Showing papers in "Psychiatric Services in 2015"
TL;DR: The author describes behaviors, such as poor eating, excessive drinking and abuse of drugs, smoking, and physical inactivity, and social factors that contribute to ill health and early demise.
Abstract: Ninety percent of the determinants of our health derive from our lifetime social and physical environment-not from the provision of health care. The author describes behaviors, such as poor eating, excessive drinking and abuse of drugs, smoking, and physical inactivity, and social factors, such as adverse childhood experiences, poor education, food insecurity, poor housing quality, unemployment, and discrimination, that contribute to ill health and early demise. Better health and mental health can be achieved by understanding and responding to these determinants of health.
446 citations
TL;DR: Low rates of treatment and high unmet need persist among adults with mental illness, and strategies to reduce both structural barriers, such as cost and insurance coverage, and attitudinal barriers are needed.
Abstract: Objective:The purpose of this study was to provide updated national estimates and correlates of service use, unmet need, and barriers to mental health treatment among adults with mental disorders.Methods:The sample included 36,647 adults ages 18–64 (9,723 with any mental illness and 2,608 with serious mental illness) from the 2011 National Survey on Drug Use and Health. Logistic regression models were used to examine predictors of mental health treatment and perceived unmet need.Results:Substantial numbers of adults with mental illness did not receive treatment (any mental illness, 62%; serious mental illness, 41%) and perceived an unmet need for treatment (any mental illness, 21%; serious mental illness, 41%). Having health insurance was a strong correlate of mental health treatment use (any mental illness: private insurance, adjusted odds ratio [AOR]=1.63, 95% confidence interval [CI]=1.29–2.06; Medicaid, AOR=2.66, CI=2.04–3.46; serious mental illness: private insurance, AOR=1.65, CI=1.12–2.45; Medicaid...
200 citations
TL;DR: The RAISE Early Treatment Program project's NAVIGATE program has the potential to fill an important gap in the U.S. health care system by providing a comprehensive intervention specially designed to meet the unique treatment needs of persons recovering from a first episode of psychosis.
Abstract: Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health’s Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project—known as the NAVIGATE program—with a particular focus on its psychosocial components. NAVIGATE is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services provided in the NAVIGATE program include the family education program (FEP), individual resiliency training (IRT), supported employment an...
170 citations
TL;DR: The MindSpot Clinic produced treatment outcomes that were comparable to results from published clinical trials of iCBT, and represents an innovative method of providing accessible, low-cost, effective, and acceptable mental health services to many people who currently are not receiving care.
Abstract: Objective:The main objective of this study was to report the feasibility of delivering online cognitive-behavioral therapy (iCBT) treatments for anxiety and depression in a national public mental health service.Methods:A prospective noncontrolled cohort study was conducted of all patients who began assessment or treatment at the MindSpot Clinic from January through December 2013. Clinic services were used by a representative cross-section of the Australian population. Mean age at assessment was 36.4±13.0 years, and age range was 18–86 years. Patients completed one of four online courses over eight weeks, during which they received weekly support from a therapist via telephone or secure e-mail. Primary outcome measures were the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder scale (GAD-7) administered at posttreatment and three months posttreatment.Results:A total of 10,293 adults who self-identified as having problems with anxiety or depression commenced asse...
136 citations
TL;DR: The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program Implementation and Evaluation Study developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis.
Abstract: Objective:The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program Implementation and Evaluation Study developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. This article describes the treatment model and reports on service utilization and outcomes. It was hypothesized that individuals’ symptoms and functioning would improve over time.Methods:A total of 65 individuals in RAISE Connection Program treatment across two sites (Baltimore and New York City) were enrolled and received services for up to two years. Primary outcomes, including social and occupational functioning and symptoms, were evaluated. Trajectories for individuals’ outcomes over time were examined with linear and quadratic mixed-effects models with repeated measures.Results:Measures of occupational and social functioning improved signif...
128 citations
TL;DR: Support is provided for adopting Housing First as an approach for ending chronic homelessness among persons with severe mental illness, even if they are actively symptomatic or using substances.
Abstract: Objective:Housing First is a groundbreaking approach to ending chronic homelessness among people with mental illness. This article presents one-year findings from a multisite randomized controlled trial (RCT) comparing Housing First with treatment as usual.Methods:The study was a nonblind, parallel-group RCT conducted in five Canadian cities. A sample of 950 high-need participants with severe mental illness, who were either absolutely homeless or precariously housed, was randomly assigned to Housing First (N=469) or treatment as usual (N=481). Housing First participants received a rent supplement, assistance to find housing, and assertive community treatment. Treatment-as-usual participants had access to all other existing programs.Results:At one-year follow-up, 73% of Housing First participants and 31% of treatment-as-usual participants resided in stable housing (p<.001, odds ratio=6.35, covariate adjusted difference=42%, 95% confidence interval [CI]=36%−48%). Improvement in overall quality of life was s...
117 citations
TL;DR: It is highlighted that PROM feedback appears to be more effective when integrated in a formalized and structured manner, and future work is required to isolate these effects from common procedural correlates, such as monitoring of the therapeutic alliance.
Abstract: Objective:Routine evaluation of mental health services has become widespread, and the use of patient-reported outcome measures (PROMs) as clinical aids or discussion tools has been receiving increasing attention. The purpose of this scoping study was to provide a typology of the diverse ways in which studies reporting on PROM use in mental health services have utilized PROMs.Methods:Iterative scoping searches of the literature identified articles reporting on the use of PROM feedback in mental health settings, which were then categorized to develop a typology along a dimension of intensity of use of PROM feedback, ranging from no feedback to patient and clinician to clinician-patient discussion that followed a formalized structure.Results:Of the 172 studies that were identified, 27 were grouped into five categories, ranging from studies in which there was no PROM feedback to clinician or patient to studies in which a formalized structure was available by which PROM feedback could be discussed between clin...
104 citations
TL;DR: Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways to specialty FEP care.
Abstract: Objective:This study is the first to examine duration of untreated psychosis (DUP) among persons receiving care in community mental health centers in the United States.Methods:Participants were 404 individuals (ages 15–40) who presented for treatment for first-episode psychosis at 34 nonacademic clinics in 21 states. DUP and individual- and site-level variables were measured.Results:Median DUP was 74 weeks (mean=193.5±262.2 weeks; 68% of participants had DUP of greater than six months). Correlates of longer DUP included earlier age at first psychotic symptoms, substance use disorder, positive and general symptom severity, poorer functioning, and referral from outpatient treatment settings.Conclusions:This study reported longer DUP than studies conducted in academic settings but found similar correlates of DUP. Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways to specialty FEP care.
93 citations
TL;DR: This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses and can also support translational research and are a relevant model for other serious mental illnesses.
Abstract: Objective:This study sought to determine the effectiveness of a comprehensive first-episode service, the clinic for Specialized Treatment Early in Psychosis (STEP), in an urban U.S. community mental health center by comparing it with usual treatment.Methods:This pragmatic randomized controlled trial enrolled 120 patients with first-episode psychosis within five years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from inpatient psychiatric units, and enrollees were randomly allocated to STEP or usual treatment. Main outcomes included hospital utilization (primary); the ability to work or attend age-appropriate schooling—or to actively seek these opportunities (vocational engagement); and general functioning. Analysis was by modified intent to treat (excluding only three who withdrew consent) for hospitalization; for other outcomes, only data for completers were analyzed.Results:After one year, STEP participants had less inpatient utilization compared with those in usual tre...
91 citations
TL;DR: This study directly compared veteran and nonveteran suicide risk while for the first time differentiating veterans by VHA service use, and found VHA-utilizing veterans appear to have declining absolute and relative suicide rates.
Abstract: Objective:Veterans are believed to be at high risk of suicide. However, research comparing suicide rates between veterans and nonveterans is limited, and even less is known regarding differences by...
88 citations
TL;DR: Investigation of the influence of psychiatric comorbidities on 30-day all-cause readmissions following hospitalizations for HF, AMI, and pneumonia found substance use and bipolar disorders were linked with higher readmissions for those with initial hospitalization for HF and pneumonia.
Abstract: Objective:In 2012, the Centers for Medicare and Medicaid Services implemented a policy that penalizes hospitals for “excessive” all-cause hospital readmissions within 30 days after discharge from an index hospitalization for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. The aim of this study was to investigate the influence of psychiatric comorbidities on 30-day all-cause readmissions following hospitalizations for HF, AMI, and pneumonia.Methods:Data from 2009–2011 were derived from the HMO Research Network Virtual Data Warehouse of 11 health systems affiliated with the Mental Health Research Network. All index inpatient hospitalizations for HF, AMI, and pneumonia were captured (N=160,169). Psychiatric diagnoses for the year prior to admission were measured. All-cause readmissions within 30 days of discharge were the outcome variable.Results:Approximately 18% of all individuals with index inpatient hospitalizations for HF, AMI, and pneumonia were readmitted within 30 days. The rate...
TL;DR: Although IPS was shown to be an effective model for helping justice-involved clients with severe mental illness achieve employment, the outcomes were modest compared with those in prior IPS studies.
Abstract: Objective:Employment is a key to participation in community life for people with severe mental illness, especially those who have been involved in the criminal justice system. Although the Individual Placement and Support (IPS) model of supported employment has been established as an evidence-based practice for helping people with severe mental illness attain competitive employment, little is known about whether IPS is effective for people with severe mental illness who have a history of arrest or incarceration. This study examined this question.Methods:A randomized controlled trial examined competitive employment outcomes for 85 participants with severe mental illness and justice involvement who were assigned to IPS or to a comparison group that offered a job club approach with peer support.Results:At one-year follow-up, a greater proportion of participants in the IPS group than in the comparison group had obtained competitive employment (31% versus 7%; p<.01). The IPS and comparison groups did not diffe...
TL;DR: Patients with first-episode psychosis were found to have high relapse rates during the first years after illness onset, including diagnosis, relapse, and functioning and factors related to these variables.
Abstract: Objective:First-episode psychosis has an annual incidence rate of 24.6 to 40.9 per 100,000 population, and most individuals develop chronic disorders, such as schizophrenia or affective psychosis. ...
TL;DR: Findings of this implementation trial align with conceptual implementation frameworks and may guide the tailoring of future implementation efforts in order to overcome barriers and maximize facilitators.
Abstract: Objective:The study examined, from the perspective of therapists, the barriers to and facilitators in implementing cognitive-behavioral therapy (CBT) for anxious youths in community settings.Methods:Fifty therapists (43% of the original training sample of 115 providers) participated in a follow-up interview two years after training and consultation. They reported on barriers to and facilitators in implementation of CBT for youths with anxiety.Results:Qualitative analyses identified numerous barriers and facilitators, including client factors (for example, motivated clients facilitated the use of CBT, whereas clients with complex issues and numerous psychosocial stressors hindered its use), intervention factors (the structure of CBT helped facilitate its use for some providers, whereas others reported feeling constrained by such structure), and organizational factors (for example, the absence of support within one’s institution served as a barrier, whereas supervision supporting the use of CBT facilitated ...
TL;DR: AAT, and perhaps EAP uniquely, may be an effective therapeutic modality for long-term psychiatric patients at risk of violence.
Abstract: Objective:Animal-assisted therapy (AAT), most frequently used with dogs, is being used increasingly as an adjunctive alternative treatment for psychiatric patients. AAT with larger animals, such as horses, may have unique benefits. In this randomized controlled study, equine and canine forms of AAT were compared with standard treatments for hospitalized psychiatric patients to determine AAT effects on violent behavior and related measures.Methods:The study included 90 patients with recent in-hospital violent behavior or highly regressed behavior. Hospitalization at the 500-bed state psychiatric hospital was two months or longer (mean 5.4 years). Participants were randomly selected to receive ten weekly group therapy sessions of standardized equine-assisted psychotherapy (EAP), canine-assisted psychotherapy (CAP), enhanced social skills psychotherapy, or regular hospital care. Participants’ mean age was 44, 37% were female, 76% had diagnoses of schizophrenia or schizoaffective disorder, and 56% had been co...
TL;DR: Findings revealed a notable subgroup with multiple barriers, including financial and stigma-related barriers, which may require additional resources and support to enter treatment.
Abstract: Objective:Low rates of alcohol treatment seeking have been shown to be associated with perceived barriers to treatment, but heterogeneity in patterns of perceived barriers has not been explored. The study analyzed data from a population-based sample of adults with alcohol abuse and dependence in order to describe latent classes of individuals who reported one or more of 15 perceived barriers to seeking alcohol treatment and to identify characteristics associated with class membership.Methods:Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (2001–2002). Analyses were restricted to treatment-naive adults with alcohol abuse or dependence who reported a perceived treatment need (N=1,053). Latent class analysis was performed to identify subgroups with respect to barriers to treatment. Latent class regression identified variables associated with each subgroup.Results:Two subgroups emerged: the low-barriers class (87%), characterized primarily by attitudinal barriers, and the hi...
TL;DR: Effect sizes for attitudinal change were significantly different from zero for education and contact, but the effect size for contact was significantly greater, suggesting future research designs need to include strategies for follow-up assessments.
Abstract: Objectives:A previous analysis showed the positive impact of education and contact with persons with lived experience on public stigma toward mental illness, with contact yielding significantly greater effect sizes than education. This study reported a further analysis of those data that examined effects of education and contact at follow-up.Methods:The literature (before October 2010) was searched and coded for studies that examined strategies for changing public stigma.Results:The search found 72 articles, and 19 contained follow-up data. The effect size for overall impact was significantly different from zero for education, but a similar effect size was not significantly different from zero for contact because a small number of contact-intervention studies included follow-up. Effect sizes for attitudinal change were significantly different from zero for education and contact, but the effect size for contact was significantly greater.Conclusions:Future research designs need to include strategies for fol...
TL;DR: Telepsychiatry delivered in the ED through a centralized coordinated program has great promise for improving linkage with outpatient mental health services while reducing inpatient utilization and hospital costs.
Abstract: Objective:This study estimated the impact of a statewide, centralized telepsychiatry service provided in nonpsychiatric emergency departments (EDs) on use of mental health services.Methods:Individuals treated via telepsychiatry were compared with a matched control group of individuals with mental health diagnoses who were treated in nonparticipating hospitals. Bivariate and two-part and generalized linear regression models were used to assess differences between the two groups in outpatient follow-up, hospital admission following the ED visit, length of hospital stay if admitted, and inpatient and total costs.Results:Between March 2009 and June 2013, there were 9,066 patients with at least one telepsychiatry visit. Of these, 7,261 had index telepsychiatry visits that the authors were able to successfully match. Compared with the matched control group, telepsychiatry recipients were more likely to receive 30-day outpatient follow-up (46% versus 16%, p<.001) and 90-day outpatient follow-up (54% versus 20%, ...
TL;DR: Housing First with intensive support was related to more positive changes among homeless adults with mental illness across five Canadian cities, and those with poor housing or support continued to struggle.
Abstract: Objective:This study compared the life changes of homeless people with mental illness participating in Housing First or treatment as usual and examined factors related to various changes.Methods:Semistructured narrative interviews were conducted with 219 participants in five Canadian cities at baseline; 197 were interviewed again at 18 months after random assignment to Housing First (N=119) or treatment as usual (N=78). Interviews were coded across 13 life domains, and each participant was categorized as reporting positive, mixed-neutral, or negative changes. Housing First and treatment as usual participants were compared with respect to change patterns. Thematic analysis was used to examine factors related to various changes.Results:The percentage of participants in Housing First reporting positive changes was more than double that for participants in treatment as usual, and treatment as usual participants were four times more likely than Housing First participants to report negative changes. Factors rel...
TL;DR: Young adults were much less likely to receive treatment for psychiatric problems than they were as adolescents, and public policy must address gaps in service use during the transition to adulthood.
Abstract: Objective:During the transition to adulthood, youths face challenges that may limit their likelihood of obtaining services for psychiatric problems. The goal of this analysis was to estimate changes in rates of service use and untreated psychiatric disorders during the transition from adolescence to adulthood.Methods:In a prospective, population-based study, participants were assessed up to four times in adolescence (ages 13–16; 3,983 observations of 1,297 participants, 1993–2000) and three times in young adulthood (ages 19, 21, and 24–26; 3,215 observations of 1,273 participants, 1999–2010). Structured diagnostic interviews were used to assess service need (participants meeting DSM-IV diagnostic criteria for a psychiatric disorder) and use of behavioral services in 21 service settings in the past three months.Results:During young adulthood, 28.9% of cases of psychiatric disorders were associated with some treatment, compared with a rate of 50.9% for the same participants during adolescence. This decrease...
TL;DR: Targeting certain groups in specific stages of care, for example, screening of black females or providing any mental health care and adequate care for Latino males, would be more effective than a blanket approach to disparities reduction.
Abstract: Objectives:This study examined the interaction of race-ethnicity and gender in depression screening, receipt of any mental health care, and receipt of adequate care.Methods:Data from electronic health records (2010–2012) of adult primary care patients from a New England urban health care system were used (N=65,079). Multivariate logit regression models were estimated to assess associations between race-ethnicity, gender, and other covariates and depression screening, any depression care among those with a positive screen, and adequate depression care. To measure disparities in utilization, we controlled for need variables but not for non-need variables, including insurance, marital status, and socioeconomic status.Results:Among males and females, blacks and Asians were less likely and Latinos were more likely to be screened for depression compared with whites. Among those with moderate or severe depression, black males and females, Latino males, and Asian males and females were less likely than whites to ...
TL;DR: Findings from a qualitative study of the effects of financial factors on the implementation of EBPs in a large urban publicly funded mental health system are presented.
Abstract: Financing has been hypothesized to be an important driver of the implementation of evidence-based practices (EBPs), yet there has been little systematic investigation of financing as a factor in EBP implementation. This column presents findings from a qualitative study of the effects of financial factors on the implementation of EBPs in a large urban publicly funded mental health system. Interviews with 33 agency leaders and 16 policy makers identified financial distress in community mental health agencies, leading to concerns about complex and expensive implementation of EBPs. Stakeholders agreed that the cost of EBP implementation should be shared between the agencies and the system; however, the stakeholders did not agree on how EBPs should be financed.
TL;DR: Results suggest that short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed, and indicate that cultural adaptations may confer additional treatment benefits.
Abstract: Objective:No randomized controlled trials (RCTs) for adults have compared the effectiveness of a well-specified psychotherapy and a culturally adapted version of the same treatment. This study evaluated the effectiveness of cognitive-behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese-American adults.Methods:This RCT treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Screening of participants began in September 2008, and the last assessment was conducted in March 2011. Participants were stratified by whether they were already taking antidepressants when they first came to the clinic and randomly assigned to 12 sessions of CBT or CA-CBT. The study did not influence regular prescription practices. The primary outcomes were dropout rates and Hamilton Depression Rating Scale scores at baseline, session 4, session 8, and session 12.Results:Participants in CA-CBT demonstrated a greater overall decreas...
TL;DR: School-age children with EBDs received a range of mental health services, but nearly half received neither medication nor psychosocial services.
Abstract: Objective:The authors reported use of mental health services among children in the United States between ages six and 11 who were described by their parents as having emotional or behavioral difficulties (EBDs).Methods:Using data from the 2010–2012 National Health Interview Survey, the authors estimated the national percentage of children ages six to 11 with serious or minor EBDs (N=2,500) who received treatment for their difficulties, including only mental health services other than medication (psychosocial services), only medication, both psychosocial services and medication, and neither type of service. They calculated the percentage of children who received school-based and non–school-based psychosocial services in 2011–2012 and who had unmet need for psychosocial services in 2010–2012.Results:In 2010–2012, 5.8% of U.S. children ages six to 11 had serious EBDs and 17.3% had minor EBDs. Among children with EBDs, 17.8% were receiving both medication and psychosocial services, 28.8% psychosocial services...
TL;DR: Obtaining outpatient appointments with psychiatrists in three cities was difficult, irrespective of payer, suggesting that expanding insurance coverage alone may do little to improve access to psychiatrists-or worse, expansion might further overwhelm the capacity of available services.
Abstract: Objectives:The study examined availability of psychiatrists for outpatient appointments in three U.S. cities.Methods:Posing as patients, investigators called 360 psychiatrists listed in a major insurer’s database in Boston, Houston, and Chicago (N=120 per city) and attempted to make appointments. Callers claimed to have Blue Cross Blue Shield or Medicare or said they would pay out of pocket (N=120 per payer type, divided evenly across cities).Results:In round 1 of calling, investigators were able to reach 119 of the 360 psychiatrists (33%). Of 216 unanswered calls, 36% were returned. After two calling rounds, appointments were made with 93 psychiatrists (26%). Significant differences were noted between cities but not between payer type.Conclusions:Obtaining outpatient appointments with psychiatrists in three cities was difficult, irrespective of payer. Results suggest that expanding insurance coverage alone may do little to improve access to psychiatrists—or worse, expansion might further overwhelm the ca...
TL;DR: It is plausible that limited language proficiency is closely associated with underutilization of psychiatric services, and the lack of prospective interventional data clearly highlights the need for further investigations of the impact of language barriers on access to psychiatric care.
Abstract: Objective:The objective of this study was to synthesize the available evidence regarding the impact of patients’ language proficiency on access to psychiatric care.Methods:A systematic literature search of PubMed, EMBASE, Medline, and PsycINFO was performed to identify studies published between January 1950 and July 2014 that examined the impact of language proficiency on access to and utilization of psychiatric services in the general population or among patients with psychiatric disorders. The keywords were psychiatry, language, utilization, access, and mental health care. Only articles in English were included. Cross-referencing of the identified articles was also performed.Results:Eighteen articles from four countries were identified, including 13 from the United States, two from Australia, two from Canada, and one from the Netherlands. These reports were generally consistent in showing a clear association between insufficient language proficiency and underutilization of psychiatric services; 15 studi...
TL;DR: Use of a patient decision aid was associated with improvements in patient-centered PTSD treatment and was also associated with greater use of evidence-based treatments and improvement of PTSD symptoms.
Abstract: Objective:Patient decision aids have been used in many clinical situations to improve the patient centeredness of care. A patient decision aid for patients with posttraumatic stress disorder (PTSD) has not been developed or tested. The authors evaluated the effects of a patient decision aid on the patient centeredness of PTSD treatment.Methods:The study was a randomized trial of a patient decision aid for PTSD versus treatment as usual (control group). The participants were 132 male and female veterans who presented to a single U.S. Department of Veterans Affairs hospital with a new diagnosis of PTSD. Patient centeredness was assessed by knowledge of PTSD and its treatment, level of decisional uncertainty, and ability to state a preferred treatment option. Secondary outcomes included treatments received and PTSD symptoms in the six months after study entry.Results:Compared with the control group (N=65), participants who reviewed the patient decision aid (N=63) had higher scores for PTSD knowledge (p=.002)...
TL;DR: Empirical support for following the RNR model (developed with general offenders) with this group of offenders shows substantial promise, but there is as yet no direct support for the applicability of the three core RNR principles to treat this population.
Abstract: Objective:National efforts to improve responses to persons with mental illness involved with the criminal justice system have traditionally focused on providing mental health services under court supervision. However, a new policy emphasis has emerged that focuses on providing correctional treatment services consistent with the risk-need-responsivity (RNR) model to reduce recidivism. The objective of this review was to evaluate empirical support for following the RNR model (developed with general offenders) with this group and to pose major questions that the field needs to address.Methods:A comprehensive search using PubMed and PsycINFO yielded 18 studies that addressed the applicability of the RNR model to the target population. The results of these studies were synthesized.Results:There is strong support for using general risk assessment tools to assess this group’s risk of recidivism. Preliminary evidence indicates that cognitive-behavioral programs targeting general risk factors are more effective th...
TL;DR: A systematic review of research investigating the association between continuity of care (CoC) and patient outcomes in mental health care concluded that evidence for an association between CoC and outcomes was inconsistent and limited and provided an update.
Abstract: Objective:Research investigating the association between continuity of care (CoC) and patient outcomes in mental health care is limited. A previous review (1970–2002) concluded that evidence for an association between CoC and outcomes was inconsistent and limited. This systematic review, conducted a decade later, provides an update.Methods:Searches (1950–2014) were conducted on MEDLINE and PsycINFO. Included studies used a clearly identified measure of CoC and examined its relation to an outcome among adults (ages 18–65). Only English-language publications were included.Results:A total of 984 studies were identified that measured CoC. Eighteen met inclusion criteria, and 13 found an association between CoC and an outcome. As found in the previous review, studies reported conflicting results for the most frequently examined outcomes (hospitalization, symptom severity, social functioning, and service satisfaction). Little consistency was found between studies in choice of CoC measures and outcomes. Studies ...
TL;DR: Findings support the feasibility of implementing universal screening for suicide in EDs, assuming adequate resources, but providers should be educated to ask suicidal patients about firearm access.
Abstract: Objective:The study examined changes in self-reported attitudes and practices related to suicide risk assessment among providers at emergency departments (EDs) during a three-phase quasi-experimental trial involving implementation of ED protocols for suicidal patients.Methods:A total of 1,289 of 1,828 (71% response rate) eligible providers at eight EDs completed a voluntary, anonymous survey at baseline, after introduction of universal suicide screening, and after introduction of suicide prevention resources (nurses) and a secondary risk assessment tool (physicians).Results:Among participants, the median age was 40 years old, 64% were female, and there were no demographic differences across study phases; 68% were nurses, and 32% were attending physicians. Between phase 1 and phase 3, increasing proportions of nurses reported screening for suicide (36% and 95%, respectively, p<.001) and increasing proportions of physicians reported further assessment of suicide risk (63% and 80%, respectively, p<.01). Alth...