Alliances to Disseminate Addiction Prevention and Treatment (ADAPT): Assessing the Exchange of Ideas in Alliances Between Juvenile Justice and Community Mental Health Centers

Background/Hypothesis: In the US, over half of youth involved in the juvenile justice system meet criteria for substance use disorder (SUD). Further, SUD is a consistent predictor of recidivism. Thus, significant improvements are needed to assure that justice-involved youth who meet criteria for SUD are screened and referred to care, especially in rural settings. ADAPT, an ongoing, statewide project, employs a learning health system (LHS) model to implement evidence-based practices (EBPs) to develop and improve alliances between juvenile justice (JJ) and community mental health centers (CMHCs). We assessed collaboration, “alliance,” between these systems. Methods: The LHS alliance was assessed with self-report surveys distributed to personnel at 8 county sites. These included the cultural exchange inventory (CEI) measure to assess the process of exchanges in knowledge (beliefs about the process of implementing EBPs), and outcomes of those exchanges (beliefs about the outcome of interagency collaboration), to assess the alliance between JJ and CMHCs. Results: Pre-implementation surveys indicated a significant difference between CMHC respondents (CEI Output M=3.55, SD=1.53) compared to JJ respondents (M=2.89, SD=1.57) about the outcomes of the exchange of ideas [t(190)=2.13, p=0.03]. Both CMHC (CEI Process M=3.93, SD=1.45) and JJ participants (CEI Process M=3.84, SD=1.96) reported similar beliefs about the process of idea exchange t(119)=0.27, p=0.78). Further, participants from low rurality counties (i.e., more urban) reported less favorably to beliefs about the outcomes of collaboration (CEI Output M=3.16, SD=1.62) compared to medium rurality county participants [M=3.76, SD=1.39; t(120)=2.03, p=0.04]. Thus, we find a difference in perception of collaboration both between systems and between counties of varying rurality. Conclusion/Potential Impact: These findings help capture the current barriers to collaboration that exist between JJ and CMHCs before implementation of the LHS framework. Understanding these barriers between systems is essential to better cultivate interagency alliances to improve care for justice-involved youth with SUDs.

Assessing Causal Pathways and Targets of Implementation Variability for EBP use (Project ACTIVE): a study protocol

Background Advancing causal implementation theory is critical for designing tailored implementation strategies that target specific mechanisms associated with evidence-based practice (EBP) use. This study will test the generalizability of a conceptual model that integrates organizational constructs and behavioral theory to predict clinician use of cognitive-behavioral therapy (CBT) techniques in community mental health centers. CBT is a leading psychosocial EBP for psychiatric disorders that remains underused despite substantial efforts to increase its implementation. Methods We will leverage ongoing CBT implementation efforts in two large public health systems (Philadelphia and Texas) to recruit 300 mental health clinicians and 600 of their clients across 40 organizations. Our primary implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. As CBT comprises discrete components that vary in complexity and acceptability, we will measure clinician use of six discrete components of CBT. After finishing their CBT training, participating clinicians will complete measures of organizational and behavior change constructs delineated in the model. Clinicians also will be observed twice via audio recording delivering CBT with a client. Within 48 h of each observation, theorized moderators of the intention-behavior gap will be collected via survey. A subset of clinicians who report high intentions to use CBT but demonstrate low use will be purposively recruited to complete semi-structured interviews assessing reasons for the intention-behavior gap. Multilevel path analysis will test the extent to which intentions and determinants of intention predict the use of each discrete CBT component. We also will test the extent to which theorized determinants of intention that include psychological, organizational, and contextual factors explain variation in intention and moderate the association between intentions and CBT use. Discussion Project ACTIVE will advance implementation theory, currently in its infancy, by testing the generalizability of a promising causal model of implementation. These results will inform the development of implementation strategies targeting modifiable factors that explain substantial variance in intention and implementation that can be applied broadly across EBPs.

A Study to Assess the Effectiveness of Video Assisted Teaching Program on Knowledge Regarding the Side Effects of Antipsychotics among Primary Care Givers of Clients With Mental Illness in Selected Mental Health Hospital, Chennai

Background: The main aim of this study is to create an awareness regarding the side effects. The primary care givers and the patients should understand that if side effects are there also they do not stop the medicines. The psychotic medicines are very essential for the treatment and it should be effectively managed and given only after the consultation with the physician. So a basic knowledge regarding drugs, side effects and the immediate management of these side effects are essential. Methodology: Present study was conducted on quantitative approach for analyzing knowledge management of the psychotic drugs among the care takers based on the conceptual frame work, Imogene King's Goal attainment theory. The research design selected for the present study was one group pretest and posttest design (01 - X - 02). The sample of the study comprised of 40 primary care givers who are staying with the mentally ill clients in the selected mental health centers. Results and Discussion: Among the total 40 sample of primary care givers out of 14 (35%) in 29-38 years of age and 60% were females. 50% having secondary education. Hindu (65%). 52.5% of people worked in private job. Only 55% informed that their income was higher than 10000, 55% from urban area. While in the post -test, 1(2.5%) of the subject had average knowledge, 19(47.5%) subject had good knowledge and 20(50%) subject had excellent knowledge regarding the side effects of antipsychotics. The comparison between the mean difference in pre-test and post test score was 8.2. The calculated ' value was 13.71, whereas the tabulated’t’ value was 2.02, shows that the calculated ’t’ value was much higher than the tabulated ’t’ value. Conclusion: It shows that the planned teaching was effective in significant improving the knowledge of primary care givers of psychiatric patient regarding side effects of typical antipsychotics, so the null hypothesis H0 is rejected and the research hypothesis H1 is accepted.

Prevalence of Internet Addiction Disorder and Its Correlates Among Clinically Stable Adolescents With Psychiatric Disorders in China During the COVID-19 Outbreak

Background: Since the Coronavirus disease 2019 (COVID-19) pandemic emerged, Internet usage has increased among adolescents. Due to this trend, the prevalence of Internet addiction disorder (IAD) may have increased within this group. This study examined the prevalence of IAD and its correlates among clinically stable adolescents with psychiatric disorders in China during the COVID-19 outbreak.Method: A multi-center, cross-sectional study was carried out between April 29 and June 9, 2020 in three major tertiary mental health centers in China. IAD and depressive symptoms were assessed using the Internet Addiction Test (IAT) and the 9-item Patient Health Questionnaire (PHQ-9), respectively.Results: A total of 1,454 adolescent psychiatric patients were included in final analyses. The prevalence of IAD was 31.2% (95% CI: 28.8–33.6%) during the COVID-19 pandemic. A multiple logistic regression analysis revealed that poor relationships with parents (P < 0.001, OR = 2.34, 95%CI: 1.49–3.68) and elevated total PHQ-9 scores (P < 0.001, OR = 1.19, 95%CI: 1.16–1.21) were significantly associated with higher risk for IAD while longer daily physical exercise durations (P = 0.04, OR = 0.67, 95%CI: 0.46–0.98) and rural residence (P = 0.003, OR = 0.62, 95%CI: 0.46–0.85) were significant correlates of lower risk for IAD.Conclusions: IAD was common among adolescent patients with clinically stable psychiatric disorders during the COVID-19 pandemic; regular physical exercise, healthy relationships with parents and fewer symptoms of depression were associated with lower risk within this population.

Proportion of U.S. Clinics Offering LGBT-Tailored Mental Health Services Decreased Over Time: A Panel Study of the National Mental Health Services Survey

Our objective was to characterize the proportion of U.S. mental health clinics that offered LGBT-tailored mental health services between 2014 and 2018. We used data from the National Mental Health Services Survey (NMHSS) to construct a mixed logistic model of availability of LGBT-tailored mental health services over time, by region (Northeast, South, Midwest and West), and by facility type (Veterans Administration, inpatient/residential, outpatient, community mental health centers and mixed). Our results show that the overall proportion of mental health clinics that offered LGBT-tailored services decreased from 2014 to 2018. Our results also indicate that Veteran Affairs clinics and facilities in the West and Northeast were most likely to offer LGBT-tailored mental health services. Given the temporal, regional, and facility gaps in LGBT-tailored mental health services availability, more effort should be dedicated to addressing this disparity.

Barriers and facilitators to implementing measurement-based care for depression in Shanghai, China: a situational analysis

Background Measurement-based care (MBC) is an evidence-based practice for depression, but its use by clinicians remains low. Enhanced MBC (eMBC), which uses digital technologies, can help to facilitate the use of MBC by clinicians and patients. Understanding factors that act as barriers and drivers to the implementation of MBC and eMBC is important to support the design of implementation strategies, promoting uptake by clinicians and patients. Objective This situational analysis identifies barriers and facilitators to the implementation of standard and eMBC at mental health centers in Shanghai, China. Methods We used mixed methods to develop a comprehensive understanding of the factors influencing MBC and eMBC implementation in Shanghai. This study took place across three mental health centers in Shanghai. We used situational analysis tools to collect contextual information about the three centers, conducted surveys with n = 116 clinicians and n = 301 patients, conducted semi-structured interviews with n = 30 clinicians and six focus groups with a total of n = 19 patients. Surveys were analysed using descriptive statistics, and semi-structured interviews and focus groups were analysed using framework analysis. Results Several potential barriers and facilitators to MBC and eMBC implementation were identified. Infrastructure, cost, attitudes and beliefs, and perceptions about feasibility and efficacy emerged as both challenges and drivers to MBC and eMBC implementation in Shanghai. Conclusions The results of this study will directly inform the design of an implementation strategy for MBC and eMBC in Shanghai, that will be tested via a randomized controlled trial. This study contributes to the emerging body of literature on MBC implementation and, to the best of our knowledge, is the first such study to take place in Asia. This study identifies several factors that are relevant to the equitable delivery of MBC, recognizing the need to explicitly address equity concerns in global mental health implementation research.

EMBED Phase 2 Study Protocol: A Cluster Randomized Controlled Trial of Enhanced versus Standard Measurement-Based Care Implementation for Depression

Background: Measurement-based care (MBC) is an evidence-based practice that incorporates routine outcome assessment using validated rating scales to guide collaborative clinical decision-making. Although MBC results in improved outcomes for patients with major depressive disorder (MDD), there are barriers to its broad implementation in clinical settings. The use of “enhanced” MBC (eMBC), with mobile apps that allow patients to track outcomes and engage in self-management via WeChat, may address some of these barriers. We hypothesize that implementation with eMBC using WeChat will be superior to standard MBC implementation using paper-pencil assessments at the clinic, for both implementation and clinical outcomes. Methods: We present a trial protocol for a 2-arm cluster randomized controlled trial (RCT) with a hybrid implementation-effectiveness design comparing standard MBC implementation versus eMBC implementation with 6-month follow up in 12 mental health centers in Shanghai, China. The eMBC implementation uses a WeChat mini-program that includes outcome tracking using brief questionnaires and self-management lessons supplemented with support by a lay coach via WeChat. Results: A total of 240 physicians and 1200 patients from the 12 mental health centers will be enrolled in the mixed-methods outcome analysis. The primary implementation outcome is implementation reach, defined as the proportion of eligible patients with a PHQ-9 score recorded in the hospital chart at 6 months after MBC implementation. The primary clinical outcome is clinical remission, defined as a PHQ-9 score of 4 or less at the 6-month follow up. Other implementation and clinical outcomes will be examined, including medication adherence, doctor-patient alliance, and a piggy-back cost-benefit economic analysis. Qualitative interviews will be conducted with physicians and patients to produce an interpretive account of the contextual factors which impact eMBC implementation.Conclusions: The results of this hybrid implementation-effectiveness cluster RCT will inform implementation of eMBC with WeChat mobile apps for patients with depression in other clinical settings in China and internationally.

Evaluating the Performance of Community Mental Health Centers in Iran: Strengths and Challenges

Objectives: This study aims to evaluate the performance of Community-based Mental Health Centers (CMHCs) in Iran and identifying the strengths and challenges in the provision of mental health services. Methods: This is a qualitative study, conducted using 36 individual interviews and 13 focus group discussions. Content analysis was performed and data were categorized. The findings were presented in terms of the needs for program implementation, achieving the expected goals and outcomes, and the findings of program evaluation. First, the points related to the provision of infrastructure and setting up the centers were mentioned, and then, the features, strengths and challenges facing the program were discussed. Results: Significant successes were achieved in providing infrastructure and implementing the community-based mental health program. Challenges in the implementation of this program included the barriers to attracting more general physicians and the impact of culture and attitudes in each city on the effectiveness of the program. Conclusion: To improve the performance of CMHCs, more attention should be paid to psychiatry and mental health educational programs in the general medicine curriculum, public education about the mental health and providing solutions for better implementation of the program.

CHANGES IN MENTAL HEALTH AFTER COVID-19 TRANSFER AND HEALTH CARE RESOURCES

The article analyzes the incidence of COVID-19 and complications after the disease, especially in terms of the mental health of the world’s population. The purpose of the study was to analyze changes in the mental health of the population of Ukraine after the transfer of COVID-19 and determine the resources of health professionals in the field of health, summarize the most common complaints that arose during the disease, identify compliance with quarantine measures and duration of treatment as in the hospital and at home, in the systematization of complications after the disorder, the duration of antidepressants and the assessment of respondents’ attitudes towards vaccination against COVID-19. A sociological survey has been conducting of 611 respondents mostly students, and teachers of Vinnytsia National University Pirogov. According to the results of the questionnaire, complaints from the nervous system: fatigue – 85.6%, sleep disorders during the disease were noted – 41.4%, irritability – 38.6%, anxiety disorders – 26.0%, memory impairment – 23,2%, depression – 17.9%, fear – 13.3%, confusion – 11.9%, panic attacks – 10.2%, convulsions – 4.9% and suicidal thoughts in 2.1% (66.6% of men) respondents. In Ukraine, it is necessary to create new conditions for alternative treatment of the mentally ill and the population that has negative consequences in mental health after the transfer of COVID-19 based on primary health care, namely: in psychiatric wards of general hospitals, day hospitals, in crisis centers, mental health centers. It is necessary to create a single electronic medical system for recording appeals from the public (personal data) to improve the health care system, as is done in European countries.