JBHSR Recent Issues
The Table of Contents and abstracts for recent issues of the JBHS&R are listed below.
Volume 41, 2014
Issue 1 / January 2014
Advancing on the New Frontier of Behavioral Health
Linda Rosenberg MSW
This is an excerpt from the content: The 50th anniversary of the Community Mental Health Act gives us occasion to celebrate a vision for behavioral health that has been 50 years in the making and to take it to scale. The Community Mental Health Act of 1963 was the last piece of legislation President John F. Kennedy signed before his assassination. He encouraged a bold new approach to mental health and developmental disabilities, one in which the “cold mercy” of custodial care would be replaced by the “open warmth” of community. He also called for a community-based focus emphasizing prevention, treatment, education, and recovery.
In the past 50 years, science has brought new knowledge, medications, psychotherapies, peer support, and other treatment technologies, sometimes even ones that fit into the palm of our hands, have expanded dramatically our ability to treat and support a range of conditions.
Modeling Interdisciplinary Research to Advance Behavioral Health Care…3–7
Holly Hills PhD, Tara Richards PhD
Abstract: Over the past 15 years, scientists have become increasingly interested in interdisciplinary research collaborations. The integration of multiple perspectives to provide input into the most complex issues in science is thought to offer the best opportunity to find real-world answers to difficult problems. In this review and introduction to the special section on interdisciplinary research in behavioral health care, the value of a collaborative strategy is explored. Examples from the research presented in the special section are described to identify how processes were modified and interpretations made richer by these collaborations. Also discussed are potential impediments to researchers choosing to work from an interdisciplinary perspective. Conditions that are thought to encourage collaborative, interdisciplinary perspectives are also described.
Developing Empirically Based, Culturally Grounded Drug Prevention Interventions for Indigenous Youth Populations…8–19
Scott K. Okamoto PhD, Susana Helm PhD, Suzanne Pel BA, Latoya L. McClain MSW, Amber P. Hill, Janai K. P. Hayashida
Abstract: This article describes the relevance of a culturally grounded approach toward drug prevention development for indigenous youth populations. This approach builds drug prevention from the “ground up” (i.e., from the values, beliefs, and worldviews of the youth that are the intended consumers of the program) and is contrasted with efforts that focus on adapting existing drug prevention interventions to fit the norms of different youth ethnocultural groups. The development of an empirically based drug prevention program focused on rural Native Hawaiian youth is described as a case example of culturally grounded drug prevention development for indigenous youth; the impact of this effort on the validity of the intervention and on community engagement and investment in the development of the program are discussed. Finally, implications of this approach for behavioral health services and the development of an indigenous prevention science are discussed.
Engagement in Outpatient Substance Abuse Treatment and Employment Outcomes…20–36
Robert Dunigan PhD, Andrea Acevedo PhD, Kevin Campbell DrPH, Deborah W. Garnick ScD, Constance M. Horgan ScD, Alice Huber PhD, Margaret T. Lee PhD, Lee Panas MA, Grant A. Ritter PhD
Abstract: This study, a collaboration between an academic research center and Washington State’s health, employment, and correction departments, investigates the extent to which treatment engagement, a widely adopted performance measure, is associated with employment, an important outcome for individuals receiving treatment for substance use disorders. Two-stage Heckman probit regressions were conducted using 2008 administrative data for 7,570 adults receiving publicly funded treatment. The first stage predicted employment in the year following the first treatment visit, and three separate second-stage models predicted the number of quarters employed, wages, and hours worked. Engagement as a main effect was not significant for any of the employment outcomes. However, for clients with prior criminal justice involvement, engagement was associated with both employment and higher wages following treatment. Clients with criminal justice involvement face greater challenge regarding employment, so the identification of any actionable step which increases the likelihood of employment or wages is an important result.
Increasing Hepatitis C Knowledge Among Homeless Adults: Results of a Community-Based, Interdisciplinary Intervention…37–49
Darlene Tyler RN, FNP, PhD, Adeline Nyamathi RN, ANP, PhD, FAAN, Judith A. Stein PhD, Deborah Koniak-Griffin RN, EdD, FAAN, Felicia Hodge DrPH, Lillian Gelberg MD
Abstract: Homeless adults have high rates of hepatitis C virus infection (HCV) and low levels of HCV knowledge. This study reports results of an interdisciplinary, community-based intervention using stakeholder cooperation, case management, risk factor identification, and modification of dysfunctional psychosocial factors to increase HCV knowledge among homeless adults (N = 747). Data are from a randomized quasi-experimental study, with the major goal of evaluating the effectiveness of a Nurse Case Managed Intervention compared to a Standard Intervention, encouraging completion of a three-series hepatitis A/hepatitis B vaccination program. Increased HCV knowledge was measured with an 18-item questionnaire discerning risk factors for HCV and common misconceptions about individuals with HCV. A significant increase in HCV knowledge resulted regardless of intervention format. Receiving the Nurse Case Managed Intervention predicted greatest gain in HCV knowledge (p < 0.000). Successfully engaging key stakeholders, outreach workers, community organizations, and homeless people themselves proved most efficacious in increasing HCV knowledge.
Clinicians’ Perceptions of Implementation Extensiveness of 100% Tobacco Free Practices…50–63
Lillian T. de Tormes Eby PhD, Tanja C. Laschober PhD
Abstract: In 2008, the state of New York required substance use disorder treatment organizations to be 100% tobacco-free. This longitudinal study examined clinicians’ perceptions of the implementation extensiveness of the tobacco-free practices approximately 10–12 months (Time 1) and 20–24 months (Time 2) post regulation and investigated whether clinicians’ commitment to change and use of provided resources at Time 1 predicts perceptions of implementation extensiveness at Time 2. Clinicians (N = 287) noted a mean implementation of 5.60 patient practices (0–10 scale), 2.33 visitor practices (0–8 scale), and 6.66 employee practices (0–12 scale) at Time 1. At Time 2, clinicians perceived a mean implementation of 5.95 patient practices (no increase from Time 1), 2.89 visitor practices (increase from Time 1), and 7.12 employee practices (no increase from Time 1). Commitment to change and use of resources positively predicted perceived implementation extensiveness of visitor and employee practices. The use of resources positively predicted implementation for patient practices.
Provider and State Perspectives on Implementing Cultural-Based Models of Care for American Indian and Alaska Native Patients with Substance Use Disorders...64–79
Raina L. Croff PhD, Traci R. Rieckmann PhD
Abstract: American Indians/Alaska Natives (AI/ANs) suffer disproportionate rates of substance use disorders compared to Americans overall. Providers serving AI/AN communities are drawing from a diverse toolkit of treatment strategies that incorporate Native worldviews and community-shared values in order to improve outcomes. This paper describes findings from interviews with 22 program directors and 18 representatives from Single State Authorities on substance abuse. Interviews assessed provider and state efforts to increase AI/AN client engagement and to improve the quality of care through culturally relevant interventions. Results suggested that providers employed flexibility and originality to cultural-based programs by broadening established practices, adopting outside traditions, and creating new ones to fit client needs. However, gaps in state–tribal collaborations and inter-group complexities such as staff-based tensions, a widening generational divide, and blurred consensus of “tradition” affect service delivery. Overall, respondents underlined the critical role culturally relevant care plays in individual and community healing.
Provider Views of Harm Reduction Versus Abstinence Policies Within Homeless Services for Dually Diagnosed Adults...80–89
Benjamin F. Henwood PhD, MSW
Abstract: Harm reduction is considered by many to be a legitimate alternative to abstinence-based services for dually diagnosed individuals, yet there is limited understanding of how varying approaches affect front-line practice within services for homeless adults. This paper examines how front-line providers working with individuals who have experienced homelessness, serious mental illness, and addiction view policies of harm reduction versus abstinence within two different approaches to homeless services: the traditional or “treatment first” approach that requires abstinence, and the more recent housing first approach that incorporates harm reduction. As part of a federally funded qualitative study, 129 in-depth interviews conducted with 41 providers were thematically analyzed to understand how providers view harm reduction versus abstinence approaches. Themes included the following: (a) harm reduction as a welcomed alternative, (b) working with ambiguity, and (c) accommodating abstinence. Drawing on recovery principles, the authors consider the broader implications of the findings for behavioral health care with this population.
The Effect of Telephone-Facilitated Depression Care on Older, Medically Ill Patients...90–96
Yolonda R. Pickett MD, MS
Abstract: The objective of this study was to determine the effectiveness of a telephone-facilitated depression care protocol in older, medically ill adults compared to routine care. A 12-week double blind randomized controlled trial was conducted in recently discharged primary care patients (N = 124). Depression was assessed with the Patient Health Questionnaire-9. Primary care providers were notified of the level of depression severity and indications for treatment, but neither they nor the patients were contacted by a psychiatrist or other mental health professional. The primary outcome was initiation of treatment. Secondary outcomes were symptoms reduction and depression remission rates. There were no significant outcome differences between the facilitated and routine care groups. This study showed that older, medically ill adults may require a level of depression care that goes beyond a telephone-facilitated protocol.
Issue 2 / April 2014
Estimating Real Change in Health Care...97–98
Linda Rosenberg MSW
Abstract: The technology revolution has accelerated the pace of change and increased our tolerance for experimentation. The National Council for Behavioral Health owes it to those served by our member organizations to keep our eye on the future. To quote leadership guru Peter Drucker, “The greatest danger in times of turbulence is not the turbulence. It is to act with yesterday's logic.” Studies in this edition of JBHS&R address the capacity of different components of the current behavioral health workforce and examine training methods successful in preparing the workforce with the new skills and abilities which will be crucial in 2014 and beyond.
Rates and Predictors of Referral for Individual Psychotherapy, Group Psychotherapy, and Medications among Iraq and Afghanistan Veterans with PTSD...99–109
Juliette M. Mott PhD, Terri L. Barrera MA
Abstract: This study examined rates of referral for medication, individual psychotherapy, and group psychotherapy within a Veterans Affairs (VA) posttraumatic stress disorder (PTSD) specialty mental health clinic. Participants were 388 Iraq and Afghanistan veterans who were referred for PTSD treatment following a mental health evaluation required for all new VA enrollees. The majority of the sample was referred for medication (79 %), with comparatively fewer referrals for individual (39 %) or group psychotherapy (24 %). Forty percent of participants were referred for combined medication and psychotherapy. Patient demographic and clinical characteristics were examined to determine whether these variables predicted referral type. Female veterans and those with lower clinician ratings of overall functioning were more likely to be referred for individual therapy. Group psychotherapy referrals were more common in veterans who were older, unemployed, identified as an ethnic minority, and had a comorbid anxiety disorder. There were no significant predictors of medication referral.
The Cost Savings of Expanding Medicaid Eligibility to Include Currently Uninsured Homeless Adults with Substance Use Disorders...110–124
Julia Zur PhD, Ramin Mojtabai MD, PhD, MPH
Abstract: Following the June 2012 Supreme Court ruling that states are no longer mandated to expand their Medicaid programs in 2014 as part of the Affordable Care Act, many states plan to opt out of the expansion, citing affordability as their primary concern. In response to this controversy, the present study evaluated the cost savings of expanding Medicaid coverage to include currently ineligible homeless adults with substance use disorders, a subset of the population that incurs some of the greatest societal costs and is disproportionately impacted by uninsurance. Using a time horizon of 7 years, separate analyses were conducted for state and federal governments, and then a final analysis evaluated the combined costs for the other two models. Results of the study demonstrate that, although the expansion will be associated with a net cost when combining state and federal expenses and savings, states will experience tremendous savings if they choose to participate.
County Workforce, Reimbursement, and Organizational Factors Associated with Behavioral Health Capacity in Health Centers...125–139
Emily Jones PhD, MPP, Leighton Ku PhD, MPH
Abstract: This study describes on-site behavioral health treatment capacity in health centers in 2007 and examines whether capacity was associated with health center characteristics, county-level behavioral health workforce, and same-day billing restrictions. Cross-sectional data from the 2007 Area Resource File and Uniform Data System were linked with data on Medicaid same-day billing restrictions. Mental health treatment capacity was common; almost four in five health centers provided on-site mental health services. Additional services such as crisis counseling (20 %), treatment from a psychiatrist (29 %), and substance abuse treatment were offered by fewer health centers (51 % provide on-site services and only 20 % employ substance abuse specialists). In multivariate analysis, larger health centers, health centers located in counties with a larger behavioral health workforce per capita, and those located in the West and Northeast were more likely to have behavioral health capacity. Same-day billing restrictions were associated with lower odds of substance use treatment capacity and providing 24 hr crisis counseling services.
Health Promotion Behaviors in Adolescents: Prevalence and Association with Mental Health Status in a Statewide Sample...140–152
Molly Adrian PhD
Abstract: The purpose of this study is to estimate the proportion of adolescents meeting Healthy People 2020 health behavior recommendations for the prevention of chronic disease and to determine the association between mental health status (depression and/or conduct problems) and the likelihood of meeting these recommendations. The data used for this study are from the 2010 Washington State Healthy Youth Survey. Descriptive statistics and linear regression were utilized to estimate the proportion of adolescents meeting recommendations and associations between youth mental health status indicators and health-promoting behaviors. A small minority (5.8 %) of youth met all six recommendations in domains of tobacco abstinence, substance use abstinence, daily physical activity, breakfast consumption, weight below obese levels, and adequate sleep, though most (84.3 %) met at least three. At the aggregate level, the proportion of Washington State youth who met Healthy People 2020 guidelines exceeded targets, with the exception of substance use abstinence. A minority of youth reported guideline levels of daily physical activity (23.3 %) and sleep (39.8 %). Mental health status was strongly associated with the number of health-promoting behaviors adolescents endorsed. Interventions to increase the adoption of sleep hygiene and exercise habits should be added to an integrative positive youth development framework within school-, community-, and primary care-based adolescent health initiatives. Attention to adolescent mental health and shared risk factors may be critical for reducing barriers to healthy behavior.
Measuring the Capacity of Staff Culture to Further Recovery from Psychiatric Disabilities...153–166
Daniel Chandler PhD, Stephen Wilson MD
Abstract: Three linked instruments for measuring the recovery-orientation of mental health program culture are introduced as the Recovery Centered Measures (RCM). Two scales assess the views of staff and of consumers, respectively, regarding staff–consumer interactions. A third scale measures staff culture. The RCM scales are quick, easy to understand (reading level of grade 5.4), and internally consistent. Test–retest correlations ranged from 0.81 to 0.67. Convergent validity with three related instruments was appropriate. The scales discriminate ACT from residential programs. The RCM scales show strong potential to be useful to program administrators and researchers working to increase the recovery-orientation of programs.
A Critical Black Feminist Ethnography of Treatment for Women with Co-occurring Disorders in the Psychiatric Hospital...167–184
Laryssa M. Creswell MMT, EdD
Abstract: The purpose of this study was to explore the perspectives of women diagnosed with co-occurring disorders on the treatments provided by a state psychiatric hospital so that appropriate recommendations for changes in treatment may be made. Critical ethnography was used and the data was viewed through the lens of intersectionality from the black feminist perspective. Seven women hospitalized in one psychiatric hospital in the Mid-Atlantic region participated in the study. Data was collected via semistructured interviews, Consumer Perceptions of Care survey, researcher's observations, and archival data. Three major findings emerged: (1) Dialectical Behavioral Therapy (DBT) was identified as a beneficial treatment, (2) a lack of trust in the system and people in the system, and (3) housing or homelessness was perceived as a barrier. Based on the results of this study, it is recommended clinicians, administrators, and policy makers listen closely to individuals receiving treatment to make decisions regarding treatment accordingly.
Cannabis Use, Employment, and Income: Fixed-Effects Analysis of Panel Data...185–202
Ioana Popovici PhD, Michael T. French PhD
Abstract: Uncertainty exists regarding the direction and magnitude of the association between cannabis use and labor market outcomes. Using panel data from waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions, the current paper estimates the associations between several patterns of cannabis use during the past year, current employment, and annual personal income. In the single-equation models (wave 2 data), nearly all patterns of cannabis use are significantly associated with worse labor market outcomes (p < 0.05). However, when using fixed-effects techniques to address unobserved and time-invariant individual heterogeneity, the estimates are generally smaller in magnitude and less likely to be statistically significant vis-à-vis the benchmark estimates. These findings suggest that unobserved individual heterogeneity is an important source of bias in models of cannabis use and labor market outcomes. Moreover, cannabis use may be less detrimental in the labor market than other studies have reported.
Towards Successful Dissemination of Psychological First Aid: A Study of Provider Training Preferences...203–215
Erin P. Hambrick MA, Sonia L. Rubens MA
Abstract: Dissemination of Psychological First Aid (PFA) is challenging considering the complex nature of disaster response and the various disaster mental health (DMH) trainings available. To understand challenges to dissemination in community mental health centers (CMHCs), interviews were conducted with nine DMH providers associated with CMHCs. Consensual qualitative analysis was used to analyze data. Interviews were targeted toward understanding organizational infrastructure, DMH training requirements, and training needs. Results clarified challenges to DMH training in CMHCs and factors that may promote buy-in for trainings. For example, resources are limited and thus allocated for state and federal training requirements. Therefore, including PFA in these requirements could promote adoption. Additionally, a variety of training approaches that differ in content, style, and length would be useful. To conclude, a conceptual model for ways to promote buy-in for the PFA Guide is proposed.
Role-playing as a Tool for Hiring, Training, and Supervising Peer Providers...216–229
Hans Oh MSW, MEd, Phyllis Solomon PhD
Abstract: This article presents role-playing as an activity that can help managers in hiring, evaluating, and supervising peer providers. With the increasing employment of peers in mental health care systems, supervisors have had to face dilemmas related to peer employment more frequently and with little guidance and direction. In response, this article presents role-playing as a practical tool to hire, train, and supervise peer providers. The effectiveness of role-playing depends largely on context and execution, and so this article also offers direction on how to maximize the utility and benefits of role-playing to enhance the performance of peer providers.
Clinical Characteristics and Outpatient Mental Health Service Use of Transition-Age Youth in the USA...230–243
Kathleen J. Pottick PhD, Lynn A. Warner PhD…
Abstract: This study examines diagnostic and service utilization patterns of transition-age youth in outpatient care derived from the 2007 nationally representative Client/Patient Sample Survey. Comparisons between 16–17, 18–21, and 22–25 year olds are highlighted. Among transition-age outpatients, the oldest youth had the highest rates of depression and bipolar disorder and co-occurring medical and substance use problems. Controlling for sociodemographic and clinical characteristics, 18–21 year olds were less likely to receive individual therapy than 16–17 year olds, but there were no age group differences in receipt of specialized therapy or psychotropic medication. Female gender and Hispanic ethnicity were positively associated with the number of services received and specialized service use, respectively; youth with private insurance were more likely than those with public insurance to receive psychotropic medication. Implications are discussed regarding access to and adequacy of services provided for young people in the critical transition to adulthood, especially with the implementation of the 2010 Affordable Care Act.
Availability and Attitudes Toward Correctional Psychiatry Training: Results of a National Survey of Training Directors...244–250
Brian S. Fuehrlein MD PhD
Abstract: An online survey was developed and administered to estimate how often psychiatry residents train at correctional facilities and to explore the residency directors’ attitudes towards this training. The survey contained two factual and eight opinion questions assessing their experiences with and attitudes toward resident training in correctional facilities, and allowed for free responses. Ninety-five people participated out of 492 for a response rate of 20%. Thirty percent of responders make a correctional rotation mandatory and another 25% offer it as an elective. Approximately one-third (36%) of responders have worked at a correctional facility themselves. Opinions towards correctional psychiatry were mostly positive with the exception of various logistical difficulties being mentioned in free responses. These provisional findings should generate interest in this area as providing more resident rotations at correctional facilities may increase access to care of this patient population and provide residents valuable training opportunities.
Issue 3 / July 2014
Assisted Outpatient Treatment: We Can Do Better...251–253
Linda Rosenberg MSW
This is an excerpt from the content: Practitioners, advocates, families, and individuals with mental illnesses: We all care very deeply about helping people. We dedicate our time to trying to figure out how to help people with mental illnesses to live well. This deep concern can sometimes lead to a clash in perspectives, most prominently in discussion of assisted outpatient treatment (AOT).
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently hosted a seminar on AOT, including panelists representing academic, state, peer, and provider perspectives.1 Behavioral Healthcare magazine ran a two-part series on AOT that also outlines the perspective from both sides of the debate.2
Based on my experience, and again in hearing from the panelists at the seminar, despite our differing perspectives, there is common ground.
Increasing Adoption of Comparative Effectiveness Research in Community Behavioral Health: Introduction to Special Section...254–257
Jessica Roberts Williams PhD, MPH, RN
This is an excerpt from the content: Comparative effectiveness research (CER), also known as patient-centered health research, is defined as “the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat, and monitor health conditions in real-world settings”.1 The focus of CER is effectiveness under “real-world” conditions in diverse populations and clinical practice settings. This focus is in stark contrast to traditional clinical trials, which emphasize control under “ideal” conditions.
In 2009, the US Congress enacted the American Recovery and Reinvestment Act (ARRA; P.L. 111–5) which dedicated an unprecedented US$831 billon over a 10-year period toward economic stimulation. As part of this stimulus package, the US federal government recognized the importance of CER in providing information necessary for appropriate health care decision-making, and as such, provided US$1.1 billion to the US Department of Health and Human Services for CER.
Increasing Adoption of Comparative Effectiveness Research in Community Behavioral Health: Methodology...258–275
Jessica Roberts Williams PhD, MPH, RN
Abstract: Increased efforts in comparative effectiveness research (CER) (comparing various health care intervention and treatment options) are being used to inform health care delivery. While CER research itself is an important step in developing best practices in health care, it is not enough to ensure success. The knowledge must also be successfully disseminated to increase adoption and implementation of practices. To ensure the greatest benefits of successful interventions, it is essential to understand which dissemination strategies are effective and under what conditions. This article provides the background and methodology used in a large-scale, 2-year study aimed at determining how knowledge gained from CER research may be most effectively disseminated to those responsible for delivering behavioral health services. The study takes an important step toward addressing the gaps in dissemination and translation of CER.
Characteristics of Community Health Organizations and Decision-Makers Considering the Adoption of Motivational Interviewing...276–293
Jessica Roberts Williams PhD, MPH, RN
Abstract: Research related to the adoption of comparative effectiveness research (CER) in mental health practice is limited. This study explores the factors that influence decisions to adopt motivational interviewing (MI)—an evidence-based practice (EBP) grounded in CER—among decision-makers (n = 311) in community health organizations (n = 92). Descriptive analyses focus on organization and decision-maker characteristics and processes that may influence the decision to adopt an EBP, including demographics, structure and operations, readiness, attitudes, barriers, and facilitators. Within-group agreement is examined to determine the degree to which participants within each organization gave similar responses. Results show characteristics differed according to type of organization (community health versus community behavioral health) and position (directors versus staff). Within-group agreement was also influenced by position. These findings indicate different strategies may be needed to best disseminate CER to the two groups.
Predictors of the Decision to Adopt Motivational Interviewing in Community Health Settings...294–307
Jessica Roberts Williams PhD, MPH, RN
Abstract: The purpose of this study is to concurrently examine the impact of individual and organizational characteristics on the decision to adopt the evidence-based practice (EBP) motivational interviewing (MI) among directors and staff (n = 311) in community health organizations (n = 92). Results from hierarchical linear modeling indicated that, at the individual level, attitudes toward EBPs and race each predicted directors’ decisions to adopt, while gender predicted staff’s decisionmaking. At the organizational level, organizational climate was inversely associated with both staff’s and directors’ decisions to adopt MI. Organizational barriers to implementing EBPs and use of reading materials and treatment manuals were related to directors’ decision to adopt. Type of organization and staff attributes were associated with staff’s decision to adopt. These findings underscore the need to tailor dissemination and implementation strategies to address differences between directors and staff in the adoption of EBPs.
Evaluation of a Randomized Intervention to Increase Adoption of Comparative Effectiveness Research by Community Health Organizations...308–323
Jessica Roberts Williams PhD, MPH, RN
Abstract: This randomized controlled trial examined the influence of two strategies (informational packets alone and in conjunction with Webinars) aimed at increasing the adoption of motivational interviewing (MI), a patient-centered behavioral health practice supported by evidence from comparative effectiveness studies, among community health organizations responsible for delivering mental and behavioral health services. Data were obtained from 311 directors and staff across 92 community organizations. Hierarchical linear modeling was used to examine changes in decision to adopt MI. The mediating effects of multiple contextual variables were also examined. Results showed that both strategies positively influenced the decision to adopt. The positive impact on decision to adopt was significantly greater among individuals that received informational packets in conjunction with Webinars. Baseline attitudes toward evidence-based practices and pressures for change appeared to mediate this effect.
Parallel Processes: Using Motivational Interviewing as an Implementation Coaching Strategy...324–336
Jennifer E. Hettema PhD, Denise Ernst PhD
Abstract: In addition to its clinical efficacy as a communication style for strengthening motivation and commitment to change, motivational interviewing (MI) has been hypothesized to be a potential tool for facilitating evidence-based practice adoption decisions. This paper reports on the rationale and content of MI-based implementation coaching Webinars that, as part of a larger active dissemination strategy, were found to be more effective than passive dissemination strategies at promoting adoption decisions among behavioral health and health providers and administrators. The Motivational Interviewing Treatment Integrity scale (MITI 3.1.1) was used to rate coaching Webinars from 17 community behavioral health organizations and 17 community health centers. The MITI coding system was found to be applicable to the coaching Webinars, and raters achieved high levels of agreement on global and behavior count measurements of fidelity to MI. Results revealed that implementation coaches maintained fidelity to the MI model, exceeding competency benchmarks for almost all measures. Findings suggest that it is feasible to implement MI as a coaching tool.
Predicting the Long-Term Sustainability of Evidence-Based Practices in Mental Health Care: An 8-Year Longitudinal Analysis...337–346
Alison E. Peterson MPH, Gary R. Bond PhD
Abstract: Few studies have examined predictors of long-term sustainability of evidence-based practices in mental health. This study used assessments of five evidence-based practices implemented in 49 sites in eight states at baseline and years 2, 4, and 8. Program characteristics, implementation characteristics, reinforcement activities, and sustainability factors were used to predict program survival status. The majority of predictors were not significant. Supervisor turnover in year 4 predicted survival status in year 8, but site characteristics, fidelity at implementation, quality improvement activities, and post-implementation activities had little impact on long-term program survival. This study extends previous sustainability research by examining the long-term impact of internal program factors over a substantial period of time using longitudinal prediction. Future research should also consider the influence of external factors such as financial policies.
Role of State Mental Health Leaders in Supporting Evidence-Based Practices over Time...347–355
Amanda M. Jones PhD, Gary R. Bond PhD
Abstract: State administrative supports of evidence-based practices (EBPs) may critically affect sustainability. As part of a larger follow-up to the multistate National Implementing Evidence-Based Practices Project, 13 leaders from eight States reported on recent statewide policies and resources that influenced the maintenance of 49 EBP programs 6 years after implementation. Nearly three-quarters (71 %) of the programs were currently operational and adhering to State fidelity standards. Most of the programs had level or increased funding over the last few years, and most received other State support and resources, such as training and technical assistance. Steady State funding as well as State-sponsored training and expertise appear critical to long-term EBP program maintenance.
Are Two Voices Better Than One? Predicting Permanency in Minority Youth Using Multi-informant Mental Health and Strength Data...356–369
Linda L. Toche-Manley PhD, Laura Dietzen MS
Abstract: Among youth in child welfare ages 6–17 years, 40 % meet the criteria for one or more DSM diagnoses. For minority youth in child welfare, poor mental health is compounded by limited access to care and racial disparity bias, leading to poorer outcomes. This paper uses data collected and analyzed by an automated behavioral health assessment system for a multiyear study that focused on ways to improve case planning in child welfare. Youth, their caseworkers, and, in some cases, parents completed assessments that measured and monitored the youths’ needs and strengths. More than 60 % of youth participating in the study were African-American; permanency rates after six months of case planning were found to be only one third. Predictive factors related to better behavioral health and permanency outcomes are identified and discussed, as well as the implications for improving case planning by incorporating the views of multiple informants, including the youth.
Effectiveness of a Psychosocial Weight Management Program for Individuals with Schizophrenia...370–380
Noosha Niv PhD, Amy N. Cohen PhD
Abstract: The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and Body Mass Index (BMI) were assessed at baseline, 1 year later, and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds, and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed.
A Neurobehavioral Intervention Incorporated into a State Early Intervention Program is Associated with Higher Perceived Quality of Care Among Parents of High-Risk Newborns... 381–389
Beth M. McManus PT, MPH, ScD
Abstract: The purpose of this study is to compare two models of early intervention (EI) service delivery—a neurobehavioral intervention and usual care—on parents' perceived quality of EI service delivery. Families of newborns referred to EI were randomly assigned to a neurobehavioral intervention or usual care group and followed until the infant was 12 weeks corrected gestational age. The intervention group (n = 25) received a weekly neurobehavioral intervention. The usual care group (n = 13) received standard weekly home visits. Mothers completed the Home Visiting Index (HVI) measuring the quality of EI service delivery. Mixed linear regression was used to examine group differences in quality scores. The intervention group reported higher quality of care related to facilitating optimal parent–infant social interaction (mean difference = 2.17, 95% CI: 0.41, 3.92).A neurobehavioral model of service delivery can be successfully integrated into EI programming and appears to be associated with higher parent-reported perceived quality.
A Preliminary 6-Month Prospective Study Examining Self-reported Religious Preference, Religiosity/Spirituality, and Retention at a Jewish Residential Treatment Center for Substance-Related Disorders...390–401
Iman Parhami MD, MPH, Margarit Davtian MA
Abstract: Although there is a substantial amount of research suggesting that higher levels of religiosity/spirituality (R/S) are associated with better treatment outcomes of substance-related disorders, no studies have explored this relationship at a faith-based residential treatment center. The objective of this prospective study is to explore the relationship between R/S, self-reported religious preference, and retention at a Jewish residential treatment center for substance-related disorders. Using the Daily Spiritual Experience Scale, R/S levels were assessed for 33 subjects at baseline, 1 month, 3 months, and 6 months. Results demonstrated a significant relationship between baseline R/S level and retention at 6 months, while R/S levels were unchanged during the course of treatment. Notably, no relationship was found between self-reported religious affiliation and retention. This study demonstrates that patients’ R/S level, rather than religious affiliation, is a possible predictor for better outcome at faith-based residential centers for substance-related disorders.
