Promoting collaborative psychiatric care decision-making in community mental health centers: Insights from a patient-centered comparative effectiveness trial.

Objective: Mental health service-users face important medication decisions; yet not all are active participants in the decision-making process. Little is known about which technology-supported interventions might effectively promote collaborative decision-making in psychiatric care. We compared the effectiveness of two technology-supported collaborative care decision-making approaches.

Community-based behavioral health administrator perspectives on sustainability of Dialectical Behavior Therapy: a qualitative evaluation.

Background: Substantial resources have been invested in evidence-based practice (EBP) implementation in community settings; however, research suggests that EBPs do not always sustain over time.

Method: This qualitative study explored the perspectives of 13 community behavioral health agency leaders regarding the sustainability of an EBP 25 to 28 months following the original training period. Administrators from 10 agencies were interviewed to understand the complexities of the implementation process, sustainability of Dialectical Behavior Therapy, and their recommendations to enhance implementation and sustainability.

Delivering on the value proposition of precision medicine: the view from healthcare payers.

A long-held assumption and expectation has been that genomics-based precision medicine will provide clinicians with the tools and therapies they need to consistently deliver the right treatment to the right patient while simultaneously reducing waste and yielding cost savings for health systems. The pace of discovery within the field of precision medicine has been remarkable, yet optimal uptake of new genetic tests and genetically targeted therapies will occur only if payers recognize their value and opt to cover them. Coverage decisions require clear evidence of clinical effectiveness and utility and an understanding of how adoption will impact healthcare costs and utilization within a payer's network.

Connected Care: improving outcomes for adults with serious mental illness.

Objectives: To evaluate the effectiveness of Connected Care-a care coordination effort of physical and behavioral health managed care partners in Pennsylvania-on acute service use among adult Medicaid beneficiaries with serious mental illness (SMI).

Study Design: We examined changes in service utilization using a difference-in-differences model, comparing study group with a comparison group, and conducted key informant interviews to better understand aspects of program implementation.

Methods: We compared the difference in service use rates between baseline year and 2-year intervention period for the Connected Care group (n = 8633) with the difference in rates for the comparison group (n = 10,514), confirming results using a regression adjustment.

Challenges encountered in the conduct of Optimal Health: A patient-centered comparative effectiveness study of interventions for adults with serious mental illness.

Background: The aim of patient-centered comparative effectiveness research is to conduct stakeholder-driven investigations that identify which interventions are most effective for which patients under specific circumstances. Conducting this research in real-world settings comes with unique experiences and challenges. We provide the study design, challenges confronted, and the solutions we devised for Optimal Health, a stakeholder-informed patient-centered comparative effectiveness study focused on the needs of seriously mentally ill individuals receiving case management services in community mental health centers across Pennsylvania.

Effectiveness of a Staff Promoted Wellness Program to Improve Health in Residents of a Mental Health Long-Term Care Facility.

The current study describes physical and mental health outcomes during a health promotion program for individuals with serious mental illness (SMI). A sample of 43 adults in a long-term residential facility volunteered for an individualized, healthy lifestyle program designed to promote physical activity and combat premature mortality among individuals with SMI. Nurses and residential counselors were trained in the program and encouraged to work collaboratively with the program's personal trainers.

Brief Critical Time Intervention to Reduce Psychiatric Rehospitalization.

Objective: The study investigated the association between implementation of a brief critical time intervention (BCTI) model and occurrence of early and long-term psychiatric readmission of adults with serious mental illness.

Methods: A sample of 149 adults with a psychiatric inpatient readmission within 30 days of a prior psychiatric hospitalization was referred to an acute level of service coordination (ASC) available at six provider organizations implementing BCTI. Activities important to the delivery of BCTI were monitored and supported.

Evaluation of an implementation initiative for embedding Dialectical Behavior Therapy in community settings.

We examined the effectiveness of Dialectical Behavior Therapy (DBT) training in community-based agencies. Data were gathered at four time points over a 2-year period from front-line mental health therapists (N=64) from 10 community-based agencies that participated in a DBT implementation initiative. We examined change on therapist attitudes toward consumers with Borderline Personality Disorder (BPD), confidence in the effectiveness of DBT, and use of DBT model components.

Facilitators and barriers associated with implementation of evidence-based psychotherapy in community settings.

OBJECTIVE Despite widespread use of individual outpatient psychotherapies among community mental health centers (CMHCs), few studies have examined implementation of these psychotherapies. This exploratory qualitative study identified key themes associated with the implementation of an empirically supported psychotherapy in CMHCs. METHODS The authors conducted semistructured interviews with 12 key informants from four CMHCs that had implemented interpersonal and social rhythm therapy (IPSRT).

Predictors of adequate depression treatment among Medicaid-enrolled youth.

Purpose: To determine if Medicaid-enrolled youth with depressive symptoms receive adequate acute treatment, and to identify the characteristics of those receiving inadequate treatment.

Methods: We used administrative claims data from a Medicaid-enrolled population in a large urban community to identify youth aged 6-24 years who started a new episode of treatment for a depressive disorder between August 2006 and February 2010. We examined rates and predictors of minimally adequate psychotherapy (four visits in first 12 weeks) and pharmacotherapy (filled antidepressant prescription for 84 of the first 144 days) among youth with a new treatment episode during the study period (n = 930).

Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.

Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers.

Concurrent mental health therapy among medicaid-enrolled youths starting antipsychotic medications.

Objective: The use of antipsychotic medications among children and adolescents has increased substantially in recent years, predominantly in disorders for which effective psychosocial interventions exist. The authors of this study examined the extent to which youths being prescribed antipsychotic medications were receiving concurrent mental health therapy.

Methods: Using administrative data, the authors identified 6,110 Medicaid-enrolled youths starting antipsychotic medications from November 1, 2006, through October 31, 2009, and identified youths who had received any concurrent mental health therapy.

Treatment of attention-deficit hyperactivity disorder: patterns of evolving care during the first treatment episode.

Objective: This study sought to better understand factors associated with different patterns of treatment among children starting treatment for attention-deficit hyperactivity disorder (ADHD).

Methods: Factors associated with service utilization and pharmacy claims data for 2,077 Medicaid-enrolled children aged six to 12 who started treatment for ADHD between October 2006 and December 2007 in a large mid-Atlantic state were investigated by using logistic regressions and Cox proportional hazard models.

Results: A total of 45% of children started ADHD treatment with a psychosocial intervention alone, 41% of children started treatment with medication alone, and 14% of children started treatment with a combination of both treatments.

Use of outcomes information in child mental health treatment: results from a pilot study.

Objective: This study examined parents and clinicians' use in treatment sessions of routinely collected information on child functioning for children receiving ambulatory mental health treatment.

Methods: Information was obtained from 1,215 Child Outcomes Surveys completed at ten provider organizations. The Child Outcomes Survey is a collaboratively developed brief strength-based measure of child functioning and therapeutic relationship.

Mental health services for children of substance abusing parents: voices from the community.

This qualitative study explores how to improve services for children of parents with Substance Use Disorders (SUD) with unmet mental health needs. Focus groups were conducted with parents and caregivers to identify perceived barriers to services, including: (1) attitudes and beliefs about mental health care, (2) inadequacies in mental health services, (3) children's ambivalence about treatment, and (4) parental disagreement and lack of involvement. Peer support, afterschool activities, and family counseling were identified as potential improvements.

One-year treatment outcomes of African-American and Hispanic patients with bipolar I or II disorder in STEP-BD.

Objective: Few studies have compared treatment outcomes of African-American, Hispanic, and non-Hispanic white patients with bipolar disorder. The U.S.

Predictors of adequate depression treatment among Medicaid-enrolled adults.

Objective: To determine whether Medicaid-enrolled depressed adults receive adequate treatment for depression and to identify the characteristics of those receiving inadequate treatment.

Data Source: Claims data from a Medicaid-enrolled population in a large mid-Atlantic state between July 2006 and January 2008.

Study Design: We examined rates and predictors of minimally adequate psychotherapy and pharmacotherapy among adults with a new depression treatment episode during the study period (N=1,098).

Increasing minority research participation through collaboration with community outpatient clinics: the STEP-BD Community Partners Experience.

Background: Minority populations have been under-represented in mental health research studies. The systematic treatment enhancement program for bipolar disorder developed the Community Partners Program (CPP) to address this issue in a large, prospective treatment study of persons with bipolar disorder.

Purpose: The primary goal of CPP was to develop a community-based infrastructure for studying bipolar disorder that would enhance the ethnic/racial and socioeconomic diversity of participants.

Understanding community mental health administrators' perspectives on dialectical behavior therapy implementation.

In this study, key informant interviews were conducted with 13 administrators from nine community-based mental health agencies implementing dialectical behavior therapy in order to assess their perspectives on implementation. Four major themes were identified. They include opinions about dialectical behavior therapy and its fit with existing practices, resource concerns (for example, reimbursement issues, time commitment, and staff training), staff selection for training and staff turnover, and ongoing client referrals.

Substance abuse detoxification and residential treatment among Medicaid-enrolled adults: rates and duration of subsequent treatment.

Background: Substance use disorders are chronic disorders with substantial public health significance, yet the treatment provided is often episodic despite ongoing need. Among the more severely ill individuals requiring detoxification or residential treatment, little empirical information is available about rates and predictors of subsequent engagement in necessary subsequent treatment.

Methods: Using administrative data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state, we used multivariate regression to examine rates and predictors of subsequent treatment engagement and retention following new episodes of detoxification or residential substance abuse treatment among 5670 Medicaid-enrolled adults during 2004-2006.

Views of mental health care consumers on public reporting of information on provider performance.

Objective: This qualitative study examined consumer preferences regarding the content and use of provider performance data and other provider information to aid in consumers' decision making.

Methods: Focus groups were conducted with 41 adults who were consumers of mental health care, and discussions were transcribed and analyzed with standard qualitative research methods.

Results: Consumers supported trends toward enhancing information about providers and its availability.

Predictors of timely follow-up care among medicaid-enrolled adults after psychiatric hospitalization.

Objective: This study examined whether predictors of timely follow-up care after inpatient psychiatric discharge in non-Medicaid populations also predicted timely follow-up care among Medicaid-enrolled adults.

Methods: The study examined the rates of seven- and 30-day follow-up care for 6,730 Medicaid-enrolled adults discharged from inpatient psychiatric facilities during 2004 and 2005 by using claims data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state. The relationship between predictor variables and timely aftercare was examined by using multiple logistic regression.

Concordance with treatment guidelines for bipolar disorder: data from the systematic treatment enhancement program for bipolar disorder.

Background: Concordance with evidence-based guidelines in the treatment of chronic mental disorders is typically low. The study assesses the degree of concordance to recommendations of published treatment guidelines for bipolar disorder in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Potential demographic and clinical predictors of adherence were examined.

Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial.

Objective: Psychosocial interventions are effective adjuncts to pharmacotherapy in delaying recurrences of bipolar disorder; however, to date their effects on life functioning have been given little attention. In a randomized trial, the authors examined the impact of intensive psychosocial treatment plus pharmacotherapy on the functional outcomes of patients with bipolar disorder over the 9 months following a depressive episode.

Method: Participants were 152 depressed outpatients with bipolar I or bipolar II disorder in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study.

Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program.

Context: Psychosocial interventions have been shown to enhance pharmacotherapy outcomes in bipolar disorder.

Objective: To examine the benefits of 4 disorder-specific psychotherapies in conjunction with pharmacotherapy on time to recovery and the likelihood of remaining well after an episode of bipolar depression.

Design: Randomized controlled trial.