Cultural Considerations in Behavioral Health Service Delivery for Social Anxiety

BACKGROUND Electronic health records (EHRs) have been widely proposed as a mechanism for improving health care quality. However, rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents. OBJECTIVE The current study evaluated the usability of an EHR developed to support the implementation of the Wraparound care coordination model for children and youth with complex behavioral health needs, and impact of the EHR on service processes, fidelity, and proximal outcomes. METHODS Thirty-four Wraparound facilitators working in two programs in two states were randomized to either use the new EHR (19/34, 56%) or to continue to implement Wraparound services as usual (SAU) using paper-based documentation (15/34, 44%). Key functions of the EHR included standard fields such as youth and family information, diagnoses, assessment data, and progress notes. In addition, there was the maintenance of a coordinated plan of care, progress measurement on strategies and services, communication among team members, and reporting on services, expenditures, and outcomes. All children and youth referred to services for eight months (N=211) were eligible for the study. After excluding those who were ineligible (69/211, 33%) and who declined to participate (59/211, 28%), a total of 83/211 (39%) children and youth were enrolled in the study with 49/211 (23%) in the EHR condition and 34/211 (16%) in the SAU condition. Facilitators serving these youth and families and their supervisors completed measures of EHR usability and appropriateness, supervision processes and activities, work satisfaction, and use of and attitudes toward standardized assessments. Data from facilitators were collected by web survey and, where necessary, by phone interviews. Parents and caregivers completed measures via phone interviews. Related to fidelity and quality of behavioral health care, including Wraparound team climate, working alliance with providers, fidelity to the Wraparound model, and satisfaction with services. RESULTS EHR-assigned facilitators from both sites demonstrated the robust use of the system. Facilitators in the EHR group reported spending significantly more time reviewing client progress (P=.03) in supervision, and less time overall sending reminders to youth/families (P=.04). A trend toward less time on administrative tasks (P=.098) in supervision was also found. Facilitators in both groups reported significantly increased use of measurement-based care strategies overall, which may reflect cross-group contamination (given that randomization of staff to the EHR occurred within agencies and supervisors supervised both types of staff). Although not significant at P<.05, there was a trend (P=.10) toward caregivers in the EHR group reporting poorer shared agreement on tasks on the measure of working alliance with providers. No other significant between-group differences were found. CONCLUSIONS Results support the proposal that use of EHR systems can promote the use of client progress data and promote efficiency; however, there was little evidence of any impact (positive or negative) on overall service quality, fidelity, or client satisfaction. The field of children’s behavioral health services would benefit from additional research on EHR systems using designs that include larger sample sizes and longer follow-up periods. CLINICALTRIAL ClinicalTrials.gov NCT02421874; https://clinicaltrials.gov/ct2/show/NCT02421874 (Archived by WebCite at http://www.webcitation.org/6yyGPJ3NA)

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Behavioral Health Service Delivery with Pacific Islanders

Handbook of Cultural Factors in Behavioral Health ◽

10.1007/978-3-030-32229-8_11 ◽

2020 ◽

pp. 143-161

Author(s):

Lisa A. Duke ◽

Hikianaliʻa Foster

Keyword(s):

Health Service ◽

Service Delivery ◽

Behavioral Health ◽

Health Service Delivery ◽

Behavioral Health Service ◽

Pacific Islanders

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Bridging the Practices of Yoga Therapy and Behavioral Health Service Delivery for Adolescents

International Journal of Yoga Therapy ◽

10.17761/ijyt.22.1.k14u343483053r49 ◽

2012 ◽

Vol 22 (1) ◽

pp. 59-60 ◽

Cited By ~ 1

Author(s):

Michelle Walsh

Keyword(s):

Public Health ◽

Health Service ◽

Service Delivery ◽

Behavioral Health ◽

Behavioral Therapy ◽

Developmentally Appropriate ◽

Health Service Delivery ◽

Mental Health Disorder ◽

Behavioral Health Service ◽

Yoga Therapy

Historically, substance use and mental health disorder interventions for adolescents were derived from adult models, such as Cognitive Behavioral Therapy and 12-step programs, which are rooted in traditional talk therapy. Young people may struggle to benefit from treatments using these models because they may not be developmentally appropriate. A need exists for developmentally attuned interventions that can engage children and adolescents. This article briefly reviews the process of bridging yoga therapy and behavioral health service delivery for adolescents served by the Massachusetts Department of Public Health (DPH).

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