Access to Conventional Mental Health and Medical Care Among Users of Complementary and Alternative Medicine With Bipolar Disorder

This research examined the role of perceived barriers to treatment as a potential contributor to the increasing use of complementary and alternative medicine (CAM) among mentally ill populations. The study examined a sample of 435 patients receiving care through the Veterans Administration Health System and having a current diagnosis of bipolar disorder (I, II, NOS), cyclothymia, or schizoaffective disorder-bipolar subtype. Access to care and use of any of 14 CAM therapies within the past year were studied. Physical CAM users reported slightly better mental health service access related to getting to mental health services and obtaining emergency mental health services when needed. Effect sizes for these differences were small (r(pb) = 0.09 and 0.13, respectively). Similarly, oral and cognitive CAM users indicated that they were slightly more likely to go without medical services when needed because they were too expensive. These effect sizes were also very small (r(pb) = 0.12 and 0.10, respectively), suggesting no clinical significance. Patients who reported use of oral and/or cognitive CAM therapies were slightly more likely than nonusers to go without medical care because of excessive costs. Patients having non-Veterans Affairs insurance reported no differences in rates of CAM use. Overall, no discernable trends were observed to suggest that CAM use among this sample was associated with service access.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62077/1/Access.pd

Response to the Letter to the Editor, “Depression not related to lower religious involvement in bipolar disorders?”

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79118/1/j.1399-5618.2010.00842.x.pd

Cluster randomized trial comparing standard versus enhanced implementation strategies for improving outreach to persons with SMI: 12-month results

http://deepblue.lib.umich.edu/bitstream/2027.42/134545/1/13012_2015_Article_940.pd

Cluster randomized adaptive implementation trial comparing a standard versus enhanced implementation intervention to improve uptake of an effective re-engagement program for patients with serious mental illness

Abstract Background Persons with serious mental illness (SMI) are disproportionately burdened by premature mortality. This disparity is exacerbated by poor continuity of care with the health system. The Veterans Health Administration (VA) developed Re-Engage, an effective population-based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services. However, such programs often encounter barriers getting implemented into routine care. Adaptive designs are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention. This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a standard implementation strategy (Replicating Effective Programs, or REP) with REP enhanced with External Facilitation (enhanced REP) to promote the uptake of Re-Engage. Methods/Design This study employs a four-phase, two-arm, longitudinal, clustered randomized trial design. VA sites (n = 158) across the United States with a designated Re-Engage provider, at least one Veteran with SMI lost to care, and who received standard REP during a six-month run-in phase. Subsequently, 88 sites with inadequate uptake were stratified at the cluster level by geographic region (n = 4) and VA regional service network (n = 20) and randomized to REP (n = 49) vs. enhanced REP (n = 39) in phase two. The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry. The intervention was at the site and network level and consisted of standard REP versus REP enhanced by external phone facilitation consults. At 12 months, enhanced REP sites returned to standard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three. Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services. Discussion Adaptive implementation designs consisting of a sequence of decision rules that are tailored based on a site’s uptake of an effective program may produce more relevant, rapid, and generalizable results by more quickly validating or rejecting new implementation strategies, thus enhancing the efficiency and sustainability of implementation research and potentially leading to the rollout of more cost-efficient implementation strategies. Trial registration Current Controlled Trials ISRCTN21059161 .http://deepblue.lib.umich.edu/bitstream/2027.42/112609/1/13012_2013_Article_711.pd

Implementing a State‐Adopted High School Health Curriculum: A Case Study

BACKGROUNDThe Michigan Model for Health™ (MMH) is the official health curriculum for the State of Michigan and prevailing policy and practice has encouraged its adoption. Delivering evidence‐based programs such as MMH with fidelity is essential to program effectiveness. Yet, most schools do meet state‐designated fidelity requirements for implementation (delivering 80% or more of the curriculum).METHODSWe collected online survey (N = 20) and in‐person interview (N = 5) data investigating fidelity and factors related to implementation of the MMH curriculum from high school health teachers across high schools in one socioeconomically challenged Michigan county and key stakeholders.RESULTSWe found that 68% of teachers did not meet state‐identified standards of fidelity for curriculum delivery. Our results indicate that factors related to the context and implementation processes (eg, trainings) may be associated with fidelity. Teachers reported barriers to program delivery, including challenges with adapting the curriculum to suit their context, competing priorities, and meeting students’ needs on key issues such as substance use and mental health issues.CONCLUSIONSMultiple factors influence the fidelity of health curriculum delivery in schools serving low‐income students. Investigating these factors guided by implementation science frameworks can inform use of implementation strategies to support and enhance curriculum delivery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155483/1/josh12892_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155483/2/josh12892.pd

Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies

Abstract Background Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide. Methods This study is a secondary analysis of the cluster-randomized Re-Engage implementation trial that assigned 3075 patients at 89 VA facilities to either the Immediate or Delayed Enhanced REP sequences. We hypothesized that sites with stronger entrepreneurial culture, task, or relational climate would benefit more from Enhanced REP than Standard REP. Veteran- and site-level data from the Re-Engage trial were combined with site-aggregated measures of entrepreneurial culture and task and relational climate from the 2012 VA All Employee Survey. Longitudinal mixed-effects logistic models examined whether the comparative effectiveness of the Immediate vs. Delayed Enhanced REP sequences were moderated by culture or climate measures at 6 and 12 months post-randomization. Three Veteran-level outcomes related to the engagement with the VA system were assessed: updated documentation, attempted contact by coordinator, and completed contact. Results For updated documentation and attempted contact, Veterans at sites with higher entrepreneurial culture and task climate scores benefitted more from Enhanced REP compared to Standard REP than Veterans at sites with lower scores. Few culture or climate moderation effects were detected for the comparative effectiveness of the full sequences of implementation strategies. Conclusions Implementation strategy effectiveness is highly intertwined with contextual factors, and implementation practitioners may use knowledge of contextual moderation to tailor strategy deployment. We found that facilitation strategies provided with Enhanced REP were more effective at improving uptake of a mental health outreach program at sites with stronger entrepreneurial culture and task climate; Veterans at sites with lower levels of these measures saw more similar improvement under Standard and Enhanced REP. Within resource-constrained systems, practitioners may choose to target more intensive implementation strategies to sites that will most benefit from them. Trial registration ISRCTN: ISRCTN21059161 . Date registered: April 11, 2013.https://deepblue.lib.umich.edu/bitstream/2027.42/144775/1/13012_2018_Article_787.pd

Mental Health Collaborative Care and its Role in Primary Care Settings

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims under healthcare reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.Psycholog

Service delivery in older patients with bipolar disorder: a review and development of a medical care model

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72872/1/j.1399-5618.2008.00602.x.pd

A brief measure of perceived clinician support by patients with bipolar spectrum disorders

The quality of the patient-provider relationship is regarded as an essential ingredient in the treatment of serious mental illnesses, and is associated with favorable outcomes including improved treatment adherence. However, monitoring the strength and influence of provider support in clinical settings is challenged by the absence of brief, psychometrically sound, and easily administered assessments. The purpose of this study was to test the factor structure and examine the clinical and psychosocial correlates of a brief measure of provider support. Participants were recruited from the continuous improvement for veterans in care-Mood Disorders study (N = 429). The hypothesized factor structure exhibited a good fit with the data. At baseline, provider support was associated with higher levels of service access and medication compliance and lower levels of alcohol use and suicidality. Regular monitoring of provider support may provide useful when tailoring psychosocial treatment strategies, especially in routine care settings.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78161/1/briefmeasure.pd