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Last BS, Crable EL, Khazanov GK, Scheinfeld LP, McGinty EE, Purtle J. Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review. Psychiatr Serv 2024:appips20230258. [PMID: 38369883 DOI: 10.1176/appi.ps.20230258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Federal loan repayment programs (LRPs) are one strategy to address the shortage of behavioral health providers. This scoping review aimed to identify and characterize the federal LRPs' impact on the U.S. behavioral health workforce. METHODS A scoping review was conducted in accordance with JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. The authors searched the Ovid MEDLINE, Web of Science, APA PsycInfo, EconLit, PAIS Index, and Embase databases, and gray literature was also reviewed. Two coders screened each article's abstract and full text and extracted study data. Findings were narratively synthesized and conceptually organized. RESULTS The full-text screening identified 17 articles that met eligibility criteria. Of these, eight were peer-reviewed studies, and all but one evaluated the National Health Service Corps (NHSC) LRP. Findings were conceptually organized into five categories: descriptive studies of NHSC behavioral health needs and the NHSC workforce (k=4); providers' perceptions of, and experiences with, the NHSC (k=2); associations between NHSC funding and the number of NHSC behavioral health providers (k=4); NHSC behavioral health workforce productivity and capacity (k=3); and federal LRP recruitment and retention (k=4). CONCLUSIONS The literature on federal LRPs and their impact on the behavioral health workforce is relatively limited. Although federal LRPs are an important and effective tool to address the behavioral health workforce shortage, additional federal policy strategies are needed to attract and retain behavioral health providers and to diversify the behavioral health workforce.
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Affiliation(s)
- Briana S Last
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Erika L Crable
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Gabriela Kattan Khazanov
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Laurel P Scheinfeld
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Emma E McGinty
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Jonathan Purtle
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
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Adams DR. Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic. Community Ment Health J 2024; 60:88-97. [PMID: 37097491 PMCID: PMC10127985 DOI: 10.1007/s10597-023-01127-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.
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Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work and Public Health, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, USA.
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Wislocki K, Jager-Hyman S, Brady M, Weiss M, Schaechter T, Khazanov G, Young S, Becker-Haimes E. Freely Available Training Videos for Suicide Prevention: Scoping Review. JMIR Ment Health 2023; 10:e48404. [PMID: 37921847 PMCID: PMC10656652 DOI: 10.2196/48404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. OBJECTIVE This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. METHODS A scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. RESULTS Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. CONCLUSIONS Results suggested an abundance of videos providing broad informational content (eg, "signs and symptoms of someone at risk for suicide") and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process.
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Affiliation(s)
- Katherine Wislocki
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Michal Weiss
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Temma Schaechter
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Gabriela Khazanov
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Sophia Young
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Emily Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, United States
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Last BS, Johnson C, Dallard N, Fernandez-Marcote S, Zinny A, Jackson K, Cliggitt L, Rudd BN, Mills C, Beidas RS. Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231199467. [PMID: 37790185 PMCID: PMC10496473 DOI: 10.1177/26334895231199467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background: In 2012, Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) developed an initiative to implement an evidence-based treatment for posttraumatic stress disorder (PTSD), trauma-focused cognitive behavioral therapy (TF-CBT), across the city's behavioral health system. This report evaluates the initiative's 10-year implementation and effectiveness outcomes. Method: The Exploration, Preparation, Implementation, and Sustainment framework guided our implementation evaluation. The implementation outcomes include adoption, reach, and sustainment; these were obtained during regular evaluation data collection from publicly funded behavioral health agencies participating in the TF-CBT initiative. We analyze effectiveness outcomes (i.e., changes in PTSD symptoms) from a subset of patients receiving TF-CBT, which were collected in 6-month intervals by our research team between 2013 and 2021. Results: From 2012 to 2021, DBHIDS trained 478 clinicians in TF-CBT across 20 behavioral health agencies. During this time, 23,401 youths were screened for potentially traumatic events and PTSD symptoms, and 7,550 youths received TF-CBT. Through the TF-CBT initiative, the city expanded the network of TF-CBT providers from 3 to 20 agencies. DBHIDS sustained this network by maintaining the participation of 16 behavioral health agencies over the course of a decade. The subset of 202 youths who were evaluated to assess TF-CBT effectiveness was drawn from 94 therapists and 20 agencies across Philadelphia. All participating youths completed a baseline assessment, and 151 (75%) completed at least one follow-up assessment. Linear mixed-effects models accounting for observations nested within participants and nested within clinicians found that treatment significantly reduced PTSD symptoms. Conclusion: Between 2012 and 2021, DBHIDS successfully implemented and sustained TF-CBT across the city's behavioral health system. Adoption, reach, and sustainment of TF-CBT were high. Despite the considerable adverse experiences faced by youths seeking treatment in Philadelphia's behavioral health system, TF-CBT was effective. Future directions to improve TF-CBT implementation in the next iteration of the initiative are described.
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Affiliation(s)
- Briana S. Last
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Natalie Dallard
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Sara Fernandez-Marcote
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Arturo Zinny
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
- Center for Nonviolence and Social Justice, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kamilah Jackson
- Community Behavioral Health, Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
- Talawa International Consultants, Philadelphia, PA, USA
| | - Lauren Cliggitt
- Hall-Mercer Community Mental Health Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N. Rudd
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Chynna Mills
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rinad S. Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Prout JT, Moffa K, Bohnenkamp J, Cunningham DL, Robinson PJ, Hoover SA. Application of a Model of Workforce Resilience to the Education Workforce: Expanding Opportunities for Support. SCHOOL MENTAL HEALTH 2022; 15:1-14. [PMID: 36530447 PMCID: PMC9741756 DOI: 10.1007/s12310-022-09560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
The current study analyzed 502 responses from members of the education workforce on the Resilience at Work (RAW) scale and other measures of health and job satisfaction as part of an initiative offering training and technical assistance to support student and staff well-being. A latent profile analysis using scores on components of the RAW identified three resilience profiles: lower, moderate, and higher capacities for resilience. Profiles were differentiated across components related to resilience capacity including alignment of work and personal values, level of social support, and ability to manage stress. Differences between profiles were observed across days of poor physical health, days of poor mental health, days of activity restriction, general health rating, and domains of burnout, compassion satisfaction, and secondary traumatic stress. These findings reinforce calls to support the education workforce through changes that allow access to meaningful work, an evaluation of demands including workload, relevant training on emotional wellness, positive experiences, connections with others, and stress management.
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Affiliation(s)
- Joanna T. Prout
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, National Center for School Mental Health, University of Maryland School of Medicine, 737 West Lombard Street, 4th Floor, Baltimore, MD 21210 USA
| | - Kathryn Moffa
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital Neighborhood Partnerships, Boston Children’s Hospital, Boston, MA USA
| | - Jill Bohnenkamp
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, National Center for School Mental Health, University of Maryland School of Medicine, 737 West Lombard Street, 4th Floor, Baltimore, MD 21210 USA
| | - Dana L. Cunningham
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, National Center for School Mental Health, University of Maryland School of Medicine, 737 West Lombard Street, 4th Floor, Baltimore, MD 21210 USA
| | - Perrin J. Robinson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, National Center for School Mental Health, University of Maryland School of Medicine, 737 West Lombard Street, 4th Floor, Baltimore, MD 21210 USA
| | - Sharon A. Hoover
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, National Center for School Mental Health, University of Maryland School of Medicine, 737 West Lombard Street, 4th Floor, Baltimore, MD 21210 USA
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Last BS, Schriger SH, Becker-Haimes EM, Fernandez-Marcote S, Dallard N, Jones B, Beidas RS. Economic Precarity, Financial Strain, and Job-Related Stress Among Philadelphia's Public Mental Health Clinicians. Psychiatr Serv 2022; 73:774-786. [PMID: 34839673 DOI: 10.1176/appi.ps.202100276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Efforts to improve mental health treatment delivery come at a time of rising inequality and cuts or insufficient increases to mental health funding. Public mental health clinicians face increased demands, experience economic stress, and treat underresourced patients disproportionately burdened by trauma. The authors sought to understand clinicians' current economic and psychological conditions and the relationship of these conditions to the delivery of an evidence-based intervention (EBI) designed to treat posttraumatic stress disorder among youths. METHODS In July 2020, 49 public mental health clinicians from 16 Philadelphia clinics who were trained in an EBI, trauma-focused cognitive-behavioral therapy (TF-CBT), were surveyed by e-mail. Respondents reported on their economic precarity, financial strain, burnout, secondary traumatic stress (i.e., the stress response associated with caring for people exposed to trauma), and TF-CBT use. Associations between clinicians' job-related stressors and their use of TF-CBT were examined with mixed models. Content coding was used to organize clinicians' open-ended responses to questions regarding financial strain related to the COVID-19 pandemic. RESULTS Clinicians' economic precarity, financial strain, and job-related stress were high; 37% of clinicians were independent contractors, 44% of whom wanted a salaried position. Of 37 clinicians with education debt, 38% reported owing ≥$100,000. In the past year, 29% of clinicians reported lack of personal mental health care because of cost, and 22% met the cutoff for experiencing secondary traumatic stress symptoms. Education debt was negatively associated with use of TF-CBT (p<0.001). CONCLUSIONS The stress of providing care in underresourced clinical settings may interfere with efforts to integrate scientific evidence into mental health care.
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Affiliation(s)
- Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Emily M Becker-Haimes
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Sara Fernandez-Marcote
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Natalie Dallard
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Bryanna Jones
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
| | - Rinad S Beidas
- Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas)
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Maxwell CA, Ehrhart MG, Williams NJ, Moore TM, Kendall PC, Beidas RS. The Organizational Financial Context of Publicly-Funded Mental Health Clinics: Development and Preliminary Psychometric Evaluation of the Agency Financial Status Scales. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:780-792. [PMID: 33740163 DOI: 10.1007/s10488-021-01128-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
Funding is a major barrier to implementation of evidence-based practices (EBPs) in publicly-funded community mental health clinics (CMHCs). Understanding how best to deploy implementation strategies that address this barrier requires greater clarity on the financial context within agencies. We developed the Agency Financial Status Scales (AFSS) to assess employee perceptions of the level of three hypothesized and theoretical funding related constructs in organizations: (a) perceptions of financial health, (b) financial attitudes toward EBPs, and (c) strategic financial climate. This investigation serves as a preliminary evaluation of this measure. Participants were 239 therapists and 40 supervisors from 25 publicly-funded CMHCs providing outpatient mental health services for young people. Confirmatory factor analysis was used to investigate the latent trait structure of the items. Internal consistency, interrater agreement, concordance between therapists and supervisors, and convergent validity were also examined. A two-factor model measuring perceptions of financial health and strategic financial climate best fit the data. For both of these scales, alpha reliability was acceptable and agreement statistics provided moderate support for aggregation at the organizational level. Analyses supported the convergent validity of the scales. The development and preliminary evaluation of the AFSS is an important first step in understanding the financial context of publicly-funded CMHCs. Though findings from this investigation are promising, additional development and testing are needed to develop a more thorough understanding of the constructs and to improve the validity and reliability of this measure.
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Affiliation(s)
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, USA
| | | | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA
| | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA.
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Penn Implementation Science Center At the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
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8
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Williams NJ, Candon M, Stewart RE, Byeon YV, Bewtra M, Buttenheim AM, Zentgraf K, Comeau C, Shoyinka S, Beidas RS. Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment. BMC Psychiatry 2021; 21:74. [PMID: 33541301 PMCID: PMC7863375 DOI: 10.1186/s12888-021-03072-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders' values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify these stakeholders' preferences for implementation strategies and to identify segments of stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling. METHODS A total of 240 clinicians, 74 clinical supervisors, and 29 administrators employed within clinics delivering publicly-funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles. RESULTS On average, stakeholders preferred two strategies significantly more than all others-compensation for use of EBP per session and compensation for preparation time to use the EBP (P < .05); two strategies were preferred significantly less than all others-performance feedback via email and performance feedback via leaderboard (P < .05). However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches and included more administrators; Segment 2 (n = 80, 23%) preferred technology-based strategies and was younger, on average; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness, strongly disliked any type of clinical consultation, and had the lowest participation in local EBP training initiatives; Segment 4 (n = 90, 26%) strongly preferred clinical consultation strategies and included more clinicians in substance use clinics. CONCLUSIONS The presence of four heterogeneous subpopulations within this large group of clinicians, supervisors, and administrators suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible and rigorous method for eliciting stakeholders' implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.
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Affiliation(s)
| | - Molly Candon
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca E Stewart
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Vivian Byeon
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Meenakshi Bewtra
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Zentgraf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carrie Comeau
- Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), Philadelphia, PA, USA
| | - Sonsunmolu Shoyinka
- Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA.
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