Self- Evaluation Tool to Support Implementation of Treatment for Tobacco Use Disorder in Behavioral Health Programs.

Tobacco use in people with behavioral health conditions remain two to three times higher than the general population causing premature death and impacting recovery negatively across several domains. Intermediary organizations can provide practical tools, training, and technical assistance to help programs improve capacity to treat tobacco use. This report describes the construction and application of the Tobacco Integration Self-Evaluation Tool (TiSET) for behavioral health programs, a 20-item scale inspired by the DDCMHT and additional content from the Facility Tobacco Policy and Treatment Practices Self-Evaluation tool that one of the study authors (JW) used previously with addiction treatment programs. Completing the TiSET is an important step for behavioral health programs to evaluate their ability to effectively treat people that use tobacco. An important next step is to use those results to facilitate a quality improvement process. We include large agency example illustrating how the TiSET can be applied in real-world practice.

Integrating Primary Care Into Assertive Community Treatment.

OBJECTIVE: This program evaluation examined integration of primary care nurse practitioners into assertive community treatment (ACT). METHODS: From January to June 2019, primary care nurse practitioners in a postgraduate fellowship program were assigned to five ACT teams (N=305 participants). Focus groups explored staff members' and participants' experiences. Screening rates for hemoglobin A1c and cholesterol for ACT participants were compared over time. RESULTS: Staff and participants in ACT described improved engagement in primary care, citing benefit from colocation and consultation. Field visits were not found to be an efficient use of the primary care nurse practitioners' time to serve most ACT participants. A significant increase in screening was observed after 6 months for the ACT teams with integrated primary care. CONCLUSIONS: An integrated primary care nurse practitioner readily available for participant engagement and consultation with the ACT team, using a cardiometabolic registry to guide care, may offer a sustainable model of integration.

ACT for Life: Why Psychiatrists Pound the Pavement to Provide Care.

To better understand the experience of psychiatrists working on assertive community treatment (ACT) teams and the factors that may draw them to this work, the authors created a survey and distributed it through e-mail groups of the American Association of Community Psychiatrists, the Columbia University Public Psychiatry Fellowship Alumni, and the New York State Center for Practice Innovations ACT Institute. A second survey, with questions primarily regarding safety concerns for ACT providers, was distributed to respondents of the first survey. Responses suggested that ACT leaders should foster teamwork, fieldwork, creativity, flexibility, safety, and leadership opportunities on ACT teams if they wish to engage psychiatrists in this work.

COVID-19 in a New York City Behavioral Health Housing and Treatment System.

OBJECTIVE: This study sought to characterize the incidence of COVID-19 illness, hospitalization, and death among congregate and noncongregate cohorts served by a New York City behavioral health agency. METHODS: From March 9 to May 3, 2020, data were collected on COVID-19 symptoms, testing, hospitalization, and mortality for 8,256 individuals living in 29 congregate programs (residences and homeless shelters) or served by 41 noncongregate programs (scattered-site housing or outpatient treatment programs). RESULTS: Of the 218 (2.6%) individuals who developed COVID-19-like illness, 84 (39%) were able to obtain testing. Of the 77 individuals who tested positive, 49 (64%) were hospitalized and 19 (25%) died. Congregate housing, age over 45, and intellectual/developmental disabilities were significantly associated with hospitalization and death. CONCLUSIONS: Further research on risk and preventive factors is needed to address the high risk for people with serious mental illnesses and intellectual/developmental disabilities during a pandemic, particularly for those living in congregate housing.

Telehealth Acceptability and Feasibility Among People Served in a Community Behavioral Health System During the COVID-19 Pandemic.

OBJECTIVE: The authors examined the acceptability and feasibility of telehealth services shortly after their rapid introduction into a community behavioral health agency as part of the response to the COVID-19 pandemic. METHODS: Individuals receiving services during May 8-18, 2020, from behavioral health programs that had introduced telehealth in March 2020, were invited to participate in a survey regarding their perceptions of the telehealth services. Ordinal logistic regressions were used to test for differences in survey responses in three ways: between program types, between the 2020 sample and a 2018 sample, and between individuals reported by staff to be distressed or not distressed by the COVID-19 pandemic. RESULTS: Of 1,482 survey respondents, >80% reported that their ability to connect to staff, receive support, and get an appointment was at least as great as before the pandemic. Among 80% of respondents indicating interest in continuing remote services after the pandemic ended, 83% preferred a mix of remote and face-to-face services. From February 2020 to April 2020, total service utilization remained stable for treatment, outreach, and housing programs. In addition, mental health-related hospital utilization did not increase. CONCLUSIONS: The findings of this study suggest that telehealth, including telephone-based services, is an acceptable and even preferred service delivery mode for clients with severe mental illness. Continued investigation into the optimal dosing of face-to-face versus remote services in various settings is needed to inform service practice during and after the COVID-19 pandemic.

Social skills training for adolescents with Asperger syndrome and high-functioning autism.

The effectiveness of a social skills training group for adolescents with Asperger syndrome and high-functioning autism (AS/HFA) was evaluated. Parents of six groups of adolescents (n = 46, 61% male, mean age 14.6) completed questionnaires immediately before and after the 12-week group. Parents and adolescents were surveyed regarding their experience with the group. Significant pre- to post-treatment gains were found on measures of both social competence and problem behaviors associated with AS/HFA. Effect sizes ranged from .34 to .72. Adolescents reported more perceived skill improvements than did parents. Parent-reported improvement suggests that social skills learned in group sessions generalize to settings outside the treatment group. Larger, controlled studies of social skills training groups would be valuable.

Research on day treatment programs for preschoolers with disruptive behavior disorders.

OBJECTIVE: This review examined the literature on psychosocial treatments for preschoolers with disruptive behavior disorders to delineate ways in which interventions developed in research settings can be used to enhance existing clinical preschool day treatment programs. METHODS: A PsycINFO search was performed by using the keywords "day treatment," "behavior problems," "disruptive behavior disorder," and "oppositional defiant disorder" to find articles published between 1974 and 2004 on randomized controlled trials of psychosocial interventions for preschoolers (ages two to five years). No randomized controlled trials of multimodal day treatment programs were found. Therefore, studies on multimodal day treatment were selected on the basis of whether they presented quantitative outcome data. RESULTS AND CONCLUSIONS: Little research was available on the effectiveness of day treatment programs, despite the programs' prevalence as a treatment modality for disruptive preschoolers. In contrast, many interventions in the disruptive behavior disorder research have not made their way into clinical practice. Preschool day treatment programs may be enhanced by improving access to care, emphasizing social problem-solving skills, and using strategies to engage families in treatment. Research studies on existing day treatment programs are needed to clarify the role of these programs in child psychiatry clinics and to shed light on optimal methods of service delivery.