How Do Patients with Mental Health Diagnoses Use Online Patient Portals? An Observational Analysis from the Veterans Health Administration Abstract Online patient portals may be effective for engaging patients with mental health conditions in their own health care. This retrospective database analysis reports patient portal use among Veterans with mental health diagnoses. Unadjusted and adjusted odds of portal feature use was calculated using logistic regressions. Having experienced military sexual trauma or having an anxiety disorder, post-traumatic stress disorder, or depression were associated with increased odds of portal use; bipolar, substance use, psychotic and adjustment disorders were associated with decreased odds. Future research should examine factors that influence portal use to understand diagnosis-level differences and improve engagement with such tools.

The Potential of Pay-for-Success as a Financing Strategy for Evidence-Based Practices: An Illustration with Multisystemic Therapy Abstract There is a critical need to identify strategies for financing the implementation of evidence-based practices. We illustrate the potential of pay-for-success financing (PFS)—a strategy in which private investors fund implementation and receive a return on investment from a government payer—using multisystemic therapy as an example. We argue that standard multisystemic therapy (for serious juvenile offenders) and several of its adaptations (for other complex behavioral problems in youth) would be good candidates for PFS in the right contexts. Despite some challenges for policymakers and administrators, PFS has significant potential as a financing strategy for evidence-based practices.

Understanding Innovation in Homeless Service Provision: A Study of Frontline Providers’ Values-Readiness for Change Abstract Service innovation for adults experiencing mental illness and homelessness typically involves shifting from treatment-led, staircase models toward recovery-oriented, Housing-First models. Aligning frontline service providers’ values to those embedded within newer models is an important, but under-investigated, influence on the innovation process. To assess values alignment in this context, we conducted semi-structured qualitative interviews with frontline providers in staircase services in Ireland (n = 50). Data showed that, while their values mostly aligned to the treatment-led model, there was meaningful evidence of more recovery-oriented values, too. Strategies to enhance innovation through values-alignment are discussed.

Current Status of Mental Health Services at the Primary Healthcare Level in Northern Nigeria Abstract Mental health services at the primary healthcare level remain critical in most developing countries, especially in resource-poor and crisis-stricken communities. This study explored the erstwhile mental health services, with particular reference to their availability, at the 47 primary healthcare centres in three selected states in northern Nigeria, with a view to drawing for action. Qualitative data were collected from a purposive sample of 13 participants through in-depth interviews. Additional data were also collected from observations during the visits (a checklist based on minimum standards for primary healthcare services) and clinic records at the centres. The data were analysed using content analysis and thematic clustering to indicate the status of the mental health services at the primary healthcare centres. Despite having the mental health units on the service delivery charts of the primary healthcare centres studied, none was providing any formal mental health services. There were only few but uncoordinated services in some centres essentially provided by individual primary healthcare service providers and a non-governmental organization found in one of the 47 primary healthcare centres in one of the three states investigated. In conclusion, mental health services at all primary healthcare centres in all the Local Government Areas in all the states visited are at best scarce, poorly and haphazardly rendered in a few places or completely absent in most centres. There is an urgent need to stimulate the primary healthcare system and other levels of government and their partners, to initiate or activate policies in favour of community-based mental health services to make these important services available at the community (primary healthcare) level for the promotion of mental health and treatment of mental illnesses.

The Perceived Impact of Sequential Intercept Mapping on Communities Collaborating to Address Adults with Mental Illness in the Criminal Justice System Abstract Sequential intercept mapping is an approach to address the overrepresentation of adults with mental illness in the criminal justice system. This approach follows the sequential intercept model, a nationally recognized framework conceptualizing the linear movement of people with mental illness through the criminal justice system. During the sequential intercept mapping process, community stakeholders identify service and policy gaps and opportunities to address the needs of this target population. This qualitative study describes the perceived impact of sequential intercept mapping among community stakeholders. Sequential intercept mapping appears to be well-received, with the potential to improve collaboration and enhance community policy and practices.

Stakeholder Preferences on Transdiagnostic Psychosocial Treatment for Trauma-Exposed Veterans Abstract While modular and transdiagnostic approaches may address implementation challenges, there remains limited investigation into the fit within large healthcare systems. The current study examines qualitative interviews from patients, clinicians and administrative stakeholders in the Veterans Administration about experiences with, and views of, the Unified Protocol (UP; Barlow et al. in The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide, Oxford University Press, New York, 2011) to understand potential for implementation. Qualitative interviews were conducted based on an established implementation framework and speak to implementation of transdiagnostic treatment in veterans, including insight into barriers, facilitators, intervention characteristics, patient characteristics, and system level variables. The UP demonstrated promise for improving efficiency, satisfaction and personalizing mental healthcare.

Multilevel Predictors of Case Managers’ Assessment Administration Behavior in a Precursor to a Measurement Feedback System Abstract This study examines factors associated with administration of a treatment monitoring assessment measure (the Ohio Scales) in the context of a precursor to a measurement feedback system in a youth public mental health setting. 82% of all state case managers (N = 46) completed interviews and administered at least one Ohio Scale over a 12-month period. A multi-level model accounting for variance between both case managers and their administrative offices indicated that case manager characteristics (lower self-reported burnout, more experience) and monthly caseload characteristics (fewer active cases, younger average age of youth, and increased time since initial administration) predicted increased monthly administration proportions.

A Mixed Methods Study of Organizational Readiness for Change and Leadership During a Training Initiative Within Community Mental Health Clinics Abstract This longitudinal mixed-methods study explored variation in organizational readiness for change and leadership behavior across seven organizations during a 12-month training initiative in person-centered care planning. Quantitative data was used to examine trajectories of organizational readiness for change and leadership behavior over time and qualitative data explored provider perspectives on the trajectory of these organizational factors during the 12-month training initiative. Findings indicated that levels of organizational readiness for change and leadership behavior varied across clinics, but most experienced a significant positive change at the mid-point of the training. Organizational readiness for change was positively correlated with leaderships behaviors across time. Provider focus group findings gave insight into their initial resistance to adopting the new practice and their increasing receptivity in the second 6 months due to increased understanding of the practice and leadership endorsement. Increasing provider openness to a new practice prior to training and having a consistently engaged leadership have the potential to improve the efficiency of a training initiative.

Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD Abstract This qualitative study describes how Medicaid policies create challenges for the delivery and receipt of mental health treatment for low-income youth in Georgia. We conducted focus groups with caregivers of Medicaid-enrolled children with ADHD and semi-structured interviews with providers and administrators at four safety net clinics that provided mental health care to these youth. Stakeholders reported that prior authorization policies for psychosocial services, restrictiveness of preferred drug lists, and changes in preferred drug lists in Medicaid plans created barriers to treatment continuity and quality for youth with ADHD and led to more administrative burden for safety-net clinics serving these youth.

Therapist and Youth Predictors of Specific Practices Derived from the Evidence-Base in Community Mental Health Abstract Over the past several years, youth treatment research has moved toward understanding the dissemination and implementation of evidence-based practices (EBPs). As a result, studies have focused on identifying predictors that aid in successful adoption and sustainment of EBPs. Theories of behavior change posit that therapist knowledge and attitudes play a fundamental role in EBP adoption; however, studies have produced mixed findings, which may be an artifact of broad definitions of both EBP knowledge and EBP itself. The current study was an examination of 46 youth community therapists and the extent to which varying types of knowledge and attitudes as well as youth characteristics predicted specific practices derived from the evidence-base. Results suggested that specific EBP knowledge predicted specific practices, highlighting the need for more specificity when examining predictors of EBP use. Therapists’ attitudes, demographic characteristics, and youth characteristics were also significant predictors of EBP use. Future research should consider examining discrete and specific practices to better understand and predict therapists’ future behavior.