Costs of Coordinated Specialty Care for First-Episode Psychosis: A Microcosting Analysis.

In this study, the authors measured and described the costs of coordinated specialty care (CSC) for first-episode psychosis in Ohio. A microcosting tool was used to estimate personnel and nonpersonnel costs of service delivery at seven CSC programs. Average annual cost per participant (N=511 participants) was estimated as $17,810 (95% CI=$9,141-$26,479). On average, 61% (95% CI=53%-69%) of annual program costs were nonbillable. Key cost drivers included facility costs, administrative tasks, and social services. Novel financing models may redress reimbursement gaps incurred by CSC programs.

Promoting the Success and Sustainability of Coordinated Specialty Care Teams in Ohio.

Recent COVID-19-related federal legislation has resulted in time-limited increases in Mental Health Block Grant (MHBG) set-aside dollars for coordinated specialty care (CSC) throughout the United States. The state of Ohio has opted to apply these funds to establish a learning health network of Ohio CSC teams, promote efforts to expand access to CSC, and quantify the operating costs and rates of reimbursement from private and public payers for these CSC teams. These efforts may provide other states with a model through which they can apply increased MHBG funds to support the success of their own CSC programs.

Unique and common elements of the role of peer support in the context of traditional mental health services.

OBJECTIVE: The goal of this report is to clarify the unique role of peer support providers (PSPs) and define peer support as a distinct occupation in the context of traditional mental health services. METHOD: A systematic methodology was used to compare roles of PSPs with those of similarly situated case managers (CMs). Key informants including 12 incumbent CMs and 11 incumbent PSPs participated in focus groups and responded to a set of prompts based on the Discovering a Curriculum (DACUM) methodology (Norton & Moser, 2014), an innovative approach to identifying and comparing duties and tasks associated with distinct occupations. Task analyses were validated through a survey of 71 CM and 29 PSP subject matter experts, including workers, supervisors, trainers, and consumers. RESULTS: The results revealed a variety of duties and tasks specific to the PSP occupation, particularly within the domains of empowering consumers, promoting consumers' educational growth, and supporting personal development. The results also reveal areas of overlapping responsibility between PSPs and CMs, including aspects of each role that promote consumers' development, wellness and recovery, administrative tasks, and care coordination activities. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings may address the role ambiguity that currently challenges efforts to establish peer support as a legitimate service in the field of behavioral health. In addition, the findings demonstrate how the roles of PSPs and CMs could be synergistic in complex organizational settings. (PsycINFO Database Record

A Specialized Treatment Court for Veterans with Trauma Exposure: Implications for the Field.

This study examines the efficacy of providing a Veterans Treatment Court specialized docket to trauma-affected veterans. Eighty-Six veterans enrolled in a jail diversion and trauma recovery Veterans Treatment Court program. Veteran participants were interviewed at baseline, 6- and 12-months to determine if the program led to improvements in jail recidivism, psychiatric symptoms, quality of life, and recovery. The results suggest that veteran's involved in the Veterans Treatment Court programs experienced significant improvement in PTSD, depression, substance abuse, overall functioning, emotional wellbeing, relationships with others, recovery status, social connectedness, family functioning, and sleep.

The impact of the great recession on community-based mental health organizations: an analysis of top managers' perceptions of the economic downturn's effects and adaptive strategies used to manage the consequences in Ohio.

The Great Recession of 2007-2009 adversely affected the financial stability of the community-based mental health infrastructure in Ohio. This paper presents survey results of the type of adaptive strategies used by Ohio community-based mental health organizations to manage the consequences of the economic downturn. Results were aggregated into geographical classifications of rural, mid-sized urban, and urban. Across all groups, respondents perceived, to varying degrees, that the Great Recession posed a threat to their organization's survival. Urban organizations were more likely to implement adaptive strategies to expand operations while rural and midsized urban organizations implemented strategies to enhance internal efficiencies.

Analyzing excess mortality from cancer among individuals with mental illness.

BACKGROUND: The objective was to compare patterns of site-specific cancer mortality in a population of individuals with and without mental illness. METHODS: This was a cross-sectional, population-based study using a linked data set comprised of death certificate data for the state of Ohio for the years 2004-2007 and data from the publicly funded mental health system in Ohio. Decedents with mental illness were those identified concomitantly in both data sets. We used age-adjusted standardized mortality ratios (SMRs) in race- and sex-specific person-year strata to estimate excess deaths for each of the anatomic cancer sites. RESULTS: Overall, there was excess mortality from cancer associated with having mental illness in all the race/sex strata: SMR, 2.16 (95% CI, 1.85-2.50) for black men; 2.63 (2.31-2.98) for black women; 3.89 (3.61-4.19) for nonblack men; and 3.34 (3.13-3.57) for nonblack women. In all the race/sex strata except for black women, the highest SMR was observed for laryngeal cancer, 3.94 (1.45-8.75) in black men and 6.51 (3.86-10.35) and 6.87 (3.01-13.60) in nonblack men and women, respectively. The next highest SMRs were noted for hepatobiliary cancer and cancer of the urinary tract in all race/sex strata, except for black men. CONCLUSIONS: Compared with the general population in Ohio, individuals with mental illness experienced excess mortality from most cancers, possibly explained by a higher prevalence of smoking, substance abuse, and chronic hepatitis B or C infections in individuals with mental illness. Excess mortality could also reflect late-stage diagnosis and receipt of inadequate treatment.

Analysis of causes of death for all decedents in Ohio with and without mental illness, 2004-2007.

OBJECTIVE: This study compared causes of death, crude mortality rates, and standardized mortality ratios (SMRs) between decedents with mental illness in Ohio's publicly funded mental health system ("mental illness decedents") and all Ohio decedents. METHODS: Ohio death certificates and Ohio Department of Mental Health service utilization data were used to assess mortality among decedents from 2004 to 2007. Age-adjusted SMRs and age-adjusted mortality rates were calculated across race and sex strata. RESULTS: Mental illness decedents accounted for 3.3% of all 438,749 Ohio deaths. Age-adjusted SMRs varied widely across the race and sex strata and by cause of death. Nonblacks with or without mental illness showed higher SMRs than blacks. Nonblack females with mental illness showed the highest SMRs in injury-related deaths. Higher SMRs were found for deaths associated with substance abuse; mental illness; diabetes; issues related to the nervous, cardiovascular, or respiratory systems; and injury. With and without mental illness, the top cause of death was violence for youths and cardiovascular disease for adults >35. CONCLUSIONS: Deaths from injury and violence, especially among those <35, should be specifically addressed to reduce excess mortality for persons with mental illness. Mental health care should be integrated with primary care to better manage chronic disease, especially cardiovascular disease. Methodological contributions included use of linked files to compare SMR and leading causes of death between mental illness decedents and all Ohio decedents. More research is needed on patterns in cause of death and any interactions from demographic characteristics and mental illness. Health care data silos must be bridged between private and public sectors and the Departments of Veterans Affairs and Defense.

The assimilation of evidence-based healthcare innovations: a management-based perspective.

In order to reap the benefits of the nation's vast investments in healthcare discoveries, evidence-based healthcare innovations (EBHI) must be assimilated by the organizations that adopt them. Data from a naturalistic field study are used to test a management-based model of implementation success which hypothesizes strategic fit, climate for EBHI implementation, and fidelity will explain variability in the assimilation of EBHIs by organizations that adopted them under ordinary circumstances approximately 6 years earlier. Data gathered from top managers and external consultants directly involved with these long-term EBHI implementation efforts provide preliminary support for predicted positive linkages between strategic fit and climate; climate and fidelity; and fidelity and assimilation. Mediated regression analyses also suggest that climate and fidelity may be important mediators. Findings raise important questions about the meaning of assimilation, top managers' roles as agents of assimilation, and the extent to which results represent real-world versus implicit models of assimilation.

Community treatment of child sexual abuse: a survey of practitioners in the National Child Traumatic Stress Network.

Practitioners from numerous agencies who sought training in Trauma-Focused Cognitive-Behavioral Therapy in several regional sites under the auspices of the National Child Traumatic Stress Network completed a baseline survey to describe their backgrounds, settings, practices, attitudes, and perceived outcomes with sexually abused children and youth. The results documented a range of experiences and common treatment practices, and identified contributors to practitioners' use of gradual exposure and perceived levels of positive treatment outcome. The results were not accounted for by geographic region or agency. The findings support recommendations to optimize research and training related to the dissemination of evidence-based treatments in the child abuse field.

Implementation of evidence-based practice in community behavioral health: agency director perspectives.

Despite a growing supply of evidence-based mental health treatments, we have little evidence about how to implement them in real-world care. This qualitative pilot study captured the perspectives of agency directors on the challenge of implementing evidence-based practices in community mental health agencies. Directors identified challenges as limited access to research, provider resistance, and training costs. Director leadership, support to providers, and partnerships with universities were leverage points to implement evidenced-based treatments. Directors' mental models of EBP invoked such concepts as agency reputation, financial solvency, and market niche. Findings have potential to shape implementation interventions.

Prosocial family processes and the quality of life of persons with schizophrenia.

OBJECTIVES: Research on the family's contribution to the quality of life of persons with serious mental illness has largely focused on negative family interactions associated with poorer client outcomes. The purpose of this naturalistic study of aging mothers and adults with schizophrenia was to investigate prosocial family processes that potentially enhance, rather than detract from, the life satisfaction of persons with serious mental illness. METHODS: The data were drawn from a longitudinal study of aging parents caring for a son or daughter with schizophrenia. This report is based on 122 mother-adult child dyads who participated in the third wave of the study. Mothers completed an in-home interview and questionnaire that included measures of the quality of the relationship between the mother and adult child, maternal warmth, and maternal praise of the adult child. The adult with schizophrenia completed a life satisfaction questionnaire. RESULTS: The adults with schizophrenia had higher life satisfaction when their mothers expressed greater warmth and praise of their son or daughter with schizophrenia and when their mothers reported the quality of their relationship as being close and mutually supportive. CONCLUSIONS: Past research has emphasized changing families, most typically by lowering expressed emotion, with little emphasis on the families' strengths, in particular, prosocial family processes that may enhance the life satisfaction of their loved one. As a recovery orientation focuses on the strengths of adults with mental illness, it also should focus equally on the supportive presence of families in the lives of clients.

Treating sexually abused children: 1 year follow-up of a randomized controlled trial.

OBJECTIVE: To measure the durability of improvement in response to two alternative treatments for sexually abused children. METHOD: Eighty-two sexually abused children ages 8-15 years old and their primary caretakers were randomly assigned to trauma-focused cognitive-behavioral therapy (TF-CBT) or non-directive supportive therapy (NST) delivered over 12 sessions; this study examines symptomatology during 12 months posttreatment. DATA ANALYSIS: Intent-to-treat and treatment completer repeated measures analyses were conducted. RESULTS: Intent-to-treat indicated significant group x time effects in favor of TF-CBT on measures of depression, anxiety, and sexual problems. Among treatment completers, the TF-CBT group evidenced significantly greater improvement in anxiety, depression, sexual problems and dissociation at the 6-month follow-up and in PTSD and dissociation at the 12-month follow-up. CONCLUSION: This study provides additional support for the durability of TF-CBT effectiveness.

Treating childhood traumatic grief: a pilot study.

OBJECTIVE: To examine the potential efficacy and specific timing of treatment response of individual child and parent trauma-focused cognitive-behavioral therapy for childhood traumatic grief (CTG), a condition in which trauma symptoms impinge on the child's ability to successfully address the normal tasks of grieving. METHOD: Twenty-two children and their primary caretakers received a manual-based 16-week treatment with sequential trauma- and grief-focused interventions. RESULTS: Children experienced significant improvements in CTG, posttraumatic stress disorder (PTSD), depressive, anxiety, and behavioral problems, with PTSD symptoms improving only during the trauma-focused treatment components and CTG improving during both trauma- and grief-focused components. Participating parents also experienced significant improvement in PTSD and depressive symptoms. CONCLUSIONS: The timing of improvements in CTG and PTSD symptoms lends support to providing sequential trauma- and grief-focused interventions and to the concept that CTG is related to but distinct from PTSD. The results also suggest the benefit of individual treatment for CTG and for including parents in the treatment of CTG. Randomized, controlled trials are needed to further test the efficacy of this treatment model.