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Journal articles on the topic 'Behavioral Health Clinicians'
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Mercado, Micaela, and Virna Little. "Clinicians’ perceptions of telephone-delivered mental health services." Journal of Mental Health Training, Education and Practice 15, no. 2 (December 26, 2019): 104–13. http://dx.doi.org/10.1108/jmhtep-08-2019-0039.
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Purpose The adoption of telephone-delivered mental health services (TDMHS) for scaling collaborative care or addressing access to mental health services in routine primary care practice is gradual despite the needs of the population. Although there are multi-level factors associated with efficient implementation of collaborative care, there is limited understanding of clinicians’ perceptions, experiences and acceptability providing mental health treatment exclusively over the telephone. The purpose of this paper is to explore behavioral health clinicians’ delivery of mental health services over the telephone within primary care settings. Design/methodology/approach This qualitative study explored behavioral health professionals’ perceptions and experiences providing remote, TDMHS. Convenience sampling was used to recruit 11 clinicians in New York, California and Arizona who provided collaborative care services to patients exclusively over the telephone. Semi-structured interviews were conducted, and analyzed using qualitative content analysis methods. Findings Three main themes and associated subthemes emerged from the analyses. The first theme was participants’ perceptions of TDMHS prior to implementation relating to patient characteristics, patient engagement and comparison to in-person therapy. The second main theme identified was participants’ experiences implementing TDMHS with subthemes relating to benefits, quality of care, gaps in care and concerns implementing TDMHS. The final theme that emerged from the analysis was participants’ perceived acceptability of TDMHS by patients. Research limitations/implications The small sample size limits the generalizability of these findings. Practical implications Mental health services delivered over the telephone are perceived as feasible and acceptable by behavioral health clinicians. Originality/value This study contributes to gaps in research about behavioral health clinicians’ beliefs, uptake and acceptability toward mental health services delivered exclusively over the telephone.
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Hemming, Patrick, Jessica A. Revels, Anh N. Tran, Lawrence H. Greenblatt, and Karen E. Steinhauser. "Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians." International Journal of Psychiatry in Medicine 54, no. 3 (September 30, 2018): 188–202. http://dx.doi.org/10.1177/0091217418802159.
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Objective Behavioral health services frequently delivered by primary care providers include care for mental health and substance abuse disorders and assistance with behavioral risk factor reduction. Internal medicine residencies in the United States lack formal expectations regarding training in behavioral health for residents. This qualitative study aimed to determine learners’ and teachers’ perceptions about appropriate behavioral health curricular components for internal medicine residents. Method Focus groups and interviews were conducted with the following individuals from the Duke Outpatient Clinic: residents with continuity practice (n = 27), advanced practice providers (n = 2), internal medicine attending physicians (n = 4), internal medicine/psychiatry attending physicians (n = 2), and behavioral health clinicians (n = 4). A focus group leader asked regarding residents’ successes and challenges in managing behavioral health issues and about specific learning components considered necessary to understand and manage these behavioral health conditions. Transcripts were coded using an editing analysis style to identify central themes and concordance/discordance between groups. Results Regarding mental health management (Theme 1), residents emphasized a need for better care coordination with specialty mental health, while attendings and behavioral health clinicians gave priority to residents’ skills in primary management of mental health. Residents, attendings, and behavioral health clinicians all emphasized advanced interviewing skills (Theme 2) with subthemes: eliciting the patient’s perspective, managing time in encounters, improving patients’ understanding, and patient counseling. Conclusions Internal medicine residents, attendings, and behavioral health clinicians may differ significantly in their perceptions of primary care’s role in mental health care. Future internal medicine behavioral health curricula should specifically address these attitudinal differences. Curricula should also emphasize interview skills training as an essential component of behavioral health learning.
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Meza, Rosemary D., Nathaniel Jungbluth, Georganna Sedlar, Prerna Martin, Lucy Berliner, Shannon Wiltsey-Stirman, and Shannon Dorsey. "Clinician-Reported Modification to a CBT Approach in Children’s Mental Health." Journal of Emotional and Behavioral Disorders 28, no. 2 (February 13, 2019): 104–13. http://dx.doi.org/10.1177/1063426619828369.
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Examining the nature and determinants of evidence-based treatment (EBT) modification is an important step toward understanding the impact of modifications and informing modification guidelines. We examined the prevalence, types, reasons for, and predictors of clinician-reported modification to cognitive behavioral therapy (CBT) for children and adolescents. Ninety-eight clinicians trained in CBT completed surveys on their intent to modify CBT, perceptions of CBT characteristics, confidence in their ability to appropriately deliver CBT in complex clinical situations, and organizational EBT implementation climate post-training. Post-consultation, clinicians self-reported the types and reasons for modifications they performed. Ninety-three percent of clinicians reported they modified CBT, primarily with fewer than half of their clients. Client needs and clinician preference or style accounted for the highest proportion of modification reasons. The number of reported modifications performed was predicted by clinician confidence in their ability to deliver CBT appropriately ( b = .90, p = .01) and their intent to modify ( b = .55, p = .01).
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Leung, Lucinda B., Karen E. Dyer, Elizabeth M. Yano, Alexander S. Young, Lisa V. Rubenstein, and Alison B. Hamilton. "Collaborative care clinician perceptions of computerized cognitive behavioral therapy for depression in primary care." Translational Behavioral Medicine 10, no. 3 (June 2020): 565–72. http://dx.doi.org/10.1093/tbm/ibz122.
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Abstract In Veterans Health Administration’s (VA) Primary Care–Mental Health Integration (PC-MHI) models, primary care providers, care managers, and mental health clinicians collaboratively provide depression care. Primary care patients, however, still lack timely, sufficient access to psychotherapy treatment. Adapting PC-MHI collaborative care to improve uptake of evidence-based computerized cognitive behavioral therapy (cCBT) may be a potential solution. Understanding primary care-based mental health clinician perspectives is crucial for facilitating adoption of cCBT as part of collaborative depression care. We examined PC-MHI mental health clinicians’ perspectives on adapting collaborative care models to support cCBT for VA primary care patients. We conducted 16 semi-structured interviews with PC-MHI nurse care managers, licensed social workers, psychologists, and psychiatrists in one VA health-care system. Interviews were audio-recorded, transcribed, coded using the constant comparative method, and analyzed for overarching themes. Although cCBT awareness and knowledge were not widespread, participants were highly accepting of enhancing PC-MHI models with cCBT for depression treatment. Participants supported cCBT delivery by a PC-MHI care manager or clinician and saw it as an additional tool to engage patients, particularly younger Veterans, in mental health treatment. They commented that current VA PC-MHI models did not facilitate, and had barriers to, use of online and mobile treatments. If effectively implemented, however, respondents thought it had potential to increase the number of patients they could treat. There is widespread interest in modernizing health systems. VA PC-MHI mental health clinicians appear open to adapting collaborative care to increase uptake of cCBT to improve psychotherapy access.
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Matevia, Marilyn L., Debby Poon, William Goldman, Brian Cuffel, and Joyce McCulloch. "Datapoints: Access to Network Clinicians in a Managed Behavioral Health Organization." Psychiatric Services 52, no. 11 (November 2001): 1428. http://dx.doi.org/10.1176/appi.ps.52.11.1428.
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Christiansen, Bruce, Stevens S. Smith, and Michael C. Fiore. "Measuring Therapeutic Alliance for Tobacco Cessation Counseling for Behavioral Health Clinicians." Journal of Smoking Cessation 2021 (March 12, 2021): 1–5. http://dx.doi.org/10.1155/2021/6671899.
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Introduction. Those coping with significant mental illness smoke at a high prevalence rate. Increasingly, behavioral health clinicians (BHCs) are being asked to provide tobacco-dependence interventions. In this context, it is important to measure their success at doing so. While the Working Alliance Inventory (WAI) is a well-established measurement of the effectiveness of therapeutic alliance, it is not specific to tobacco-dependence interventions. The Working Alliance Inventory for Tobacco (WAIT-3) has been found valid for tobacco cessation counselors (health providers who address tobacco), but its validity has not been established when BHCs address tobacco cessation as part of addressing all other needs of their patients. The purpose of this study was to examine the validity of the WAIT-3 in the context of behavioral health clinicians. Methods. Wisconsin Community Support Programs and Comprehensive Community Services programs distributed an anonymous, brief (14 items) survey to 1,930 of their clients. Measured variables included smoking status, behavioral intentions regarding quitting, and perception of help received from their clinic. Respondents could enter a chance to win a gift card as a thank you. Results. WAIT-3 scores were correlated with quitting-related variables. Compared to those with lower WAIT-3 scores, those with higher scores reported more attempts to quit, were more motivated to quit, were more likely to have a smoking cessation/reduction goal in their general treatment plan, had more conversations about quitting with their BHC, and wanted more help from their BHC to quit. Conclusions. The WAIT-3 may be a valid way to measure the effectiveness of BHCs to address the tobacco use of their patients. Next steps include establishing its predictive validity.
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Williams, Dallas, Jessica Eckstrom, Marc Avery, and Jürgen Unützer. "Perspectives of Behavioral Health Clinicians in a Rural Integrated Primary Care/Mental Health Program." Journal of Rural Health 31, no. 4 (April 8, 2015): 346–53. http://dx.doi.org/10.1111/jrh.12114.
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Bhattacharya, Arpita, Ria Nagar, Jessica Jenness, Sean A. Munson, and Julie A. Kientz. "Designing Asynchronous Remote Support for Behavioral Activation in Teenagers With Depression: Formative Study." JMIR Formative Research 5, no. 7 (July 13, 2021): e20969. http://dx.doi.org/10.2196/20969.
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Background Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based on behavioral activation (BA) help teens understand the relationship between mood and activity, help them practice goal-directed behaviors to improve mood, and may be particularly well-suited to delivery via internet-based platforms. Objective This study aims to understand the needs and challenges that teens and mental health clinicians face in depression management and involve them in the design process of a remote intervention that uses asynchronous remote communities. Our goal is to understand the benefits and challenges of adapting BA to an internet-based platform that supports the asynchronous remote community approach as a delivery tool for teen depression management. Methods We enrolled mental health clinicians (n=10) and teens (n=8) in separate, private, internet-based groups on Slack (Slack Technologies Inc). They participated in 20-minute design activities for 10 weeks and were then invited to interviews about their experiences in the study. Results Both teen and clinician participants wanted internet-based support for BA as a supplement to in-person therapy. Although participants perceived the asynchronous format as conducive to supporting accessible care, teens and clinicians raised concerns about safety, privacy, and the moderating of the internet-based group. Design decisions that address these concerns need to be balanced with the potential benefits of learning coping skills, increasing access to mental health care, and promoting asynchronous human connection to support teens. Conclusions We discuss considerations for balancing tensions in privacy and safety while designing and selecting internet-based platforms to support remote care and integrating evidence-based support when designing digital technologies for the treatment of teens with depression.
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Mautone, Jennifer A., Courtney Benjamin Wolk, Zuleyha Cidav, Molly F. Davis, and Jami F. Young. "Strategic implementation planning for integrated behavioral health services in pediatric primary care." Implementation Research and Practice 2 (January 2021): 263348952098755. http://dx.doi.org/10.1177/2633489520987558.
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Background: Delivering physical and behavioral health services in a single setting is associated with improved quality of care and reduced health care costs. Few health systems implementing integrated care develop conceptual models and targeted measurement strategies a priori with an eye toward adoption, implementation, sustainment, and evaluation. This is a broad challenge in the field, which can make it difficult to disentangle why implementation is or is not successful. Method: This article discusses strategic implementation and evaluation planning for a pediatric integrated care program in a large health system. Our team developed a logic model, which defines resources and community characteristics, program components, evaluation activities, short-term activities, and intermediate and anticipated long-term patient-, clinician-, and practice-related outcomes. The model was designed based on research and stakeholder input to support strategic implementation and evaluation of the program. For each aspect of the logic model, a measurement battery was selected. Initial implementation data and intermediate outcomes from a pilot in five practices in a 30-practice pediatric primary care network are presented to illustrate how the logic model and evaluation plan have been used to guide the iterative process of program development. Results: A total of 4,619 office visits were completed during the 2 years of the pilot. Primary care clinicians were highly satisfied with the integrated primary care program and provided feedback on ways to further improve the program. Members of the primary care team and behavioral health providers rated the program as being relatively well integrated into the practices after the second year of the pilot. Conclusion: This logic model and evaluation plan provide a template for future projects integrating behavioral health services in non-specialty mental health settings, including pediatric primary care, and can be used broadly to provide structure to implementation and evaluation activities and promote replication of effective initiatives. Plain language abstract: Up to 1 in 5 youth have difficulties with mental health; however, the majority of these youth do not receive the care they need. Many youth seek support from their primary care clinicians. Pediatric primary care practices have increasingly integrated behavioral health clinicians into the care team to improve access to services and encourage high-quality team-based care. Definitions of “behavioral health integration” vary across disciplines and organizations, and little is known about how integrated behavioral health care is actually implemented in most pediatric settings. In addition, program evaluation activities have not included a thorough examination of long-term outcomes. This article provides detailed information on the implementation planning and evaluation activities for an integrated behavioral health program in pediatric primary care. This work has been guided by a logic model, an important implementation science tool to guide the development and evaluation of new programs and promote replication. The logic model and measurement plan we developed provides a guide for policy makers, researchers, and clinicians seeking to develop and evaluate similar programs in other systems and community settings. This work will enable greater adoption, implementation, and sustainment of integrated care models and increase access to high-quality care.
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Brown, G. S., Edward R. Jones, Ellen Betts, and Jingyang Wu. "Improving Suicide Risk Assessment in a Managed-Care Environment." Crisis 24, no. 2 (March 2003): 49–55. http://dx.doi.org/10.1027//0227-5910.24.2.49.
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Summary: This article describes the quality improvement intervention of a managed behavioral healthcare company to improve the quality of suicide risk assessments by its panel of providers. At-risk cases are identified by the patient's self-reported high frequency of suicidal ideation on a standardized outcome measure. Clinicians also assess severity of suicidal ideation based on clinical interviews. The clinician's assessment is identified as probably erroneous if the patient report indicates a high frequency of suicidal ideation and the clinicians assessment of suicidal ideation is none. The article describes the methods used to encourage clinicians to utilize information from the patient self-report measure as part of the clinical assessment. Probable suicidal ideation assessment errors were subsequently reduced by 29% over a 1-year period of administration.
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Cho, Insook, and David Bates. "Behavioral Economics Interventions in Clinical Decision Support Systems." Yearbook of Medical Informatics 27, no. 01 (August 2018): 114–21. http://dx.doi.org/10.1055/s-0038-1641221.
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Background: Clinical decision support (CDS) systems can improve safety and facilitate evidence-based practice. However, clinical decisions are often affected by the cognitive biases and heuristics of clinicians, which is increasing the interest in behavioral and cognitive science approaches in the medical field. Objectives: This review aimed to identify decision biases that lead clinicians to exhibit irrational behaviors or responses, and to show how behavioral economics can be applied to interventions in order to promote and reveal the contributions of CDS to improving health care quality. Methods: We performed a systematic review of studies published in 2016 and 2017 and applied a snowball citationsearch method to identify topical publications related to studies forming part of the BEARI (Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections) multisite, cluster-randomized controlled trial performed in the United States. Results: We found that 10 behavioral economics concepts with nine cognitive biases were addressed and investigated for clinician decision-making, and that the following five concepts, which were actively explored, had an impact in CDS applications: social norms, framing effect, status-quo bias, heuristics, and overconfidence bias. Conclusions: Our review revealed that the use of behavioral economics techniques is increasing in areas such as antibiotics prescribing and preventive care, and that additional tests of the concepts and heuristics described would be useful in other areas of CDS. An improved understanding of the benefits and limitations of behavioral economics techniques is also still needed. Future studies should focus on successful design strategies and how to combine them with CDS functions for motivating clinicians.
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Wren, Frances J., Sarah H. Scholle, Jungeun Heo, and Diane M. Comer. "Pediatric Mood and Anxiety Syndromes in Primary Care: Who Gets Identified?" International Journal of Psychiatry in Medicine 33, no. 1 (March 2003): 1–16. http://dx.doi.org/10.2190/ut6d-rdfg-lbt7-g39n.
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Objective: To seek clues to the enhancement of primary care management by (i) Determining how often and in whom primary care clinicians in the United States, Puerto Rico, and Canada identify pediatric mood or anxiety syndromes; (ii) Determining which clinical and demographic features predict higher rates of identification; (iii) Describing assessment methods used. Methods: This report uses the database of the multi-site Child Behavior Study. This cross-sectional study involved 206 primary care practices in the United States, Puerto Rico, and Canada; 395 clinicians and 20,861 primary care attenders aged 4–15 years. Clinicians completed a visit questionnaire addressing presence and type of psychosocial problems and how assessed. Parents completed a questionnaire addressing family demographics, child symptoms (Pediatric Symptom Checklist) and functioning, and child service use. Results: Clinicians identified psychosocial problems on 17.9% of visits, but mood or anxiety syndromes on only 3.3%, most commonly in children judged to have co-morbid behavioral syndromes, of whom the majority (66.7%) already had contact with specialized mental health. Neither parental concerns about mood and anxiety symptoms nor clinician familiarity with the patient were major predictors of identification. When making a diagnosis of a pure internalizing syndrome (i.e., without a co-morbid behavioral syndrome) clinicians rarely used standardized tools or school reports. Conclusions: Neither screening for nor diagnosis of mood and anxiety syndromes is a routine part of primary care of children and adolescents. Efforts to improve care must include practical, validated screening procedures to enhance assessment for mood and anxiety syndromes, particularly among children in whom primary care clinicians identify psychosocial problems.
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Wilk, Joshua E., Richard K. Herrell, Abby L. Carr, Joyce C. West, Joseph Wise, and Charles W. Hoge. "Diagnosis of PTSD by Army Behavioral Health Clinicians: Are Diagnoses Recorded in Electronic Health Records?" Psychiatric Services 67, no. 8 (August 2016): 878–82. http://dx.doi.org/10.1176/appi.ps.201500292.
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Le Foll, B., P. Melihan-Cheinin, G. Rostoker, and G. Lagrue. "Smoking cessation guidelines: evidence-based recommendations of the French Health Products Safety Agency." European Psychiatry 20, no. 5-6 (August 2005): 431–41. http://dx.doi.org/10.1016/j.eurpsy.2004.12.008.
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AbstractTobacco use is the leading preventable cause of death in developed countries. Millions of smokers are willing to stop, but few of them are able to do so. Clinicians should only use approaches that have demonstrated their efficacy in helping patients to stop smoking. This article summarizes the evidence-based major findings and clinical recommendations for the treatment of tobacco dependence of the French Health Products Safety Agency (AFSSAPS). Clinicians should enquire about the smoking status of each patient and provide information about health consequence of smoking and effective treatments available. These treatments include counseling (mainly individual or social support and behavioral and cognitive therapy) and pharmacological treatment with either nicotine replacement therapy (NRT) or bupropion LP. Pharmacological treatments should be used only for proven nicotine dependence, as assessed by the Fagerstrom test for Nicotine Dependence. The choice of pharmacologic treatment depends of the patient's preference and history and of the presence of contra-indications. The clinician should start with a single agent, but these treatments may be used in combination. Smoking behavior is a chronic problem that requires long-term management and follow-up. Access to intensive treatment combining pharmacological treatment and extensive behavioral and cognitive therapy should be available for highly dependent patients.
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Sundram, Frederick, Susan J. Hawken, Karolina Stasiak, Mathijs FG Lucassen, Theresa Fleming, Matthew Shepherd, Andrea Greenwood, Raechel Osborne, and Sally N. Merry. "Tips and Traps: Lessons From Codesigning a Clinician E-Monitoring Tool for Computerized Cognitive Behavioral Therapy." JMIR Mental Health 4, no. 1 (January 11, 2017): e3. http://dx.doi.org/10.2196/mental.5878.
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Background Computerized cognitive behavioral therapy (cCBT) is an acceptable and promising treatment modality for adolescents with mild-to-moderate depression. Many cCBT programs are standalone packages with no way for clinicians to monitor progress or outcomes. We sought to develop an electronic monitoring (e-monitoring) tool in consultation with clinicians and adolescents to allow clinicians to monitor mood, risk, and treatment adherence of adolescents completing a cCBT program called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts). Objective The objectives of our study were as follows: (1) assess clinicians’ and adolescents’ views on using an e-monitoring tool and to use this information to help shape the development of the tool and (2) assess clinician experiences with a fully developed version of the tool that was implemented in their clinical service. Methods A descriptive qualitative study using semistructured focus groups was conducted in New Zealand. In total, 7 focus groups included clinicians (n=50) who worked in primary care, and 3 separate groups included adolescents (n=29). Clinicians were general practitioners (GPs), school guidance counselors, clinical psychologists, youth workers, and nurses. Adolescents were recruited from health services and a high school. Focus groups were run to enable feedback at 3 phases that corresponded to the consultation, development, and postimplementation stages. Thematic analysis was applied to transcribed responses. Results Focus groups during the consultation and development phases revealed the need for a simple e-monitoring registration process with guides for end users. Common concerns were raised in relation to clinical burden, monitoring risk (and effects on the therapeutic relationship), alongside confidentiality or privacy and technical considerations. Adolescents did not want to use their social media login credentials for e-monitoring, as they valued their privacy. However, adolescents did want information on seeking help and personalized monitoring and communication arrangements. Postimplementation, clinicians who had used the tool in practice revealed no adverse impact on the therapeutic relationship, and adolescents were not concerned about being e-monitored. Clinicians did need additional time to monitor adolescents, and the e-monitoring tool was used in a different way than was originally anticipated. Also, it was suggested that the registration process could be further streamlined and integrated with existing clinical data management systems, and the use of clinician alerts could be expanded beyond the scope of simply flagging adolescents of concern. Conclusions An e-monitoring tool was developed in consultation with clinicians and adolescents. However, the study revealed the complexity of implementing the tool in clinical practice. Of salience were privacy, parallel monitoring systems, integration with existing electronic medical record systems, customization of the e-monitor, and preagreed monitoring arrangements between clinicians and adolescents.
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Clarke‐Walper, Kristina, Elizabeth A. Penix, Felicia Trachtenberg, Erica Simon, Julia Coleman, Ashley Magnavita, Kile Ortigo, et al. "Efficacy of a Web‐Based Tool in Reducing Burnout Among Behavioral Health Clinicians: Results From the PTSD Clinicians Exchange." Psychiatric Research and Clinical Practice 2, no. 1 (June 2020): 3–9. http://dx.doi.org/10.1176/appi.prcp.20190004.
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Cochran, Randyl A., Sue S. Feldman, Nataliya V. Ivankova, Allyson G. Hall, and William Opoku-Agyeman. "Intention to Use Behavioral Health Data From a Health Information Exchange: Mixed Methods Study." JMIR Mental Health 8, no. 5 (May 27, 2021): e26746. http://dx.doi.org/10.2196/26746.
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Background Patients with co-occurring behavioral health and chronic medical conditions frequently overuse inpatient hospital services. This pattern of overuse contributes to inefficient health care spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management; however, their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information. Objective This study aims to identify and describe factors influencing the intention to use behavioral health information that is shared through HIEs. Methods We used a mixed methods design consisting of two sequential phases. A validated survey instrument was emailed to clinical and nonclinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision making. Follow-up interviews were conducted with a subsample of participants to elaborate on the survey results. Partial least squares structural equation modeling was used to analyze survey data. Thematic analysis was used to identify themes from the interviews. Results A total of 62 participants completed the survey. In total, 63% (n=39) of the participants were clinicians. Performance expectancy (β=.382; P=.01) and trust (β=.539; P<.001) predicted intention to use behavioral health information shared via HIEs. The interviewees (n=5) expressed that behavioral health information could be useful in clinical decision making. However, privacy and confidentiality concerns discourage sharing this information, which is generally missing from patient records altogether. The interviewees also stated that training for HIE use was not mandatory; the training that was provided did not focus specifically on the exchange of behavioral health information. Conclusions Despite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.
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Khanna, Niharika, Elena Klyushnenkova, Vibha Rao, Neil Siegel, and Sara Wolfe. "Electronic referrals to the tobacco Quitline: implementation strategies in a large health system to optimize delivery of tobacco cessation to patients." Translational Behavioral Medicine 11, no. 5 (January 7, 2021): 1107–14. http://dx.doi.org/10.1093/tbm/ibaa094.
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Abstract Electronic referrals provide an efficient solution for clinicians to connect patients to free tobacco cessation services, such as the tobacco Quitline. However, strategic planning is necessary for the successful adoption of this method across the health care system. The purpose of this study was to develop an implementation strategy for electronic referrals to the tobacco Quitline in a large health system. A clinical decision support tool created a closed-loop e-referral pathway between the electronic health record system and the Quitline. Multilevel strategies were developed to implement the e-referral process across the entire health system, including leadership buy-in, Epic tip sheets, newsletters, training for practice champions and staff, physician educator, patient-focused advertisements, and video clips distribution by the Maryland Department of Health Center for Tobacco Prevention and Control. The implementation of a system-wide e-referral pathway for tobacco cessation involved continuous clinician education and training, systematic quality control, and engaging “champion” clinicians. Postimplementation data analysis revealed that 1,790 e-referrals were received by the Quitline in 2018–2019, of which 18% accepted follow-up services, 18% declined, and 64% were not reached after multiple attempts. Among 322 patients who accepted Quitline services, 55% requested nicotine replacement therapy. Overall, 282 clinicians referred patients, including 107 primary care physicians and 175 specialists; 62 clinicians e-referred 72% patients, thereby emerging as “tobacco champions.” The e-referral process is an efficient method for tobacco users to receive a cessation referral from clinicians. Sustainability can be achieved through leadership buy-in, physician ease of use, patient motivation, information technology supports, and reminders.
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Glueck, Bethany. "Roles, Attitudes, and Training Needs of Behavioral Health Clinicians in Integrated Primary Care." Journal of Mental Health Counseling 37, no. 2 (March 31, 2015): 175–88. http://dx.doi.org/10.17744/mehc.37.2.p84818638n07447r.
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As integrated primary care (IPC) evolves, so does the new role of the behavioral health clinician (BHC). At present, mental health providers from various specialties are working as BHCs and adapting their training and skills to work as part of the medical team. The purpose of this qualitative study is to explore the experiences of BHCs who work in IPC so as to better understand their roles, attitudes, and training needs. The themes that emerged from semi-structured interviews suggest that the roles of a BHC are multifaceted and rooted in a holistic mind-body approach. Participants supported the need for additional training in graduate programs and internships for integrated care. The results informed a conceptual model of BHCs working in IPC.
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Stumbo, Scott P., Bobbi Jo H. Yarborough, Micah T. Yarborough, and Carla A. Green. "Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses." American Journal of Health Promotion 32, no. 8 (April 15, 2018): 1730–39. http://dx.doi.org/10.1177/0890117118763233.
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Purpose: Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Design: Cross-sectional; mixed methods. Setting: An integrated health system and a network of federally qualified health centers and safety net clinics. Participants: Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Measures: Semi-structured interviews and surveys. Analysis: Thematic analysis for qualitative data; frequencies for quantitative data. Results: More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Conclusions: Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician–patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.
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Agarwal, Anish, and Mitesh Patel. "Prescribing Behavior Change: Opportunities and Challenges for Clinicians to Embrace Digital and Mobile Health." JMIR mHealth and uHealth 8, no. 8 (August 4, 2020): e17281. http://dx.doi.org/10.2196/17281.
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Individual behaviors impact physical and mental health. Everyday behaviors such as physical activity, diet, sleep, and tobacco use have been associated with a range of acute and chronic medical conditions. Educating, motivating, and promoting sustained healthy behaviors can be challenging for clinical providers attempting to manage their patients’ health. The ubiquity and integration of mobile and digital health devices (eg, wearable step counters, smartphone-based apps) allow for individuals to generate and record enormous amounts of patient-generated health data. Research studies have begun to reveal how mobile and digital devices offer promise in motivating individual behavior change but they have not had consistent results. In this viewpoint, we discuss the potential synergy of digital health modalities and behavioral strategies as an approach for clinicians to prescribe, motivate, monitor, and sustain healthy behaviors. We discuss the strengths, challenges, and opportunities for the future of promoting health behaviors.
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Puspitasari, Ajeng J., Dagoberto Heredia, Elise Weber, Hannah K. Betcher, Brandon J. Coombes, Ellen M. Brodrick, Susan M. Skinner, et al. "Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation." Journal of Primary Care & Community Health 12 (January 2021): 215013272199688. http://dx.doi.org/10.1177/2150132721996888.
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Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.
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Penix, Elizabeth A., Kristina M. Clarke-Walper, Felicia L. Trachtenberg, Ashley M. Magnavita, Erica Simon, Kile Ortigo, Julia Coleman, et al. "Risk of Secondary Traumatic Stress in Treating Traumatized Military Populations: Results from the PTSD Clinicians Exchange." Military Medicine 185, no. 9-10 (June 26, 2020): e1728-e1735. http://dx.doi.org/10.1093/milmed/usaa078.
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Abstract Introduction This study examined risk factors for secondary traumatic stress (STS) in behavioral health clinicians and whether access to the Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange website mitigated STS risk. Methods A diverse sample of clinicians (N = 605) treating traumatized military populations in Department of Veterans Affairs (VA), Department of Defense, and community practice settings were randomized to a newsletter-only control group or the exchange group. The exchange website included resources for treating PTSD and promoting clinician well-being. Online surveys were administered at 0-, 6-, and 12-months postrandomization. Regression analyses were used to examine the link among risk factors, exchange access, and STS. Results Baseline clinician demographics, experience, total caseload, appeal of evidence-based practices (EBPs), and likelihood of adopting EBPs if required were not linked with STS at the 12-month assessment period. Providing care at the VA, more burnout, less compassion satisfaction, greater trauma caseload, less openness to new EBPs, and greater divergence from EBP procedures were linked with greater STS. Only burnout and divergence were associated with STS after accounting for other significant STS risk factors. Exchange and control group clinicians reported similar STS levels after accounting for burnout and divergence. Conclusions Given that burnout was linked with STS, future intervention may use techniques targeting burnout and STS (eg, emotion regulation strategies). Research exploring the link between divergence from EBPs and STS may inform EBP dissemination efforts and STS interventions. Finally, results highlight the need for research optimizing STS intervention efficacy among clinicians treating military populations.
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Moyers, Theresa B., Jennifer K. Manuel, Paul G. Wilson, Stacey M. L. Hendrickson, Wayne Talcott, and Peter Durand. "A Randomized Trial Investigating Training in Motivational Interviewing for Behavioral Health Providers." Behavioural and Cognitive Psychotherapy 36, no. 2 (November 22, 2007): 149–62. http://dx.doi.org/10.1017/s1352465807004055.
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AbstractEvidence indicates that workshop training, personalized feedback, and individual consultation can increase competence in motivational interviewing (MI) among highly motivated and skilled substance abuse counselors. Little is known, however, about the translational value of these training strategies for counselors with fewer counseling skills and less stated motivation to learn MI. This study presents evidence from a randomized, controlled trial of 129 behavioral health providers assigned to receive workshop training and enrichments to learn MI. A diverse group of Air Force behavioral health providers working in substance abuse treatment programs were trained in MI and subsequently observed in clinical sessions at 4, 8 and 12 months after training. Results indicate that training was effective in increasing the skill level of these clinicians; however, these gains had decreased by the 4-month follow-up point. Training enrichments in the form of personalized feedback and consultation phone calls did not have an expected, additive effect on clinician skill level. The results of this study lend support to the hypothesis that a greater investment of resources and incentives may be necessary to achieve gains in MI skills for counselors with relatively lower baseline skills than those commonly participating in research studies.
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Patel, Minal R., Jennifer Vichich, Ian Lang, Jessica Lin, and Kai Zheng. "Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review." Journal of the American Medical Informatics Association 24, e1 (August 18, 2016): e207-e215. http://dx.doi.org/10.1093/jamia/ocw121.
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Objective: The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill “best” behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. Methods: We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Results: Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. Discussion and Conclusion: We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care.
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Friedberg, Robert D., and Gina M. Brelsford. "Training Methods in Cognitive Behavioral Therapy: Tradition and Invention." Journal of Cognitive Psychotherapy 27, no. 1 (2013): 19–29. http://dx.doi.org/10.1891/0889-8391.27.1.19.
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Cognitive behavioral supervisors influence new generations of clients and clinicians. Accordingly, the task is meaningful, rewarding, challenging, and critically important. This article describes traditional and unconventional approaches to supervising clinicians in cognitive behavioral therapy (CBT). Traditional methods such as the use of the Cognitive Therapy Rating Scale, videotape/audiotape review, live supervision, and cotherapy are reviewed. Further, inventive procedures for teaching supervisees cognitive flexibility, empathy, tolerance for ambiguity, and remaining steadfast when faced with negative emotional arousal are explained. Popular media, improvisation and acting exercises, and working with professional actors as teaching methods are explained.
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Allen, Brian, and Jennifer C. Johnson. "Utilization and Implementation of Trauma-Focused Cognitive–Behavioral Therapy for the Treatment of Maltreated Children." Child Maltreatment 17, no. 1 (August 29, 2011): 80–85. http://dx.doi.org/10.1177/1077559511418220.
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Trauma-Focused Cognitive–Behavioral Therapy (TF-CBT) is one of the most researched and widely disseminated interventions for maltreated children. This study describes the findings of a survey of 132 mental health clinicians in children’s advocacy centers (CACs) across the United States to determine the percentage of clinicians who are trained in and utilize TF-CBT and the frequency with which TF-CBT components are implemented. A total of 103 (78%) of the clinicians reported being trained in and utilizing TF-CBT on a regular basis; however, only 66% of these clinicians (58% of the full sample) reported being likely to use each component. The most preferred components were teaching relaxation skills and providing psychoeducation, whereas teaching caregiver child behavior management skills, developing a trauma narrative, and cognitive restructuring were less preferred. Results are discussed in the context of continued dissemination efforts and implications for improving clinical practice.
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Richardson, Safiya, Katherine L. Dauber-Decker, Thomas McGinn, Douglas P. Barnaby, Adithya Cattamanchi, and Renee Pekmezaris. "Barriers to the Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Qualitative Interview Study." JMIR Human Factors 8, no. 3 (August 4, 2021): e25046. http://dx.doi.org/10.2196/25046.
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Background Clinicians often disregard potentially beneficial clinical decision support (CDS). Objective In this study, we sought to explore the psychological and behavioral barriers to the use of a CDS tool. Methods We conducted a qualitative study involving emergency medicine physicians and physician assistants. A semistructured interview guide was created based on the Capability, Opportunity, and Motivation-Behavior model. Interviews focused on the barriers to the use of a CDS tool built based on Wells’ criteria for pulmonary embolism to assist clinicians in establishing pretest probability of pulmonary embolism before imaging. Results Interviews were conducted with 12 clinicians. Six barriers were identified, including (1) Bayesian reasoning, (2) fear of missing a pulmonary embolism, (3) time pressure or cognitive load, (4) gestalt includes Wells’ criteria, (5) missed risk factors, and (6) social pressure. Conclusions Clinicians highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care.
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Becker-Haimes, Emily M., Melanie R. Klein, Bryce D. McLeod, Sonja K. Schoenwald, Shannon Dorsey, Aaron Hogue, Perrin B. Fugo, Mary L. Phan, Carlin Hoffacker, and Rinad S. Beidas. "The TPOCS-self-reported Therapist Intervention Fidelity for Youth (TPOCS-SeRTIFY): A case study of pragmatic measure development." Implementation Research and Practice 2 (January 2021): 263348952199255. http://dx.doi.org/10.1177/2633489521992553.
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Background: Developing pragmatic assessment tools to measure clinician use of evidence-based practices is critical to advancing implementation of evidence-based practices in mental health. This case study details our community-partnered process of developing the Therapy Process Observation Coding Scale-Self-Reported Therapist Intervention Fidelity for Youth (TPOCS-SeRTIFY), a pragmatic, clinician-report instrument to measure cognitive behavioral therapy (CBT) delivery. Approach: We describe a five-step community-partnered development process. Initial goals were to create a self-report instrument that paralleled an existing direct observation measure of clinician delivery of CBT use to facilitate later assessment of measure performance. Cognitive interviews with community clinicians ( n = 6) and consultation with CBT experts ( n = 6) were used to enhance interpretability and usability as part of an iterative refinement process. The instrument was administered to 247 community clinicians along with an established self-reported measure of clinician delivery of CBT and other treatments to assess preliminary psychometric performance. Preliminary psychometrics were promising. Conclusion: Our community-partnered development process showed promising success and can guide future development of pragmatic implementation measures both to facilitate measurement of ongoing implementation efforts and future research aimed at building learning mental health systems. Plain language summary Developing brief, user-friendly, and accurate tools to measure how therapists deliver cognitive behavioral therapy (CBT) in routine practice is important for advancing the reach of CBT into community settings. To date, developing such “pragmatic” measures has been difficult. There is little known about how researchers can best develop these types of assessment tools so that they (1) are easy for clinicians in practice to use and (2) provide valid and useful information about implementation outcomes. As a result, there are few well-validated measures in existence that measure therapist use of CBT that are feasible for use in community practice. This paper contributes to the literature by describing our community-partnered process for developing a measure of therapist use of CBT (Therapy Process Observation Coding Scale -Self-Reported Therapist Intervention Fidelity for Youth; TPOCS-SeRTIFY). This descriptive case study outlines the community-partnered approach we took to develop this measure. This case study will contribute to future research by serving as a guide to others aiming to develop pragmatic implementation measures. In addition, the TPOCS-SeRTIFY is a pragmatic measure of clinician use of CBT that holds promise for its use by both researchers and clinicians to measure the success of CBT implementation efforts.
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Saritoprak, Seyma N., and Dorothy Yun. "David H. Rosmarin: Spirituality, Religion, Cognitive-Behavioral Therapy: A Guide for Clinicians." Journal of Contemporary Psychotherapy 49, no. 2 (April 23, 2019): 129–30. http://dx.doi.org/10.1007/s10879-019-09429-4.
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Sampson, McClain. "Teaching Note—Meeting the Demand for Behavioral Health Clinicians: Innovative Training Through the GLOBE Project." Journal of Social Work Education 53, no. 4 (May 26, 2017): 744–50. http://dx.doi.org/10.1080/10437797.2017.1287024.
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Martin, Matthew P. "Integrated behavioral health training for primary care clinicians: Five lessons learned from a negative study." Families, Systems, & Health 35, no. 3 (September 2017): 352–59. http://dx.doi.org/10.1037/fsh0000278.
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Strauss, John, Peggy Olbrycht, and Vincent Woo. "Behavioral Health Order Sets in a Hybrid Information Environment." Open Medical Informatics Journal 7, no. 1 (September 3, 2013): 30–33. http://dx.doi.org/10.2174/1874431120130607002.
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Introduction: The Centre for Addiction and Mental Health (CAMH) is a 500 bed freestanding psychiatric hospital in Canada. We are in the process of preparing for an integrated commercial clinical information system, which will have computerized physician order entry (CPOE) functionality. Methods: As a preparation for CPOE, we developed inpatient order sets (OSs). Development teams from individual clinical programs created and sent their OSs to an OS Working Group for initial endorsement, and then to Pharmacy & Therapeutics and Medical Advisory committees subsequent approvals. Results: In twelve months we created and introduced 22 behavioral health OSs across eight clinical programs in our hybrid information system with an excellent adoption rate (>97%) by clinicians. Discussion: The development and implementation temporarily contributed to a multifactorial flow problem in the emergency department (ED), which was addressed by substantially simplifying the General Admission via the ED OS. Also, as the OSs were developed and sent for approval the project identified areas where local clinical practice can improve. Our electronic-paper hybrid set of clinical systems was a major factor impacting the effort.
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Valeras, Aimee Burke, Erin Cobb, Mark Prodger, Erica Hochberg, Lucy Allosso, and Haley VandenHazel. "Addressing adults with adverse childhood experiences requires a team approach." International Journal of Psychiatry in Medicine 54, no. 4-5 (August 22, 2019): 352–60. http://dx.doi.org/10.1177/0091217419860359.
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Objective The primary care office is an ideal setting to identify and address adverse childhood experiences, which is a strong predictor of chronic health outcomes and morbidity. This study sought to understand the experiences of primary care from the perspective of patients who experienced trauma. Method Purposive sampling was used to select eligible and interested participants who identify a high adverse childhood experience score at a residency-based community health center, which offers integrated behavioral health services in primary care. Semistructured in-depth interviews conducted by doctoral-level behavioral health clinicians were audio-recorded, transcribed, and analyzed thematically. Results Subjects ( n = 6) described aspects of medical setting, including removal of clothing or physical touch, that trigger their past trauma, which often resulted in maladaptive stress responses. Subjects also reported sensing when their complexity resulted in negative interpersonal dynamics between team members, and they described fearing abandonment from their team during these heightened stress states. The behavioral health clinician on the health care team served as an advocate, enhanced trust, and allowed for increased continuity and access to care. Conclusions Given the role of adverse childhood experiences in health outcomes and the results of this study, incorporating a trauma-informed approach is essential to treating patients with adverse childhood experiences. We propose that integrating mental health professionals into primary care settings better serves patients with trauma histories.
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Galvin, Hannah K., Carolyn Petersen, Vignesh Subbian, and Anthony Solomonides. "Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System." Applied Clinical Informatics 10, no. 05 (October 2019): 841–48. http://dx.doi.org/10.1055/s-0039-1700536.
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AbstractAuthentic inclusion and engagement of behavioral health patients in their care delivery and in the process of scientific discovery are often challenged in the health care system. Consequently, there is a growing need to engage with and better serve the needs of behavioral health patients, particularly by leveraging health information technologies. In this work, we present rationale and strategies for improving patient engagement in this population in research and clinical care. First, we describe the potential for creating meaningful patient–investigator partnerships in behavioral health research to allow for cocreation of knowledge with patients. Second, in the context of behavioral health services, we explore the utility of sharing clinical notes to promote patients' agency in care delivery. Both lines of inquiry are centered in a Learning Health System model for behavioral health, where patients are agents in enhancing the therapeutic alliance and advancing the process of knowledge generation. Recommendations include genuinely democratizing the health care system and biomedical research enterprise through patient-centered information technologies such as patient portals. In research and technology development, we recommend seeking and tailoring behavioral health patients' involvement to their abilities, promoting patient input in data analysis plans, evaluating research and informatics initiatives for patients and clinicians, and sharing success and research findings with patients. In clinical practice, we recommend encouraging patients to read behavioral health notes on portals, engaging in proactive communication regarding note content, assessing outcomes including stress and anxiety in response to note content, and working with technology providers to support note-sharing governance and deployment.
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Kehoe, William A., and Roger C. Katz. "Health Behaviors and Pharmacotherapy." Annals of Pharmacotherapy 32, no. 10 (October 1998): 1076–86. http://dx.doi.org/10.1345/aph.17418.
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OBJECTIVE: To review factors related to health beliefs and behavior that affect treatment adherence, and to suggest behavioral strategies for improving adherence. DATA SOURCES: We conducted MEDLINE and PSYHLIT (January 1966–October 1997) searches of English-language literature pertaining to behavioral medicine and health behavior as they relate to treatment adherence. Additional articles from these sources and reference texts were identified. DATA EXTRACTION: All articles and chapters identified were considered. The most pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: Health care is moving into an era of disease management, and practitioners will be called upon to help patients change health-related behaviors and to improve adherence to treatment. Fundamental to this new paradigm of practice is an understanding of behavior, its relationship to health, and methods by which it can be altered. Current concepts of health behavior have been heavily influenced by social learning theory, self-efficacy theory, and a biopsychosocial view of health and disease. The intent of this review is to provide clinicians with an overview of factors that affect health-related behaviors, as well as suggestions for helping patients to improve them. As illustrations, behavioral interventions used in patients with asthma are presented. CONCLUSIONS: Adherence to treatment recommendations depends on a complex interplay of many psychological variables. An understanding of these factors, and how behavioral techniques may be used, will help healthcare providers to assist patients in improving adherence.
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Lynch, James H., Peter D. Muench, John C. Okiishi, Gary E. Means, and Sean W. Mulvaney. "Behavioral health clinicians endorse stellate ganglion block as a valuable intervention in the treatment of trauma-related disorders." Journal of Investigative Medicine 69, no. 5 (March 16, 2021): 989–93. http://dx.doi.org/10.1136/jim-2020-001693.
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The stellate ganglion block (SGB) procedure has been used successfully for over 10 years to treat post-traumatic stress symptoms in thousands of US military service members, civilians, and veterans in select hospitals in Europe and North America. Primarily through targeting the autonomic nervous system, the SGB procedure serves as an invaluable adjunct to trauma-focused psychotherapy. Without published best practices for emerging therapies, clinicians are left on their own to determine how best to apply new treatments to their patient populations. The aim of this qualitative research was to compile attitudes and recommendations from therapists with expertise in using SGB for treating symptoms of post-traumatic stress disorder, so that their experiences could be disseminated widely to clinicians without SGB expertise. An 18-item survey was developed and distributed electronically to a group of behavioral health professionals of various specialties between May and June 2020. Of surveyed behavioral health clinicians with personal experience incorporating SGB into their trauma-focused psychotherapy, 95% of respondents would recommend SGB to a colleague as a useful tool for the treatment of trauma-related disorders. SGB was rated at least as useful as the most valuable interventions listed in the American Psychological Association Clinical Practice Guideline for the Treatment of Post-traumatic Stress Disorder with 100% of respondents characterizing SGB as ‘Very Beneficial’ or ‘Somewhat Beneficial’, and 0 respondents characterizing SGB as ‘Not Helpful’ or ‘Harmful’. Given the feedback from this study, behavioral health providers should consider using SGB in conjunction with standard trauma-focused care.
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Leal, Isabel Martinez, Tzu-An Chen, Virmarie Correa-Fernández, Kathy Le, Daniel P. O'Connor, Bryce Kyburz, William T. Wilson, Teresa Williams, and Lorraine R. Reitzel. "Adapting and Evaluating Implementation of a Tobacco-Free Workplace Program in Behavioral Health Centers." American Journal of Health Behavior 44, no. 6 (November 1, 2020): 820–39. http://dx.doi.org/10.5993/ajhb.44.6.7.
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Objectives: State-administered community behavioral health centers (CBHCs) rarely treat tobacco dependence, despite high client tobacco use. Using a mixed-methods approach we examine the adaptation and implementation of an evidence-based tobacco-free workplace (TFW) program in 2 CBHCs (17 individual clinics). Methods: Varied data collection included pre- and post-implementation leader, clinician, and staff surveys; pre-, mid-, and post-implementation staff and client focus groups; and monthly implementation logs. The RE-AIM framework guided translation of behavioral interventions into sustainable practice. Results: Pre- to post-implementation increases were seen in training receipt among clinicians and employees. Both CBHCs adopted a 100% TFW policy, integrated tobacco screenings into routine practice, and delivered evidence-based practices (EBPs). Qualitative methods enlisted key stakeholders contributing towards adapting program strategies to local contexts, addressing barriers, adjusting tobacco screening administration, and understanding reasons for success or failure to implement specific components. Conclusions: Program implementation at both CBHCs increased organizational capacity in the provision of EBPs to treat tobacco dependence through successfully meeting the majority of our RE-AIM targets. Findings contribute to the development of flexible strategies and interventions responsive to variable implementation contexts and barriers; enhancing the effectiveness and sustainability of a TFW program.
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Pravettoni, Gabriella, Bernardo Dell’Osso, Tommaso Bocci, Francesca Cortese, Roberta Ferrucci, Valentina Lampis, Chiara Rosci, and Alberto Priori. "Psychiatric, behavioral, and cognitive disorders in patients with extracranial cancers." CNS Spectrums 23, no. 6 (July 23, 2018): 388–401. http://dx.doi.org/10.1017/s1092852918000883.
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Patients with cancer may report neuropsychiatric abnormalities including cognitive impairment, behavioral disturbances, and psychiatric disorders that potentially worsen their quality of life, reduce their treatment response, and aggravate their overall prognosis. Neuropsychiatric disturbances have a different pathophysiology, including immuno-inflammatory and neuroendocrine mechanisms, as a consequence of oncologic treatments (chemo- and radio-therapy). Among clinicians involved in the management of such patients, psychiatrists need to pay particular attention in recognizing behavioral disturbances that arise in oncologic patients, and determining those that may be effectively treated with psychotropic medications, psychotherapeutic interventions, and an integration of them. Through the contribution of different clinicians actively involved in the management of oncological patients, the present review is ultimately aimed at updating psychiatrists in relation to the pathophysiological mechanisms responsible for the onset of cognitive, affective, and behavioral syndromes in these patients, along with epidemiologic and clinical considerations and therapeutic perspectives.
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Homma, Akira. "Parameters Considered in Multinational Clinical Drug Trials." International Psychogeriatrics 8, S2 (February 1996): 165–67. http://dx.doi.org/10.1017/s1041610297003323.
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Before evaluating behavioral distrubances of dementia (BDD), several factors should be considered. This includes the patient population, the properties of the rating scales to be used, and the assessor. The frequency of behavioral symptoms appears to vary between countries, making comparisons in multinational studies difficult. These variations may be caused by cultural differences, clinicians' attitudes to behavioral symptoms, and interrater variability. The psychometric properties of a rating scale may be affected by differences in clinicians' attitudes in different countries, which may, in turn, alter the frequency of diagnosis of BDD, causing problems in the interpretation of data in multinational studies. Consideration should be given to all these factors before initiating a multinational clinical trial.
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Lecomte, Tania, Crystal Samson, Farooq Naeem, Leslie Schachte, and John Farhall. "Implementing cognitive behavioral therapy for psychosis: An international survey of clinicians’ attitudes and obstacles." Psychiatric Rehabilitation Journal 41, no. 2 (June 2018): 141–48. http://dx.doi.org/10.1037/prj0000292.
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Connors, Elizabeth H., Jason Schiffman, Kathleen Stein, Sarah LeDoux, John Landsverk, and Sharon Hoover. "Factors Associated with Community-Partnered School Behavioral Health Clinicians’ Adoption and Implementation of Evidence-Based Practices." Administration and Policy in Mental Health and Mental Health Services Research 46, no. 1 (September 22, 2018): 91–104. http://dx.doi.org/10.1007/s10488-018-0897-3.
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Noujaim, Deborah, Richard H. Fortinsky, and Lisa C. Barry. "The Relationship Between Emotional Support and Health-Related Self-Efficacy in Older Prisoners." Journal of Aging and Health 31, no. 3 (September 27, 2017): 439–62. http://dx.doi.org/10.1177/0898264317733363.
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Objective: To determine whether emotional support, and proportion of emotional support provided by specific sources (e.g., family, other prisoners, clinicians), is associated with health-related self-efficacy among older prisoners. Method: Cross-sectional study of 140 older prisoners age ≥50 with chronic medical illness who completed face-to-face interviews. Logistic regression, controlling for demographic, incarceration, and clinical/behavioral factors evaluated the association between emotional support, operationalized as a score and as a proportion of total emotional support from specific sources, and health-related self-efficacy. Results: Higher emotional support scores, and greater proportion of support from clinicians, were associated with lower likelihood of poor health-related self-efficacy. Those with >50% of their emotional support coming from other prisoners had higher likelihood of poor self-efficacy. Discussion: Among older prisoners with chronic illness, higher emotional support, particularly from clinicians, is associated with lower likelihood of poor self-efficacy; relying on other prisoners for emotional support is associated with poor health-related self-efficacy.
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Gilmore-Bykovskyi, Andrea L., Laura M. Block, Lily Walljasper, Nikki Hill, Carey Gleason, and Manish N. Shah. "Unstructured clinical documentation reflecting cognitive and behavioral dysfunction: toward an EHR-based phenotype for cognitive impairment." Journal of the American Medical Informatics Association 25, no. 9 (June 27, 2018): 1206–12. http://dx.doi.org/10.1093/jamia/ocy070.
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Abstract Despite increased risk for negative outcomes, cognitive impairment (CI) is greatly under-detected during hospitalization. While automated EHR-based phenotypes have potential to improve recognition of CI, they are hindered by widespread under-diagnosis of underlying etiologies such as dementia—limiting the utility of more precise structured data elements. This study examined unstructured data on symptoms of CI in the acute-care EHRs of hip and stroke fracture patients with dementia from two hospitals. Clinician reviewers identified and classified unstructured EHR data using standardized criteria. Relevant narrative text was descriptively characterized and evaluated for key terminology. Most patient EHRs (90%) had narrative text reflecting cognitive and/or behavioral dysfunction common in CI that were reliably classified (κ 0.82). The majority of statements reflected vague descriptions of cognitive/behavioral dysfunction as opposed to diagnostic terminology. Findings from this preliminary derivation study suggest that clinicians use specific terminology in unstructured EHR fields to describe common symptoms of CI. This terminology can inform the design of EHR-based phenotypes for CI and merits further investigation in more diverse, robustly characterized samples.
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Bowles, K. H., M. C. Adelsberger, J. L. Chittams, C. Liao, and P. S. Sockolow. "Impact of Homecare Electronic Health Record on Timeliness of Clinical Documentation, Reimbursement, and Patient Outcomes." Applied Clinical Informatics 05, no. 02 (2014): 445–62. http://dx.doi.org/10.4338/aci-2013-12-ra-0106.
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SummaryBackground: Homecare is an important and effective way of managing chronic illnesses using skilled nursing care in the home. Unlike hospitals and ambulatory settings, clinicians visit patients at home at different times, independent of each other. Twenty-nine percent of 10,000 homecare agencies in the United States have adopted point-of-care EHRs. Yet, relatively little is known about the growing use of homecare EHRs.Objective: Researchers compared workflow, financial billing, and patient outcomes before and after implementation to evaluate the impact of a homecare point-of-care EHR.Methods: The design was a pre/post observational study embedded in a mixed methods study. The setting was a Philadelphia-based homecare agency with 137 clinicians. Data sources included: (1) clinician EHR documentation completion; (2) EHR usage data; (3) Medicare billing data; (4) an EHR Nurse Satisfaction survey; (5) clinician observations; (6) clinician interviews; and (7) patient outcomes.Results: Clinicians were satisfied with documentation timeliness and team communication. Following EHR implementation, 90% of notes were completed within the 1-day compliance interval (n = 56,702) compared with 30% of notes completed within the 7-day compliance interval in the pre-implementation period (n = 14,563; OR 19, p < .001). Productivity in the number of clinical notes documented post-implementation increased almost 10-fold compared to pre-implementation. Days to Medicare claims fell from 100 days pre-implementation to 30 days post-implementation, while the census rose. EHR implementation impact on patient outcomes was limited to some behavioral outcomes.Discussion: Findings from this homecare EHR study indicated clinician EHR use enabled a sustained increase in productivity of note completion, as well as timeliness of documentation and billing for reimbursement with limited impact on improving patient outcomes. As EHR adoption increases to better meet the needs of the growing population of older people with chronic health conditions, these results can inform homecare EHR development and implementation.Citation: Sockolow PS, Bowles KH, Adelsberger MC, Chittams JL, Liao C. Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes. Appl Clin Inf 2014; 5: 445–462 http://dx.doi.org/10.4338/ACI-2013-12-RA-0106
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Lenhard, Fabian, Kajsa Mitsell, Maral Jolstedt, Sarah Vigerland, Tove Wahlund, Martina Nord, Johan Bjureberg, et al. "The Internet Intervention Patient Adherence Scale for Guided Internet-Delivered Behavioral Interventions: Development and Psychometric Evaluation." Journal of Medical Internet Research 21, no. 10 (October 1, 2019): e13602. http://dx.doi.org/10.2196/13602.
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Background Patient adherence is defined as the extent to which a patient complies with medical or health advice. At present, there is a lack of reliable and valid measures specifically designed to measure adherence to internet-delivered behavioral interventions. Objective The objective of this study was to develop and psychometrically evaluate a novel measure of adherence to guided internet-delivered behavioral interventions. Methods In collaboration with experienced clinicians and researchers in the field, a 5-item, clinician-rated internet intervention Patient Adherence Scale (iiPAS) was developed. The initial scale was tested in a sample of children and adolescents (N=50) participating in internet-delivered cognitive behavioral therapy (ICBT) studies. A revised version of the iiPAS was then administered to a larger sample of children and adolescents (N=148) with various behavioral problems participating in ICBT trials. The scale was evaluated according to a classical test theory framework. Results The iiPAS demonstrated excellent internal consistency. Factor analyses revealed one underlying factor, explaining about 80% of the variance, suggesting that the scale captures a homogeneous adherence construct. The iiPAS was strongly associated with objective measures of patient activity in ICBT (number of logins, number of written characters, and completed modules). Furthermore, mid- and posttreatment ratings of the iiPAS were significantly correlated with treatment outcomes. By contrast, objective measures of patient activity in the Web-based platform did not correlate with treatment outcomes. Conclusions The iiPAS could be a useful tool to measure adherence in a broad range of internet-delivered behavioral interventions.
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Spring, Bonnie, Sherry Pagoto, Peter G. Kaufmann, Evelyn P. Whitlock, Russell E. Glasgow, Timothy W. Smith, Kimberlee J. Trudeau, and Karina W. Davidson. "Invitation to a dialogue between researchers and clinicians about evidence-based behavioral medicine." Annals of Behavioral Medicine 30, no. 2 (October 1, 2005): 125–37. http://dx.doi.org/10.1207/s15324796abm3002_5.
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Reynolds, Julia, Kathleen M. Griffiths, John A. Cunningham, Kylie Bennett, and Anthony Bennett. "Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework." JMIR Mental Health 2, no. 1 (March 23, 2015): e6. http://dx.doi.org/10.2196/mental.4200.
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Background Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care. The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups. Objective The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities. Methods Information about service providers’ use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors’ experience of training primary care service providers. Results Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers Conclusions The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation.
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Waltman, Scott H. "Model-Consistent Cognitive Behavioral Therapy Supervision: A Case Study of a Psychotherapy-Based Approach." Journal of Cognitive Psychotherapy 30, no. 2 (2016): 120–30. http://dx.doi.org/10.1891/0889-8391.30.2.120.
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There is a great need for training in cognitive behavioral therapy (CBT) for community clinicians who work in public mental health systems where resources are low and demands are high. Researchers have found that simply attending intensive CBT workshops will not result in adherent or competent CBT being delivered, rather ongoing CBT supervision/consultation has been found to be associated with the best training outcomes. Psychotherapy-based approaches to supervision have recently received some attention for their value in providing experiential learning. What follows is a case example of a community clinician who had little previous training in CBT and following an intensive training and 16 weeks of CBT supervision had substantial gains in her CBT adherence and competency ratings. Recommendations such as the value of experiential learning are discussed.
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Shinagawa, Shunichiro, Joseree Ann Catindig, Nikolas R. Block, Bruce L. Miller, and Katherine P. Rankin. "When a Little Knowledge Can Be Dangerous: False-Positive Diagnosis of Behavioral Variant Frontotemporal Dementia among Community Clinicians." Dementia and Geriatric Cognitive Disorders 41, no. 1-2 (2016): 99–108. http://dx.doi.org/10.1159/000438454.
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Background: Accurate diagnosis of behavioral variant frontotemporal dementia (bvFTD) is important as patients' behavioral symptoms have profound implications for their families and communities. Since the diagnosis of bvFTD derives from behavioral features, accurate identification of patients can be difficult for non-specialists. Concrete rates of diagnostic accuracy among non-specialists are unavailable. Methods: To examine the accuracy of community clinicians' diagnoses of bvFTD and to identify patient characteristics leading to misdiagnosis, we reviewed the charts and referral letters of 3,578 patients who were seen at our specialized center. Referral diagnosis and reasons, manifesting symptoms, demographic data, Mini-Mental State Examination score, Clinical Dementia Rating score and Neuropsychiatric Inventory score were extracted. Results: 60% of patients assigned a single diagnosis of bvFTD by community clinicians did not have bvFTD according to specialists. Compared to specialist-confirmed bvFTD patients, false bvFTD patients were more likely to be depressed and to be non-Caucasian, showed less euphoria, apathy, disinhibition and abnormal eating behaviors, had milder disease severity and better overall cognition. bvFTD was mentioned by referring clinicians in 86% of specialist-confirmed bvFTD cases, but missed cases were called Alzheimer's, Parkinson's or Huntington's disease, or progressive aphasia. Conclusion: These results revealed a widespread lack of familiarity with core diagnostic symptoms among non-specialists and suggest that community clinicians require specialized diagnostic support before providing a definitive diagnosis of bvFTD.