critical importance if services are to be truly person-centered and person-driven. Sources include the personal experience of the authors as well as published literature on the value of basic counseling skills and best practices in training on listening and other related soft skills. Training in listening is often needed but rarely sought by behavioral health service providers. Effective curricula exist, providing content and practice opportunities that can be incorporated into training, supervision, and team meetings. When providers do not listen well to the people who use their services, the entire premise of recovery-oriented person-driven services is undermined. (PsycINFO Database Record

The Potential for Change in Rehabilitation and Reentry for Behaviorally and Mentally Disordered Offenders in the Post-Affordable Care Act and Second Chance Act Health Care Climate

The United States has the highest incarceration rate among developed nations. With more than half of offenders estimated to have mental illness or addiction, correctional systems are the largest de-facto mental and behavioral health service providers. Correctional facilities are often poorly equipped to serve as treatment facilities and are limited in scope of services due to budgetary restrictions. Historically, the coordination of care during release from jails and prisons is insufficient to secure efficient and uninterrupted care. With low continuity of community-based services during reentry periods, offenders are more likely to become caught in the revolving door of the criminal justice system. Specialty courts and new treatment and reentry models have emerged from evidence-based roots over the past decades, though such approaches have yet to become ubiquitous fixtures in the justice system. The cost of disease burden remains substantial, and large-scale implementation of evidence-based reentry has yet to become a staple of the justice system. In 2014, the Affordable Care Act (ACA) made affordable health care plans and Medicaid coverage available to justice-involved individuals, expanding the possibilities for transitional care. This article reviews the current state of mental and behavioral health care for offender populations, evidence-based models for improving reentry processes, the economic impact of mental and behavioral disorders in justice-involved populations, directions for the future of treatment and reentry, and the implications of the Affordable Care Act (ACA) for bringing about long-term change in the systemic approach to high-need offenders.

‘Phantom Networks’ of Managed Behavioral Health Providers: An Empirical Study of Their Existence and Effect on Patients in Two New Jersey Counties

Managed care organizations often tout the availability of clinicians in their provider networks, yet their clients seeking mental healthcare may find it difficult to obtain such care in a timely and effective manner. Using comprehensive data from two counties in New Jersey, the authors examine the prevalence of phantom networks of managed care providers of behavioral health services and the effects of such networks on patients’ wait times and the availability of therapists treating children.

Developing Effective Research-Practice Partnerships for Creating a Culture of Evidence-Based Decision Making

With growing evidence that treatment as usual may have limited effectiveness in mental health the pressure on service providers to be accountable and produce evidence as to the effectiveness of their services has increased. Measurement Feedback Systems, such as the Contextualized Feedback System (CFS), have the potential to be powerful tools for service providers in assessing their own effectiveness at multiple levels with an organization. These systems represent an amalgamation of the data driven world of science and the experience driven world of clinical practice. However, the synthesis of these two worlds is not without significant challenges as these two very different cultures can easily clash. The key for successful collaboration in developing and implementing Measurement Feedback Systems is a good university-practice partnership that has a strong foundation in common goals and the positive relationships among its members. In addition, the partnership needs to be flexible so that it can adapt to new challenges and continuously grow with each obstacle. These are some of several lessons learned the authors of this article will share as part of their experience with developing and implementing CFS in one of the largest behavioral health service providers in the U.S.

Funding Cultural Adaptations to Promote Effective and Efficient Mental Health Service Provision

· Given the changing demographics of the U.S. and documented racial and ethnic health disparities, behavioral health service providers must look at adapting their services to better meet the needs of their diverse client populations.

Examining racial/ethnic minority treatment experiences with specialty behavioral health service providers.

This study investigated whether satisfaction and helpfulness of treatment by mental health service provider is related to race/ethnicity and psychosocial factors. Data from the National Co morbidity Survey-Replication study, which administered mental health service use questions for the past 12-months (1332), was analyzed. Data were stratified by service provider and analyzed with multiple logistic regressions. Racial/ethnic minorities were generally more likely to be satisfied with services provided by specialty mental health providers compared to white respondents. Racial/ethnic minorities generally perceived the services provided by specialty mental health providers as more helpful than did other racial/ethnic groups. Those who reported high cultural identity were more likely to find their treatment experience less satisfying and less helpful. Greater attention to specialty referrals for racial/ethnic minority groups may fruitfully contribute to improve help-seeking for these groups. The role culture plays in shaping the mental health treatment experience needs to be further investigated.

Counseling and Wellness Services Integrated with Primary Care: A Delivery System That Works

The continuity and coordination of care between medical and behavioral health services is a major issue facing our health care delivery system. Barriers to basic communication between providers of medical services and providers of behavioral health services, include: no coordination of services, and poor recognition of the relationship between medical and behavioral issues. Colocating behavioral health counselors and nutritionists alongside primary care physicians and clinicians (PCPs). Grand Valley Health Plan (GVHP) established the national benchmark for patients using ambulatory services for mental health, and ranked first in Michigan on all six HEDIS "effectiveness of care" measures for behavioral health. One result was a 54% decrease in mental health hospitalization. Up to 70% of primary care visits are driven by psychosocial factors, with 25% of patients having a diagnosable mental disorder, and comorbidity occurring in up to 80%. With colocated services, PCPs now often explain to patients that "this is just how we deliver care to you," when introducing health coaches to patients and asking them to be involved.

Caregiver Strain in Families of Children with Serious Emotional Disturbance: Does Relationship to Child Make a Difference?

ABSTRACT With the prevalence of kinship care increasing, it is critical to understand the role of caregiver strain among this population. This study focused on the strain experienced by relative caregivers as compared to parents who were caring for children with serious emotional disturbance (SED). Descriptive and multiple regression analyses demonstrated that both caregiver groups reported similar amounts of elevated strain, with the exception that parent caregivers of children with SED reported more subjective internalized strain than did other relative caregivers. The child welfare system, providers of behavioral health services, and policy-makers need to pay closer attention to this special population of caregivers and the children in their care.