Psychiatric services最新文献_第9页

Effects of an Organizational Implementation Strategy on Sustainment of Measurement-Based Care in Community Mental Health. 组织实施策略对社区心理卫生测量性护理维持的影响。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2025-01-30 DOI: 10.1176/appi.ps.20240302

Nathaniel J Williams, Gregory A Aarons, Mark G Ehrhart, Susan Esp, Nallely Vega, Marisa Sklar, Kristine Carandang, Lauren Brookman-Frazee, Steven C Marcus

{"title":"Effects of an Organizational Implementation Strategy on Sustainment of Measurement-Based Care in Community Mental Health.","authors":"Nathaniel J Williams, Gregory A Aarons, Mark G Ehrhart, Susan Esp, Nallely Vega, Marisa Sklar, Kristine Carandang, Lauren Brookman-Frazee, Steven C Marcus","doi":"10.1176/appi.ps.20240302","DOIUrl":"10.1176/appi.ps.20240302","url":null,"abstract":"Objective: Little is known about how to sustain evidence-based interventions with fidelity in community mental health settings. Phase 1 of the Working to Implement and Sustain Digital Outcome Measures (WISDOM) trial showed that an organizational strategy improved the implementation of measurement-based care (MBC) in mental health services for youths 1-12 months after clinician MBC training. The authors report results from phase 2 of the trial, in which the strategy's effects on MBC sustainment 13-26 months after clinician MBC training were examined.Methods: Twenty-one outpatient mental health clinics were randomly assigned to MBC training and technical assistance plus the Leadership and Organizational Change for Implementation (LOCI) strategy (11 clinics) or to training and technical assistance only (10 clinics). In phase 2, the primary outcomes of MBC completion rate, youth symptom improvement, and MBC fidelity were examined for 452 youths who entered treatment 13-26 months after clinician MBC training.Results: No differences were found in MBC completion rate or symptom improvement between the two conditions; however, among the 81 youths who received MBC, fidelity was significantly higher at LOCI sites relative to control sites (24%, SE=11.1 vs. 1%, SE=1.0, respectively; p=0.003).Conclusions: During phase 2, LOCI sites (vs. control sites) sustained superior MBC fidelity when MBC was used; however, superior MBC completion rates and clinical outcomes were not sustained. Sustainment of MBC may require strategies that improve its fit with regulatory and reimbursement environments in addition to strategies that develop clinic infrastructure.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"358-365"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mobile Crisis Teams' Reliance on Law Enforcement for Multiple Key Functions. 移动危机团队对多个关键功能的执法依赖。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2025-03-06 DOI: 10.1176/appi.ps.20240346

Blake R Erickson, Leah G Pope, Michael T Compton, Lisa B Dixon, Rachel Odes, Preston Looper, Matthew L Goldman

引用次数: 0

Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care. 急性精神病护理患者暴力风险评估中的系统和人际偏见。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2024-12-19 DOI: 10.1176/appi.ps.20240108

Christoffer Dharma, Susan J Bondy, Laura Sikstrom, Peter S Muirhead, Juveria Zaheer, Marta M Maslej

{"title":"Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care.","authors":"Christoffer Dharma, Susan J Bondy, Laura Sikstrom, Peter S Muirhead, Juveria Zaheer, Marta M Maslej","doi":"10.1176/appi.ps.20240108","DOIUrl":"10.1176/appi.ps.20240108","url":null,"abstract":"Objective: The assessment and management of inpatient risk for violence in acute psychiatric care are challenges that introduce the potential for bias. This study aimed to examine inequities based on social determinants of health (SDoH) (e.g., race-ethnicity, gender, or mode of admission to acute care) that may lead to unfair assessment of psychiatric patients.Methods: The authors analyzed electronic health records of 7,424 acute care patients across 12,650 stays (2016-2022) at a large Canadian psychiatric hospital. Risk ratios (RRs) were calculated by SDoH for staff assessments of high risk (perceived risk), for violent incidents (actual risk), and for potentially biased risk assessment (particularly when a patient was assessed as high risk but did not become violent).Results: In univariate analyses, patients assessed as high risk who did not become violent were more likely to be male than female and to be Black, Indigenous, or Middle Eastern than White. When RRs were mutually adjusted for all variables, the associations for gender and race-ethnicity were attenuated or were no longer statistically significant. Associations with potentially biased risks that remained significant included most psychiatric diagnoses (vs. a depressive or anxiety disorder), supportive or unstable housing (vs. owning a home), and admission by police (vs. self-admission; RR=2.14, 95% CI=1.92-2.40).Conclusions: Systemic factors, such as admission by police and housing status, and having severe mental illness were the primary drivers of observed inequities in risk assessments of patients from racial-ethnic minority groups. Addressing these systemic factors might be key to improving acute psychiatric care.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"326-335"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of Rurality on Type of Clinicians Delivering Psychotherapy and Prescribing Antidepressants to Veterans. 乡村性对退伍军人心理治疗及抗抑郁药物处方临床医生类型的影响

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2024-12-12 DOI: 10.1176/appi.ps.20240186

Luke Rozema, Sarah L Cornelius, Brian Shiner, Bradley Vince Watts, Matthew Vincenti

{"title":"Effect of Rurality on Type of Clinicians Delivering Psychotherapy and Prescribing Antidepressants to Veterans.","authors":"Luke Rozema, Sarah L Cornelius, Brian Shiner, Bradley Vince Watts, Matthew Vincenti","doi":"10.1176/appi.ps.20240186","DOIUrl":"10.1176/appi.ps.20240186","url":null,"abstract":"Objective: Mental health care is delivered by teams that include social workers, psychologists, nonphysician prescribing clinicians (NPPCs), and physicians. The objective of this study was to determine whether patient rurality has an effect on the types of U.S. Department of Veterans Affairs (VA) clinicians delivering psychotherapy and prescribing antidepressants to veterans.Methods: Patients (N=3,537,595) receiving VA mental health services between 2013 and 2022 were stratified by rural, micropolitan, and metropolitan residence. A generalized estimating equation with a negative binomial distribution was used to estimate rates of psychotherapy delivered by social workers or psychologists and antidepressant prescribing rates by NPPCs or physicians. Rate ratios (RRs) comparing rural with metropolitan patients were calculated for each fiscal year.Results: Total psychotherapy visit rates were similar for rural, micropolitan, and metropolitan veterans, but women received psychotherapy from psychologists at higher rates than men and combat veterans received psychotherapy from psychologists at higher rates than noncombat veterans. Rural patients received psychotherapy from social workers more often (RR=1.24-1.30) and from psychologists less often (RR=0.80-0.88) than metropolitan patients. Rural patients were given prescriptions for antidepressants by NPPCs more often (RR=1.28-1.36) and by physicians less often (RR=0.87-0.92) than metropolitan patients.Conclusions: Rural veterans with mental health conditions receive more of their psychotherapy and antidepressant prescriptions from clinicians with master's- versus doctoral-level training. Future work should assess how rural-urban differences in mental health care delivery affect patient satisfaction, cost, and clinical outcomes.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"336-342"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mental Health Treatment Engagement Among Deaf Individuals. 聋人心理健康治疗参与研究

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2025-02-27 DOI: 10.1176/appi.ps.20240079

Aileen Aldalur, Melissa L Anderson, Kimberly A Van Orden, Kenneth R Conner

{"title":"Mental Health Treatment Engagement Among Deaf Individuals.","authors":"Aileen Aldalur, Melissa L Anderson, Kimberly A Van Orden, Kenneth R Conner","doi":"10.1176/appi.ps.20240079","DOIUrl":"10.1176/appi.ps.20240079","url":null,"abstract":"Objective: Members of the U.S. Deaf community experience higher rates of mental health problems than do hearing individuals, but empirical data on Deaf people's treatment engagement are lacking. This cross-sectional study analyzed novel mixed-methods data on Deaf adults' current mental health symptoms, treatment engagement, and past treatment experiences.Methods: Seventy-one Deaf adults recruited from across the United States completed screening assessments on the videoconferencing platform Zoom.Results: Although 63% (N=45) of participants screened positive for one or more current mental health problems, only 31% (N=14) of those individuals were engaged in treatment. Participants reported multiple barriers to treatment engagement, including communication incompatibilities, limited culturally appropriate options, confidentiality concerns, and perceived ineffectiveness of treatment.Conclusions: Results suggest significant treatment disparities for Deaf adults. Strategies are needed to overcome the barriers they encounter, including increasing the number of Deaf providers, training providers to work with Deaf patients, and developing interventions to assist Deaf individuals in modifying their beliefs about treatment and problem-solving the barriers to treatment seeking.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"402-405"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Youth Inpatient and Residential Treatment Psychiatric Beds: National Trends and Potential Causal Factors, 2010-2022. 青少年住院和住院治疗精神病床位：2010-2022年全国趋势和潜在原因。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2025-01-30 DOI: 10.1176/appi.ps.20240200

Sushmita Shoma Ghose, Sarah Beehler, Debra A Pinals, Laura Crocker, Tabitha Hoey, N Phil Masiakowski, Howard Goldman, Mustafa Karakus, Tison Thomas, Nikhil A Patel

{"title":"Youth Inpatient and Residential Treatment Psychiatric Beds: National Trends and Potential Causal Factors, 2010-2022.","authors":"Sushmita Shoma Ghose, Sarah Beehler, Debra A Pinals, Laura Crocker, Tabitha Hoey, N Phil Masiakowski, Howard Goldman, Mustafa Karakus, Tison Thomas, Nikhil A Patel","doi":"10.1176/appi.ps.20240200","DOIUrl":"10.1176/appi.ps.20240200","url":null,"abstract":"Objective: Youth inpatient and residential treatment psychiatric services are essential components of the continuum of care. Concern has grown about the diminished availability of these services and the increasing need for them. This study aimed to examine the number of youths treated at inpatient and residential psychiatric facilities over a 12-year period and to assess the perceptions of state mental health authorities (SMHAs) about the reasons for changes in availability.Methods: In this multimodal study, the authors conducted a secondary analysis of a national survey (including all 50 states, Washington, D.C., and Puerto Rico) of mental health facilities that was administered seven times between 2010 and 2022. In addition, the study relied on 2023 data from a survey of SMHAs (N=34 respondents).Results: Most states experienced a decline in the number of youths in inpatient (79%) and residential treatment psychiatric facilities (94%). Although some people posit that increased use of outpatient services may explain such declines, 81% of states had a reduction in community outpatient psychiatric care for youths during the study period. SMHAs reported that the impact of the COVID-19 pandemic and preexisting workforce shortages contributed to the reduction of youths treated.Conclusions: These findings show a nationwide decline in the number of youths treated in inpatient and residential treatment psychiatric facilities over time. Determining causal factors in these declines is challenging, and it is critical to develop a monitoring and reporting system for the number of youths requiring services and the capacity within each state for addressing youth needs.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"343-349"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of a Continuum-Based Framework to Advance General Health Integration in Community Behavioral Health Clinics. 使用基于连续体的框架来促进社区行为健康诊所的一般健康整合。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2025-01-30 DOI: 10.1176/appi.ps.20240019

Ekaterina Smali, Molly T Finnerty, Harold A Pincus, Rachel Talley, Matthew L Goldman, David Woodlock, Henry Chung

{"title":"Use of a Continuum-Based Framework to Advance General Health Integration in Community Behavioral Health Clinics.","authors":"Ekaterina Smali, Molly T Finnerty, Harold A Pincus, Rachel Talley, Matthew L Goldman, David Woodlock, Henry Chung","doi":"10.1176/appi.ps.20240019","DOIUrl":"10.1176/appi.ps.20240019","url":null,"abstract":"Objective: This study assessed the utility and effectiveness of the new general health integration (GHI) framework among community behavioral health organizations designated as certified community behavioral health clinics (CCBHCs) or in the process of applying to become a CCBHC.Methods: Nineteen licensed community behavioral health clinics, 18 of which had CCBHC status, participated in a 12-month learning collaborative. They used the GHI framework to assess their integration stage for 15 subdomains within eight domains of evidence-based practice. The clinics worked to improve their GHI practices with the support of monthly learning collaborative webinars, individual consultation calls, and technical assistance sessions. Clinics reported on performance quality metrics aligned with national CCBHC standards. Outcome measures included GHI framework scores at baseline and 1-year follow-up, capacity to report quality metrics at baseline and at the end of the collaborative, and average performance on the quality metrics at baseline versus at the end of the collaborative.Results: Clinics showed overall improvement in integration stage over the study period. Of note, higher baseline GHI framework scores demonstrated a significant association with greater-quality performance at baseline (r=0.577, p=0.024) and follow-up (r=0.782, p=0.001). Capacity to track and report quality metrics increased significantly during the learning collaborative, as did average performance on quality metrics.Conclusions: Community behavioral health clinics using the GHI framework were able to advance their GHI practices with a 12-month learning collaborative project. The framework has the potential to serve as a useful tool for clinics aiming to enhance GHI practices.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"366-372"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Gift of Love. 爱的礼物

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2024-11-19 DOI: 10.1176/appi.ps.20240512

Diane Roston

引用次数: 0

A Trauma-Informed Approach to Outpatient Psychiatric Services. 门诊精神科服务的创伤知情方法。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-04-01 Epub Date: 2025-02-13 DOI: 10.1176/appi.ps.20240378

Rachael Rosales, Hermioni L Amonoo, Lorna Campbell, Nomi C Levy-Carrick

引用次数: 0

Changes in Mental Health Services Use Under the ACA in One State: Role of Mental Health Provider Shortages. 一个州在《全民保健法案》下心理健康服务使用的变化：心理健康服务提供者短缺的作用》。

IF 3.3 3区医学

Psychiatric services Pub Date : 2025-02-01 Epub Date: 2024-11-05 DOI: 10.1176/appi.ps.20230628

Lyoung Hee Kim, Dominic Hodgkin, Mary Jo Larson, Michael Doonan

{"title":"Changes in Mental Health Services Use Under the ACA in One State: Role of Mental Health Provider Shortages.","authors":"Lyoung Hee Kim, Dominic Hodgkin, Mary Jo Larson, Michael Doonan","doi":"10.1176/appi.ps.20230628","DOIUrl":"10.1176/appi.ps.20230628","url":null,"abstract":"Objective: This study aimed to examine whether changes in mental health services use under the Patient Protection and Affordable Care Act (ACA) differed in Mental Health Professional Shortage Areas (MHPSAs) versus non-MHPSAs.Methods: Multiple waves of data from the California Health Interview Survey (2011-2018) were analyzed. The sample (N=10,497) was restricted to adults (ages 18-64) who reported experiencing serious psychological distress (SPD) during the past 12 months. MHPSAs were identified by using scores from the Health Resources and Services Administration and were matched to respondents' zip codes. Weighted logistic regression and generalized linear models were used to identify adjusted changes in the rates of four measures of mental health services use (any primary care visit for mental health reasons, any specialty mental health care visit, any prescription psychiatric medication, and total number of outpatient visits for mental health) before and after implementation of the ACA.Results: Rates of uninsured nonelderly adults with SPD in MHPSAs and non-MHPSAs decreased under the ACA. Changes in rates of specialty mental health services use under the ACA were statistically significant only in non-MHPSAs. Changes in mental health services use did not differ significantly between MHPSAs and non-MHPSAs for any of the four measures.Conclusions: Changes in the four measures of mental health use under the ACA did not differ in MHPSAs versus non-MHPSAs. Future research into the ACA's long-term effects should examine systemic and structural barriers to mental health care and to having sufficient numbers of mental health professionals.","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"149-156"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0