Determinants of remote measurement-based care uptake in a safety net outpatient psychiatry department as part of learning health system transition.

Introduction: Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation.

Methods: This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system.

Assessing the Long-Term Effectiveness of a Behavioral Health Home for Adults With Bipolar and Psychotic Disorders.

Objective: This study aimed to examine the impact of a behavioral health home (BHH) to better understand its potential to improve health for individuals with serious mental illness.

Methods: Propensity score-weighted interrupted time series analysis was used to estimate service utilization and chronic disease management through 3.5 years after BHH implementation and to compre BHH enrollees (N=413) with other patients with serious mental illness in the same health system (N=1,929).

Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis.

Objective: Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness.

Changes in Psychiatric Emergency Room Visits Following the Boston Marathon Bombing.

Objective: This study reviews patient encounters at a Boston-area community hospital Psychiatric Emergency Services (PES) following the Boston Marathon bombings, with the goal of describing the impact of terrorist attacks on PES encounters.

Methods: All PES encounters for 2 months preceding and 2 months following the bombing were identified in the electronic medical record. Demographics, current and past psychiatric problems, and trauma history were assessed for all records.

Mind the Gap: Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness.

Objective: This study evaluated the impact of an integrated behavioral health home (BHH) pilot on adults with psychotic and bipolar disorders.

Methods: Quasi-experimental methods were used to compare outcomes before (September 2014-August 2015) and after the intervention (September 2015-August 2016) among ambulatory BHH patients and a control group. Electronic health records were compared between 424 BHH patients (N=369, psychotic disorder; N=55, bipolar disorder) and 1,521 individuals from the same urban, safety-net health system who were not enrolled in the BHH.

No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities.

Objective: A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ.

Methods: Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations.

Measurement of Perceived and Technical Quality of Care for Depression in Racially and Ethnically Diverse Groups.

Measurement of patient satisfaction is now considered essential for providing patient centered care and is an important tool for addressing health care disparities. However, little is known about how ethnically and racially diverse (ERD) groups differ in how they perceive quality, and widely used instruments for measuring perceived quality give little attention to cultural elements of care. This study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N = 160) and the technical quality of treatment for depression provided in four "culturally-specific" primary care clinics.

A menu with prices: Annual per person costs of programs addressing community integration.

Information on costs of programs addressing community integration for persons with serious mental illness in the United States, essential for program planning and evaluation, is largely lacking. To address this knowledge gap, community integration programs identified through directories and snowball sampling were sent an online survey addressing program costs and organizational attributes. 64 Responses were received for which annual per person costs (APPC) could be computed.

Does one size fit all? What we can and can't learn from a meta-analysis of housing models for persons with mental illness.

Objective: Numerous studies have evaluated the impacts of community housing models on outcomes of persons with severe mental illness. The authors conducted a meta-analysis of 44 unique housing alternatives described in 30 studies, which they categorized as residential care and treatment, residential continuum, permanent supported housing, and nonmodel housing. Outcomes examined included housing stability, symptoms, hospitalization, and satisfaction.

The employment intervention demonstration program: major findings and policy implications.

This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations.

Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness.

Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors.

Desired attributes of evidence assessments for evidence-based practices.

In this paper we describe three approaches to assessing evidence for stakeholders interested in evidence-based practices: narrative reviews, systematic reviews (including meta-analyses), and registries. We then compare the approaches in terms of the degree to which they posses desired attributes of evidence assessments. Our review suggests that hybrid approaches that combined the best features of all three should be pursued to further the use of evidence-based practices, and that such hybrids are possible given the capacity of the World Wide Web.

Estimated payments to employment service providers for persons with mental illness in the Ticket to Work program.

Objective: The Ticket to Work and Work Incentives Improvement Act of 1999 removes work disincentives and promotes access to vocational services for people with disabilities. This study calculated the amount of payments that would have been made to employment service providers if study participants had been enrolled in the Ticket program.

Methods: Data were from 450 Social Security Disability Insurance beneficiaries with psychiatric disabilities enrolled in a multisite study of supported employment.

Demographic characteristics and employment among people with severe mental illness in a multisite study.

People with psychiatric disabilities experience disproportionately high rates of unemployment. As research evidence is mounting regarding effective vocational programs, interest is growing in identifying subgroup variations. Data from a multisite research and demonstration program were analyzed to identify demographic characteristics associated with employment outcomes, after adjusting for the effects of program, services, and study site.

Clinical factors associated with employment among people with severe mental illness: findings from the employment intervention demonstration program.

Research has shown that supported employment programs are effective in helping psychiatric outpatients achieve vocational outcomes, yet not all program participants are able to realize their employment goals. This study used 24 months of longitudinal data from a multisite study of supported employment interventions to examine the relationship of patient clinical factors to employment outcomes. Multivariate random regression analysis indicated that, even when controlling for an extensive series of demographic, study condition (experimental versus control), and work history covariates, clinical factors were associated with individuals' ability to achieve competitive jobs and to work 40 or more hours per month.

Assessment of Medicaid managed behavioral health care for persons with serious mental illness.

Objectives: This five-site study compared Medicaid managed behavioral health programs and fee-for-service programs on use and quality of services, satisfaction, and symptoms and functioning of adults with serious mental illness.

Methods: Adults with serious mental illness in managed care programs (N=958) and fee-for-service programs (N=1,011) in five states were interviewed after the implementation of managed care and six months later. After a multiple regression to standardize the groups for case mix differences, a meta-analysis using a random-effects model was conducted, and bioequivalence methods were used to determine whether differences were significant for clinical or policy purposes.

Effects of job development and job support on competitive employment of persons with severe mental illness.

Objectives: Few studies have sought to determine which specific supported employment services improve employment outcomes for people with pyschiatric disabilities. This study examined the effects of job development and job support among other services on acquisition and retention of competitive employment.

Methods: Data used in the analysis came from seven sites of the Employment Intervention Demonstration Program.

Integration of psychiatric and vocational services: a multisite randomized, controlled trial of supported employment.

Objective: Although large-scale surveys indicate that patients with severe mental illness want to work, their unemployment rate is three to five times that of the general adult population. This multisite, randomized implementation effectiveness trial examined the impact of highly integrated psychiatric and vocational rehabilitation services on the likelihood of successful work outcomes.

Method: At seven sites nationwide, 1,273 outpatients with severe mental illness were randomly assigned either to an experimental supported employment program or to a comparison/services-as-usual condition and followed for 24 months.

Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness.

Context: National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment.

Methods: We randomly assigned 1273 outpatients with severe mental illness from 7 states in the United States to an experimental SE program or to a comparison or a services-as-usual condition, with follow-up for 24 months.

What is evidence?

The evidence-based practice movement rests on the premise that the scientific evidence regarding treatment should be used judiciously to inform treatment decisions. This article focuses on the most fundamental question regarding evidence-based practice: What is evidence? To address this question, the authors first review several of the definitions, criteria, and strategies that have been used to define scientific evidence. Second, a number of critical issues that have been raised regarding the nature of treatment evidence are discussed.

Toward a national consumer survey: evaluation of the CABHS and MHSIP instruments.

This article describes a study evaluating the Consumer Assessment of Behavioral Health Survey (CABHS) and the Mental Health Statistics Improvement Program (MHSIP) surveys. The purpose of the study was to provide data that could be used to develop recommendations for an improved instrument. Subjects were 3,443 adults in six behavioral health plans.

Use of consumer ratings for quality improvement in behavioral health insurance plans.

Background: The Consumer Assessment of Behavioral Healthcare Services (CABHS) survey collects consumers' reports about their health care plans and treatment. The use of the CABHS to identify opportunities for improvement, with specific attention to how organizations have used the survey information for quality improvement, is described.

Methods: In 1998 and 1999, data were collected from five groups of adult patients in commercial health plans and five groups of adult patients in public assistance health plans with services received through four organizations (one of three managed behavioral health care organizations or a health system).

Implementing evidence-based practices in routine mental health service settings.

The authors describe the rationale for implementing evidence-based practices in routine mental health service settings. Evidence-based practices are interventions for which there is scientific evidence consistently showing that they improve client outcomes. Despite extensive evidence and agreement on effective mental health practices for persons with severe mental illness, research shows that routine mental health programs do not provide evidence-based practices to the great majority of their clients with these illnesses.