Care Retention Among Veterans with Serious Mental Illness who were once lost-to-Veterans Health Administration care.

Objective: To evaluate care retention among Veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care for at least one year and subsequently returned to VHA care via the SMI Re-Engagement program, an outreach program for Veterans with SMI who are lost-to-care.

Methods: For the 410 Veterans with SMI who returned to care via SMI Re-Engagement between April 4th, 2016 and January 31, 2018, we assessed VHA in-person and telehealth utilization (overall, primary care, mental health care) for two years following the date of return to care.

Results: Care retention was common: 70.

Behavioral Health Provider Burnout and Mental Health Care in the Veterans Health Administration.

Background: Although many studies assess predictors of provider burnout, few analyses provide high-quality, consistent evidence on the impact of provider burnout on patient outcomes exist, particularly among behavioral health providers (BHPs).

Objective: To assess the impact of burnout among psychiatrists, psychologists, and social workers on access-related quality measures in the Veterans Health Administration (VHA).

Design: This study used burnout in VA All Employee Survey (AES) and Mental Health Provider Survey (MHPS) data to predict metrics assessed by the Strategic Analytics for Improvement and Learning Value, Mental Health Domain (MH-SAIL), VHA's quality monitoring system.

An Assessment of the 10-Item Mental Health Recovery Measure in a Predominantly African American Sample of Adults with Serious Mental Illness.

Study objectives were to 1) assess the reliability and validity of the 10-item Mental Health Recovery Measure (MHRM-10) in sample of predominately African American participants with serious mental illness, and 2) evaluate differences in MHRM-10 scores between the present sample and two other samples of persons with serious mental illness with different racial compositions. Participants included 230 adults (85.7% African American) with chart diagnoses of schizophrenia-spectrum, bipolar-spectrum, and major depressive disorders receiving services from community mental health centers in Detroit, Michigan.

An examination of predisposing and enabling factors that predict dental utilization among individuals with serious mental illness in Detroit, Michigan.

Objectives: This study evaluated which predisposing and enabling factors prospectively predicted dental utilization over 6 months among people with serious mental illness.

Methods: A sample of individuals with serious mental illness (86.3% African American; 97.

Relationships between work-environment characteristics and behavioral health provider burnout in the Veterans Health Administration.

Objective: To identify work-environment characteristics associated with Veterans Health Administration (VHA) behavioral health provider (BHP) burnout among psychiatrists, psychologists, and social workers.

Data Sources: The 2015-2018 data from Annual All Employee Survey (AES); Mental Health Provider Survey (MHPS); N = 57,397 respondents; facility-level Mental Health Onboard Clinical (MHOC) staffing and productivity data, N = 140 facilities.

Study Design: For AES and MHPS separately, we used mixed-effects logistic regression to predict BHP burnout using surveys from year pairs (2015-2016, 2016-2017, 2017-2018; six models).

Outreach to facilitate return to VA care for veterans with serious mental illness: A mixed-methods evaluation of best practices.

Outreach to people with serious mental illness who are disengaged from treatment can facilitate return to care. However, little is known regarding what outreach strategies are effective. This mixed-methods evaluation assessed best practices for conducting outreach to Veterans with serious mental illness via the national Veterans Health Administration Re-Engaging Veterans with Serious Mental Illness program by comparing the strategies used by high-performing sites and low-performing sites.

Access to timely mental health care treatment initiation among Veterans Health Administration patients with and without serious mental illness.

Timely care initiation is a priority within the Veterans Health Administration (VHA). Patients with serious mental illnesses (SMI) are a group that benefits from timely care initiation due to elevated risks of negative outcomes with delayed care. However, no evaluation has assessed whether VHA SMI patients disproportionately experience delays in mental health care initiation.

Employment After Vocational Rehabilitation Predicts Decreased Health Care Utilization in Veterans With Mental Health Diagnoses.

Introduction: Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans' employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans' employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA).

Materials And Methods: This study used a sample of 29,022 veterans with mental health and substance use disorders who were discharged from VHA's employment services programs between fiscal years 2006 and 2010.

Correction: Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study.

[This corrects the article DOI: 10.2196/18345.].

Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study.

Background: In the Veterans Health Administration (VHA), mental health providers (MHPs) report the second highest level of burnout after primary care physicians. Burnout is defined as increased emotional exhaustion and depersonalization and decreased sense of personal accomplishment at work.

Objective: This study aims to characterize variation in MHP burnout by VHA facility over time, identifying workplace characteristics and practices of high-performing facilities.

Effectiveness of Peer-Supported Computer-Based CBT for Depression Among Veterans in Primary Care.

Objective: This study tested whether computerized cognitive-behavioral therapy for depression supported by a peer specialist with lived experience of depression (PS-cCBT) improves mental health-related outcomes for primary care patients.

Methods: In the U.S.

Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies.

Background: Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide.

Enhancing Treatment Reengagement for Veterans With Serious Mental Illness: Evaluating the Effectiveness of SMI Re-Engage.

Objective: This evaluation assessed the effectiveness of the Veterans Health Administration (VHA) program Reengaging Veterans With Serious Mental Illness in Treatment (SMI Re-Engage). The program serves veterans with serious mental illness who experience extended gaps in use of VHA care.

Methods: Propensity score-weighted survival analysis that adjusted for demographic, clinical, and utilization factors assessed whether being contacted via SMI Re-Engage predicted return to VHA care within 18 months of when clinicians received patient contact information and, among veterans contacted, whether return to VHA care was associated with mortality risk within the 18-month follow-up period.

Competitive Employment Outcomes Among Veterans in VHA Therapeutic and Supported Employment Services Programs.

Objective: The study assessed whether receiving specific types of Veterans Health Administration (VHA) Therapeutic and Supported Employment Services (TSES) between fiscal years (FYs) 2006 and 2010 (a time frame that encompasses the Great Recession) was associated with obtaining competitive employment among veterans with mental illnesses.

Methods: The sample included 38,199 veterans discharged from the VHA's TSES program in FY 2006 through FY 2010. On the basis of program monitoring forms completed by TSES clinicians and workload data, veterans were classified as having received one main type of employment service: supported employment (SE), transitional work in the community (TW-community), transitional work in a Department of Veterans Affairs medical center (TW-VA), incentive therapy or sheltered workshop (IT/SW), and no main type of employment service.

Outreach to veterans with serious mental illness who are lost to care: Predictors of outreach contact.

This evaluation identified factors associated with outreach contact to veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care. From March 2012 through September 2013, the VHA SMI Re-Engage initiative identified 4,241 veterans for reengagement outreach; 31% of whom were successfully contacted. Higher odds of contact was associated with older age, married status, no history of homelessness, bipolar disorder diagnosis, having no recent inpatient stay, living closer to a VHA medical center, fewer years since last visit, and having a service-connected disability.

Implementing Effective Policy in a National Mental Health Reengagement Program for Veterans.

Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This article used validated measures of organizational resources, culture, and climate to predict uptake of a nationwide Veteran's Health Administration (VA) policy aimed at implementing Re-Engage, a brief care management program that reestablishes contact with veterans with serious mental illness lost to care. Patient care databases were used to identify 2738 veterans lost to care.

Psychometric analysis of the Mental Health Recovery Measure in a sample of veterans with depression.

Using data from a sample of 398 veterans diagnosed with depression, the present study used principal components analysis to shorten the Mental Health Recovery Measure (MHRM) to a 10-item instrument. Results indicated the 10-item MHRM had excellent internal reliability. Construct validity for the 10-item MHRM was evidenced by correlations with measures of depression coping self-efficacy, social adjustment, hopelessness, and depression.

Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).

In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model.

Employment status, employment functioning, and barriers to employment among VA primary care patients.

Background: Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes.

Methods: The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center.

Stress-related personal growth among emerging adults whose mothers have been diagnosed with mental illness.

Objective: This study explored whether emerging adults' reports of their relationships with their mothers who have been diagnosed with mental illness and their attempts to make meaning of the experience of having a mother with mental illness were associated with stress-related personal growth.

Methods: Fifty-two emerging adult children with mothers who have been diagnosed with mental illness responded to a self-report questionnaire containing measures of adult parent-child relationships, meaning making, and stress-related personal growth.

Results: Hierarchical multiple linear regression analysis of the cross-sectional data indicated that meaning making contributed to stress-related personal growth after accounting for emerging adult-mother relationship factors.

Reengaging veterans with serious mental illness into care: preliminary results from a national randomized trial.

Objective: This study compared effectiveness of an enhanced versus standard implementation strategy (Replicating Effective Programs [REP]) on site-level uptake of Re-Engage, a national program for veterans with serious mental illness.

Methods: Mental health providers at 158 Veterans Affairs (VA) facilities were given REP-based manuals and training in Re-Engage, which involved identifying veterans who had not been seen in VA care for at least one year, documenting their clinical status, and coordinating further health care. After six months, facilities not responding to REP (N=88) were randomized to receive six months of facilitation (enhanced REP) or continued standard REP.