Fútbol y psicoanálisis: una experiencia entre varios

En el Centro de Salud Mental Nº 1 de la Ciudad de Buenos Aires, el equipo de Niños Tarde comenzó en 2018 a integrar a los niños en tratamiento a un taller de fútbol, pensado como un espacio en el cual pudieran jugar con otros, y posibilitar múltiples transferencias e intervenciones. Se describe cómo fueron desarrollándose las actividades de este dispositivo.

Who is driving change, and where is it taking us? Interview with an expert.

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Integrated Pharmacies at Community Mental Health Centers: Medication Adherence and Outcomes.

BACKGROUND: Patients receiving psychiatric services at community mental health centers (CMHCs) are often prescribed medication that is critical to the treatment of behavioral health conditions, including schizophrenia, bipolar disorder, anxiety, and depression. Previous studies have shown correlation between rates of medication adherence and risk of hospitalization, but potential differences in medication adherence and other outcomes for patients of CMHCs by pharmacy type have not been widely studied. OBJECTIVE: To determine potential benefits of placing a pharmacy within a mental health service delivery setting on both adherence to medication and health outcomes. METHODS: A retrospective cohort analysis of medication adherence rates, hospital and emergency department (ED) use, and related costs between patients of CMHCs was conducted using integrated pharmacies versus community pharmacies. Data were from Medicaid claims paid by Southwest Michigan Behavioral Health for all (behavioral and nonbehavioral) inpatient and outpatient services as well as pharmacy prescriptions filled from April 1, 2014, through April 30, 2015. The primary study analysis was composed of an adult dataset representing persons served from 1 of the 2 CMHCs who had filled at least 2 prescriptions for a specific medication from 1 of 2 Genoa pharmacies located in a CMHC during the study period. Each unique patient dataset in the treatment group was matched to a corresponding control patient dataset prescribed the same medication using a modified version of the Gale-Shapley algorithm. The primary analysis compared medication possession ratio, which is a measure of adherence that indicates gaps or oversupply in a patient's medication use history. Statistical tests were performed using the R statistical programming language and Microsoft Excel. RESULTS: Patients using pharmacies integrated within the CMHCs had higher medication adherence rates, lower rates of hospitalization, and lower ED use than those filling their prescriptions at community pharmacies. These results were associated with a cost savings of $58 per member per month (approximately $700,000 per 1,000 patients annually). CONCLUSIONS: Pharmacies integrated within CMHCs not only can improve medication adherence but also can reduce the need for other expensive health care services. DISCLOSURES: Southwest Michigan Behavioral Health sponsored this study, which was funded by Genoa, a QoL Healthcare Company. SWMBH is a client of Care Management Technologies and permitted the use of its data for this analysis. Wright and Clayton are employed by Care Management Technologies, which was contracted by Genoa to conduct this analysis. Gorman owns Franklin Behavioral Health Consultants and reports consulting fees from Care Management Technologies; Gorman also reports stock ownership in various pharmaceutical companies. Odorzynski and Peterson are employed by Genoa. Study concept and design were contributed by Clayton, Odorzynski, Peterson, and Gorman, with assistance from Wright. Wright took the lead in data collection, with assistance from Clayton and Odorzynski, and data interpretation was performed by Wright and Gorman, with assistance from Odorzynski, Clayton, and Peterson. The manuscript was written by Gorman, Wright, and Odorzynski, assisted by Clayton and Peterson, and revised by Clayton, Gorman, Odorzynski, and Peterson.

The Concord Centre for Mental Health's new 'phase of illness' model of care: are we on the right track?

OBJECTIVE: The aim of this study was to provide an overview of a new 'phase of illness' model of care after relocation of Rozelle Hospital to the new purpose built Concord Centre for Mental Health and discuss its implementation and progress thus far. METHOD: One year after relocation, staff were asked to provide feedback of their views of the new model of care in order to identify implementation barriers and ways forward. RESULTS: The new model has clear benefits for the consumer, but there are a number of practical challenges and dilemmas emerging that necessitate some refinement and evaluation. Feedback from staff provided a wide range of opinions indicating that some were quite cynical of the new model while others were very supportive and thought that patient care was enhanced. CONCLUSIONS: Further development and consolidation of the model is required, including more education sessions and a clear mission statement at unit, hospital and community levels. Further research is also required to assess the impact and ability of the new model to deliver better patient outcomes, especially in regard to continuity of care.