The Discriminating Characteristics of For-Profit versus Not-For-Profit Freestanding Psychiatric Inpatient Facilities

This study examines the characteristics that discriminate between ownership types among private, freestanding psychiatric inpatient facilities in the United States. Use of data from the Inventory of Mental Health Organizations (NIMH, 1983, 1986), revealed that not-for-profits provide more services and serve more of the underinsured, while for-profits serve the better insured, concentrate primarily on inpatient services, and serve more children, adolescents, and substance abusers. A surplus bed capacity among for-profit psychiatric hospitals is presumed to contribute to lower occupancy rates and less turnover in the for-profit sector. Not-for-profit psychiatric facilities are also found to be more involved in professional training and to be more accessible through emergency services. However, the misclassification test in the discriminant procedure reveals that a significant group of not-for-profit facilities looks more like its for-profit counterpart group than like other not-for-profits. Study findings are interpreted both in terms of debates over the tax-exempt status of not-for-profit hospitals and the potential negative services effects of proprietization

Prevalence of Treated Behavioral Disorders among Adult Shelter Users: A Longitudinal Study

Of 27,638 homeless adults admitted to Philadelphia public shelters in the years 1990 through 1992, 20.1% received treatment for a mental health disorder, and 25.3% for a substance use disorder in the years 1985 through 1993. An additional 20.7% were identified as having untreated substance use problems. Overall, a total of 65.5% of adult shelter users were identified as ever having had a mental health or substance use problem, treated or untreated

The Treated Prevalence of Mental Health and Substance Use Disorders among Adults Admitted to the Philadelphia Shelter System: Results from the Integration of Longitudinal Data on Shelter and Mental Health Services Utilization

This paper reports results from a study of the treated prevalence of mental health and substance use disorders among adults admitted to Philadelphia public shelters between 1990 and 1992 (N=28,638). Identifiers and service records from longitudinal databases on shelter and mental health services were merged, finding that 49% of single homeless adults and 33.2% of homeless adults with children had a treatment for a mental health or substance use disorder between 1985 and 1993. The rate of treatment for serious mental illness (SMI) was 10.7% (by most frequently occurring diagnosis). Single women (18.6%) had twice the rate of SMI as single men (9.9%), and single adults (12.1%) had twice the rate of SMI as adults with children (6.2%). The treatment rate of substance use disorders (25.2%) was higher than the rate of mental health disorders (20%), and was twice as high for single adults (28.6%) as for adults with children (14.6%). An additional 20% of adult shelter users were identified through shelter records as having untreated substance use problems. Veterans had comparable rates of disorders as nonveterans. Overall, 65% of adult shelter users were identified as ever having some mental health or substance use problem, treated or untreated. People with SMI were less represented among shelter users on two single day censuses than over three years, suggesting a higher rate of turnover among people with SMI, while people with substance use disorders were overrepresented by a third on the two single day censuses, suggesting a lower rate of turnover among people treated for substance abuse. Of the treated Medicaid population, 6.8% became homeless in the three year study period, representing 7.8% of the treated population with SMI, 9.5% of the treated schizophrenia population, and 20.1% of the population receiving inpatient substance abuse services. Approximately 3,000 people with SMI became homeless in the 3-year study period, with an average of 73 people with SMI entering shelter for the first time each month. An analysis of inpatient usage found that 25.7% of the SMI and 34.2% of the treated substance abuse population were hospitalized within 120 days of their first shelter admission (before or after). Fourteen percent of the SMI were also seen in an emergency room within 120 days of shelter admission (before or after)

Expenditure and Revenue Patterns of State Mental Health Agencies from 1981 to 1987

This paper documents expenditure and revenue patterns of state mental health agencies from 1981 to 1987. Expenditure data show an overall decline of mental health expenditures of 4.9% over this period. States with declining overall expenditures were more likely to make deep cuts in hospital expenditures and little or no increases in community programs, while the few states with increasing expenditures showed substantial increases in community programs and contant funding for hospitals. A relatively more dramatic shift was noted across states of shifting expenditures from inpatient to ambulatory care. Revenue data reveal that federal support for state mental health agencies increased slightly during this period, but solely as a function of the introduction of the Block Grant in 1982. However, once introduced, both the Block Grant and other federal sources show steady losses against inflation. State sources also show a decline of 4% during this period, most of which was felt between 1981 and 1983, after which there has been no further decreases. Interstate variability in percapita spending on mental health is described and found to significant even beyond adjustments for costs of services. Expenditures on mental health also show relatively greater declines compared to overall state budgets and state health and welfare budgets during this period, suggesting an increasingly lower priority for mental health services in the state budget alloction process

PRESSURE BALANCE OF A MULTIPLE-LOOP CHEMICAL REACTOR

For a chemical looping (CL) process it is important to determine the optimum reactor configuration that would offer good pressure balance to ensure smooth transfer of the solids between the reactor loops as well as satisfying the oxygen carrier and heat requirements. A variation of the CL process for production of enriched hydrogen stream is investigated which adopts multiple reactor loops. A pressure balance model is developed and a methodology is proposed to find a feasible reactor configuration at an industrial scale production of hydrogen

Non-Participants in Policy Efforts to Promote Evidence-Based Practices in a Large Behavioral Health System

Background: System-wide training initiatives to support and implement evidence-based practices (EBPs) in behavioral health systems have become increasingly widespread. Understanding more about organizations who do not participate in EBP training initiatives is a critical piece of the dissemination and implementation puzzle if we endeavor to increase access in community settings. Methods: We conducted 30 1-h semi-structured interviews with leaders in non-participating agencies who did not formally participate in system-wide training initiatives to implement EBPs in the City of Philadelphia, with the goal to understand why they did not participate. Results: We found that despite not participating in training initiatives, most agencies were adopting (and self-financing) some EBP implementation. Leadership from agencies that were implementing EBPs reported relying on previously trained staff to implement EBPs and acknowledged a lack of emphasis on fidelity. Most leaders at agencies not adopting EBPs did not have a clear understanding of what EBP is. Those familiar with EBPs in agencies not adopting EBPs reported philosophical objections to EBPs. When asked about quality assurance and treatment selection, leaders reported being guided by system audits. Conclusions: While it is highly encouraging that many agencies are adopting EBPs on their own, significant questions about fidelity and implementation success more broadly remain

Predictors of Community Therapists\u27 Use of Therapy Techniques in a Large Public Mental Health System

Importance Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. Objective To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. Design, Setting, and Participants In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Main Outcomes and Measures Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist–Family Revised. Results Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. Conclusions and Relevance This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique

Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

Raghavan et al. (Implement Sci 3(26):1-9, 2008) proposed that effective implementation of evidence-based practices requires implementation strategies deployed at multiple levels of the "policy ecology," including the organizational, regulatory or purchaser agency, political, and social levels. However, much of implementation research and practice targets providers without accounting for contextual factors that may influence provider behavior. This paper examines Philadelphia's efforts to work toward an evidence-based and recovery-oriented behavioral health system, and uses the policy ecology framework to illustrate how multifaceted, multilevel implementation strategies can facilitate the widespread implementation of evidence-based practices. Ongoing challenges and implications for research and practice are discussed

Exome sequencing reveals predominantly de novo variants in disorders with intellectual disability (ID) in the founder population of Finland

The genetics of autosomal recessive intellectual disability (ARID) has mainly been studied in consanguineous families, however, founder populations may also be of interest to study intellectual disability (ID) and the contribution of ARID. Here, we used a genotype-driven approach to study the genetic landscape of ID in the founder population of Finland. A total of 39 families with syndromic and non-syndromic ID were analyzed using exome sequencing, which revealed a variant in a known ID gene in 27 families. Notably, 75% of these variants in known ID genes were de novo or suspected de novo (64% autosomal dominant; 11% X-linked) and 25% were inherited (14% autosomal recessive; 7% X-linked; and 4% autosomal dominant). A dual molecular diagnosis was suggested in two families (5%). Via additional analysis and molecular testing, we identified three cases with an abnormal molecular karyotype, including chr21q22.12q22.2 uniparental disomy with a mosaic interstitial 2.7 Mb deletion covering DYRK1A and KCNJ6. Overall, a pathogenic or likely pathogenic variant was identified in 64% (25/39) of the families. Last, we report an alternate inheritance model for 3 known ID genes (UBA7, DDX47, DHX58) and discuss potential candidate genes for ID, including SYPL1 and ERGIC3 with homozygous founder variants and de novo variants in POLR2F and DNAH3. In summary, similar to other European populations, de novo variants were the most common variants underlying ID in the studied Finnish population, with limited contribution of ARID to ID etiology, though mainly driven by founder and potential founder variation in the latter case.Peer reviewe