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Administration and Policy in Mental Health

Stephen S Johnston, David S Salkever, Nicholas S Ialongo, Eric P Slade, Elizabeth A Stuart
When candidates for school-based preventive interventions are heterogeneous in their risk of poor outcomes, an intervention's expected economic net benefits may be maximized by targeting candidates for whom the intervention is most likely to yield benefits, such as those at high risk of poor outcomes. Although increasing amounts of information about candidates may facilitate more accurate targeting, collecting information can be costly. We present an illustrative example to show how cost-benefit analysis results from effective intervention demonstrations can help us to assess whether improved targeting accuracy justifies the cost of collecting additional information needed to make this improvement...
July 8, 2017: Administration and Policy in Mental Health
Mike Lucock, Michael Barkham, Gillian Donohoe, Stephen Kellett, Dean McMillan, Sarah Mullaney, Andrew Sainty, David Saxon, Richard Thwaites, Jaime Delgadillo
Practice research networks (PRNs) can support the implementation of evidence based practice in routine services and generate practice based evidence. This paper describes the structure, processes and learning from a new PRN in the Improving Access to Psychological Therapies programme in England, in relation to an implementation framework and using one study as a case example. Challenges related to: ethics and governance processes; communications with multiple stakeholders; competing time pressures and linking outcome data...
July 1, 2017: Administration and Policy in Mental Health
Pamela N Roberto, Nicole Brandt, Eberechukwu Onukwugha, Eleanor Perfetto, Christopher Powers, Bruce Stuart
Prior research demonstrates substantial access problems associated with utilization management and formulary exclusions for antipsychotics in Medicaid, but the use and impact of coverage restrictions for these medications in Medicare Part D remains unknown. We assess the effect of coverage restrictions on antipsychotic utilization in Part D by exploiting a unique natural experiment in which low-income beneficiaries are randomly assigned to prescription drug plans with varying levels of formulary generosity...
June 28, 2017: Administration and Policy in Mental Health
Maureen T Stewart, Constance M Horgan, Amity E Quinn, Deborah W Garnick, Sharon Reif, Timothy B Creedon, Elizabeth L Merrick
Health plan policies can influence delivery of integrated behavioral health and general medical care. This study provides national estimates for the prevalence of practices used by health plans that may support behavioral health integration. Results indicate that health plans employ financing and other policies likely to support integration. They also directly provide services that facilitate integration. Behavioral health contracting arrangements are associated with use of these policies. Delivery of integrated care requires systemic changes by both providers and payers thus health plans are key players in achieving this goal...
June 23, 2017: Administration and Policy in Mental Health
Scott T Ronis, Amanda K Slaunwhite, Kathryn E Malcom
This paper reviews how child and youth mental health care services in Canada, the United States, and the Netherlands are organized and financed in order to identify systems and individual-level factors that may inhibit or discourage access to treatment for youth with mental health problems, such as public or private health insurance coverage, out-of-pocket expenses, and referral requirements for specialized mental health care services. Pathways to care for treatment of mental health problems among children and youth are conceptualized and discussed in reference to health insurance coverage and access to specialty services...
June 13, 2017: Administration and Policy in Mental Health
Nina A Sayer, Craig S Rosen, Nancy C Bernardy, Joan M Cook, Robert J Orazem, Kathleen M Chard, David C Mohr, Shannon M Kehle-Forbes, Afsoon Eftekhari, Jill Crowley, Josef I Ruzek, Brandy N Smith, Paula P Schnurr
Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment...
June 9, 2017: Administration and Policy in Mental Health
Ming-Hui Tai, Bethany Lee, Eberechukwu Onukwugha, Julie M Zito, Gloria M Reeves, Susan dosReis
A state Care Management Entity (CME) using the wraparound practice model provided intensive care coordination for youth with severe mental illness, those most likely to receive antipsychotics. The model has led to improved clinical/functional outcomes, but little is known about the impact on antipsychotic prescribing and safety monitoring. A pre-post study was conducted to evaluate antipsychotic dosing, concomitant antipsychotic use, and metabolic monitoring among CME-enrolled and non-CME-enrolled comparison groups...
June 5, 2017: Administration and Policy in Mental Health
Martin Salzmann-Erikson
Ward rules in psychiatric care aim to promote safety for both patients and staff. Simultaneously, ward rules are associated with increased patient violence, leading to neither a safe work environment nor a safe caring environment. Although ward rules are routinely used, few studies have explicitly accounted for their impact. To describe the process of a team development project considering ward rule issues, and to develop a working model to empower staff in their daily in-patient psychiatric nursing practices...
May 18, 2017: Administration and Policy in Mental Health
Adrian J Blow
No abstract text is available yet for this article.
May 2, 2017: Administration and Policy in Mental Health
Scott D Miller, Mark A Hubble, Bruce E Wampold
No abstract text is available yet for this article.
May 2, 2017: Administration and Policy in Mental Health
Nikki R Wooten, Rachel Sayko Adams, Beth A Mohr, Diana D Jeffery, Wendy Funk, Thomas V Williams, Mary Jo Larson
We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence estimates were: 26.2 % for any select MHDX and 18.1 % for any MHT. Army women who had physical injuries since FY2002 or any behavioral health treatment between FY2002 and the pre-deployment year had increased odds of pre-deployment year MHT...
July 2017: Administration and Policy in Mental Health
Yunqiao Wang, Christine A Henriksen, Margreet Ten Have, Ron de Graaf, Murray B Stein, Murray W Enns, Jitender Sareen
The study aimed to determine whether some depressive, anxiety, and substance-use (DAS) disorders are mild, transient cases that remit without treatment. The first two waves of the first Netherlands Mental Health Survey and Incidence Study were used (age 18-64 years at baseline; wave two N = 5618). Mental disorders were assessed using CIDI 1.1. Past-year and past-month measures of DAS disorders, health service use, and quality of life were assessed at both waves. Individuals with a past-year DAS disorder who received no prior lifetime treatment were significantly more likely than those who received treatment to: (1) remit from their index disorder(s) without subsequent treatment, (2) be free of comorbid disorders, and (3) not have attempted suicide during follow-up (remission rates: 68...
July 2017: Administration and Policy in Mental Health
Patrick W Corrigan, Alessandra Torres, Juana L Lara, Lindsay Sheehan, Jonathon E Larson
Latinos with serious mental illness get sick and die much younger than other adults. In this paper, we review findings of a community based participatory research project meant to identify important healthcare needs, barriers to these needs, solutions to the barriers, and the promise of peer navigators as a solution. Findings from focus groups reflected general concerns of people with mental illness (e.g., insurance, engagement, accessibility) and Latinos with serious mental illness (e.g., immigration, language, and family)...
July 2017: Administration and Policy in Mental Health
Evan D Holloway, Keith R Cruise, Sarah M Downs, Patrick O Monahan, Matthew C Aalsma
Justice-involved youth endorse high rates of mental health problems. Juvenile probation is the most common disposition in the justice system and juvenile probation officers (JPOs) are crucial for connecting justice-involved youth with appropriate care. We examined the role of mental health competency on the use of self-report case management strategy types (deterrence, restorative justice, and treatment) by JPOs and whether jurisdiction-level differences were relevant. Results suggest that mental health competency predicted use of restorative justice and treatment strategies and all three strategy types varied at the county level...
July 2017: Administration and Policy in Mental Health
Joy R Pemberton, Nicola A Conners-Burrow, Benjamin A Sigel, Chad M Sievers, Lauren D Stokes, Teresa L Kramer
For proficiency in an evidence-based treatment (EBT), mental health professionals (MHPs) need training activities extending beyond a one-time workshop. Using data from 178 MHPs participating in a statewide TF-CBT dissemination project, we used five variables assessed at the workshop, via multiple and logistic regression, to predict participation in three post-workshop training components. Perceived in-workshop learning and client-treatment mismatch were predictive of consultation call participation and case presentation respectively...
July 2017: Administration and Policy in Mental Health
Emily B Jones, Julia Zur, Sara Rosenbaum
Community health centers provide co-located medical, behavioral, and case management services to meet the unique and complex needs of the underserved, including homeless individuals. Multivariate analysis of staffing patterns in health centers serving high homeless caseloads highlights above-average behavioral and case management staffing, regardless of Health Care for the Homeless funding status. Rural health centers and those in the South had lower behavioral health and enabling services staffing. Implications include the need to monitor disparities, link health centers with available technical assistance, and emphasize integrating co-located behavioral health, enabling, and medical services through grant oversight mechanisms...
July 2017: Administration and Policy in Mental Health
Laysha Ostrow, Donald Steinwachs, Philip J Leaf, Sarah Naeger
This study sought to understand whether knowledge of the Affordable Care Act (ACA) was associated with willingness of mental health peer-run organizations to become Medicaid providers. Through the 2012 National Survey of Peer-Run Organizations, organizational directors reported their organization's willingness to accept Medicaid reimbursement and knowledge about the ACA. Multinomial logistic regression was used to model the association between willingness to accept Medicaid and the primary predictor of knowledge of the ACA, as well as other predictors at the organizational and state levels...
July 2017: Administration and Policy in Mental Health
Elizabeth B Matthews
Despite increasing rates of electronic health record (EHR) adoption, the impact of these systems on the delivery of behavioral health treatment remains poorly understood. This qualitative study examined the experiences of 37 behavioral health providers using EHRs during face-to-face visits. Providers described environmental, relational and system related strategies that were used to meaningfully integrate EHRs into treatment and enhance the patient-centeredness of clinical encounters. Barriers to deploying these techniques were also identified...
July 2017: Administration and Policy in Mental Health
Michel L A Dückers, Anke B Witteveen, Jonathan I Bisson, Miranda Olff
This study confirms that the developmental stage of post-disaster psychosocial support planning and delivery systems in Europe is associated with countries' level of disaster vulnerability. Lower vulnerability is accompanied by more evolved planning and delivery systems. Countries in north, west and central regions have more developed planning and delivery systems and lower vulnerability levels than those in the south, southeast and east. The highest proportion of variance in vulnerability is located at the regional level, most of the variance in planning and delivery systems is at the individual level...
July 2017: Administration and Policy in Mental Health
Gregory A Aarons, Mark G Ehrhart, Lauren R Farahnak, Marisa Sklar, Jonathan Horowitz
The role of leadership in the management and delivery of health and allied health services is often discussed but lacks empirical research. Discrepancies are often found between leaders' self-ratings and followers' ratings of the leader. To our knowledge no research has examined leader-follower discrepancies and their association with organizational culture in mental health clinics. The current study examines congruence, discrepancy, and directionality of discrepancy in relation to organizational culture in 38 mental health teams (N = 276)...
July 2017: Administration and Policy in Mental Health
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