Investigating service features to sustain engagement in early intervention mental health services.

AIM: To understand what service features would sustain patient engagement in early intervention mental health treatment. METHODS: Mental health patients, family members of individuals with mental illness and mental health professionals completed a survey consisting of 18 choice tasks that involved 14 different service attributes. Preferences were ascertained using importance and utility scores. Latent class analysis revealed segments characterized by distinct preferences. Simulations were carried out to estimate utilization of hypothetical clinical services. RESULTS: Overall, 333 patients and family members and 183 professionals (N = 516) participated. Respondents were distributed between a Professional segment (53%) and a Patient segment (47%) that differed in a number of their preferences including for appointment times, individual vs group sessions and mode of after-hours support. Members of both segments shared preferences for many of the service attributes including having crisis support available 24 h per day, having a choice of different treatment modalities, being offered help for substance use problems and having a focus on improving symptoms rather than functioning. Simulations predicted that 60% of the Patient segment thought patients would remain engaged with a Hospital service, while 69% of the Professional segment thought patients would be most likely to remain engaged with an E-Health service. CONCLUSIONS: Patients, family members and professionals shared a number of preferences about what service characteristics will optimize patient engagement in early intervention services but diverged on others. Providing effective crisis support as well as a range of treatment options should be prioritized in the future design of early intervention services.

Modeling the mental health service utilization decisions of university undergraduates: A discrete choice conjoint experiment.

OBJECTIVE: We modeled design factors influencing the intent to use a university mental health service. PARTICIPANTS: Between November 2012 and October 2014, 909 undergraduates participated. METHOD: Using a discrete choice experiment, participants chose between hypothetical campus mental health services. RESULTS: Latent class analysis identified three segments. A Psychological/Psychiatric Service segment (45.5%) was most likely to contact campus health services delivered by psychologists or psychiatrists. An Alternative Service segment (39.3%) preferred to talk to peer-counselors who had experienced mental health problems. A Hesitant segment (15.2%) reported greater distress but seemed less intent on seeking help. They preferred services delivered by psychologists or psychiatrists. Simulations predicted that, rather than waiting for standard counseling, the Alternative Service segment would prefer immediate access to E-Mental health. The Usual Care and Hesitant segments would wait 6 months for standard counseling. CONCLUSIONS: E-Mental Health options could engage students who may not wait for standard services.

Preferences for Early Intervention Mental Health Services: A Discrete-Choice Conjoint Experiment.

OBJECTIVE: Early intervention services (EISs) for mental illness may improve outcomes, although treatment engagement is often a problem. Incorporating patients' preferences in the design of interventions improves engagement. A discrete-choice conjoint experiment was conducted in Canada to identify EIS attributes that encourage treatment initiation. METHODS: Sixteen four-level attributes were formalized into a conjoint survey, completed by patients, family members, and mental health professionals (N=562). Participants were asked which EIS option people with mental illness would contact. Latent-class analysis identified respondent classes characterized by shared preferences. Randomized first-choice simulations predicted which hypothetical options, based on attributes, would result in maximum utilization. RESULTS: Participants in the conventional-service class (N=241, 43%) predicted that individuals would contact traditional services (for example, hospital location and staffed by psychologists or psychiatrists). Membership was associated with being a patient or family member and being male. Participants in the convenient-service class (N=321, 57%) predicted that people would contact services promoting easy access (for example, self-referral and access from home). Membership was associated with being a professional. Both classes predicted that people would contact services that included short wait times, direct contact with professionals, patient autonomy, and psychological treatment information. The convenient-service class predicted that people would use an e-health model, whereas the conventional-service class predicted that people would use a primary care or clinic-hospital model. CONCLUSIONS: Provision of a range of services may maximize EIS use. Professionals may be more apt to adopt EISs in line with their beliefs regarding patient preferences. Considering several perspectives is important for service design.

A 'navigator' model in emerging mental illness?

AIM: While there is clearly much to be gained from ensuring that youth with emerging mental illness across a variety of psychiatric illnesses receive care that reduces symptoms and improves functioning, it is not at all clear how best to achieve these results within a health-care system that has limited resources. Outside of the area of psychosis, there is little evidence to guide us around a model of care that might be effective, efficient and linked to existing mental health systems. METHODS: We summarize the literature on early intervention (EI) in psychosis and derive five key lessons for transdiagnostic prevention. We then broadened our search to find clinical and systems models that shared challenges similar to those identified for EI, high levels of patient and family distress, need for rapid yet comprehensive diagnostic assessment and timely initiation of specific treatment. RESULTS: Cancer navigators have numerous functions that appear to overlap with the key issues in transdiagnostic psychiatric EI. A navigation clinic with a separate identity, but clearly connected to specialized mental health facilities has the potential to speed assessment, diagnosis and treatment streaming. Navigators would be involved with youth and their family throughout different levels of care, making clinical decisions based on illness and functional status. CONCLUSIONS: In sum, the evidence from navigation services in cancer care offers the mental health field a progressive clinical model that might be an important guide for EI in youth.

Sustained transfer of knowledge to practice in long-term care: facilitators and barriers of a mental health learning initiative.

This article explores facilitators and barriers to the impact and sustainability of a learning initiative to increase capacity of long-term care (LTC) homes to manage the mental health needs of older persons, through development of in-house Psychogeriatric Resource Persons (PRPs). Twenty interviews were conducted with LTC staff. Management support, particularly designation of time for PRP activities, development of PRP teams, and supportive learning strategies were significant factors affecting sustained knowledge transfer. Continuing education that is provided and evaluated on an ongoing basis, secures management commitment, is integrated within a broader system strategy, and provides on-the-job support has the greatest potential to affect care.

Evaluation of the sustained implementation of a mental health learning initiative in long-term care.

BACKGROUND: This paper describes an innovative education program for the management of mental health problems in long-term care (LTC) homes and the evaluation of its longer-term sustainability. Since 1998, the "Putting the P.I.E.C.E.S. Together" learning initiative has been providing education sessions and related learning strategies aimed at developing the knowledge and skills of health professionals who care for older persons with complex physical and mental health needs and associated behaviors, in Ontario, Canada. A major focus of this province-wide initiative was the development of in-house Psychogeriatric Resource Persons (PRPs). Evaluation of this initiative included the completion of pre- and post-education questionnaires (over three data collection time periods) assessing learner confidence (N = 1,024 and 792, for pre- and post-education, respectively) and session evaluation questionnaires gathering feedback on the session (N = 2,029 across all sessions). A survey of LTC homes in Ontario (N = 439, 79% of the homes in the province) was conducted to assess longer-term sustainability. RESULTS: Ratings of the sessions indicated that they were relevant to learners' clinical practice. There were significant increases in ratings of ability to recognize and understand challenging behaviors and mental health problems, and in ability to use a variety of assessment tools. Few homes (15%) do not have a PRP; over 50% of the staff who completed the first session in 1999 continue to serve as a PRP and to apply learned skills. CONCLUSIONS: A learning initiative with supportive and reinforcing strategies can develop in-house PRPs to enhance the care of the elderly in LTC. Incorporation of PRP functions into job descriptions and management support contributed to the success of this initiative. This study highlights the importance of work environments that support and reinforce the use of learned skills to the success of continuing education and quality improvement initiatives in LTC.