scholarly journals Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Emma Elizabeth McGinty ◽  
David Thompson ◽  
Karly A. Murphy ◽  
Elizabeth A. Stuart ◽  
Nae-Yuh Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Pilot Study ◽  
Physical Health ◽  
Care Coordination ◽  
Implementation Strategy ◽  
Evidence Based ◽  
Specialty Mental Health ◽  
Physical Health Care ◽  
Cardiovascular Care

Abstract Background People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated “behavioral health home” models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers. Methods This pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers’ self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI. Discussion While we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery. Trial registration ClinicalTrials.gov, NCT04696653. Registered on January 6, 2021

scholarly journals Integrated care to address the physical health needs of people with severe mental illness: a rapid review

2016 ◽  
Vol 4 (13) ◽  
pp. 1-130 ◽  
Author(s):  
Mark Rodgers ◽  
Jane Dalton ◽  
Melissa Harden ◽  
Andrew Street ◽  
Gillian Parker ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Physical Health ◽  
Integrated Care ◽  
Health Needs ◽  
Rapid Review ◽  
Advisory Group ◽  
Service Users ◽  
Physical Health Care ◽  
Facilitators And Barriers

BackgroundPeople with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests that this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors and health system factors.Objective(s)To explore current service provision and map the recent evidence on models of integrated care addressing the physical health needs of people with severe mental illness (SMI) primarily within the mental health service setting. The research was designed as a rapid review of published evidence from 2013–15, including an update of a comprehensive 2013 review, together with further grey literature and insights from an expert advisory group.SynthesisWe conducted a narrative synthesis, using a guiding framework based on nine previously identified factors considered to be facilitators of good integrated care for people with mental health problems, supplemented by additional issues emerging from the evidence. Descriptive data were used to identify existing models, perceived facilitators and barriers to their implementation, and any areas for further research.Findings and discussionThe synthesis incorporated 45 publications describing 36 separate approaches to integrated care, along with further information from the advisory group. Most service models were multicomponent programmes incorporating two or more of the nine factors: (1) information sharing systems; (2) shared protocols; (3) joint funding/commissioning; (4) colocated services; (5) multidisciplinary teams; (6) liaison services; (7) navigators; (8) research; and (9) reduction of stigma. Few of the identified examples were described in detail and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge from the evidence. Efforts to improve the physical health care of people with SMI should empower people (staff and service users) and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication between professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.Limitations and future workThe literature identified in the rapid review was limited in volume and often lacked the depth of description necessary to acquire new insights. All members of our advisory group were based in England, so this report has limited information on the NHS contexts specific to Scotland, Wales and Northern Ireland. A conventional systematic review of this topic would not appear to be appropriate in the immediate future, although a more interpretivist approach to exploring this literature might be feasible. Wherever possible, future evaluations should involve service users and be clear about which outcomes, facilitators and barriers are likely to be context-specific and which might be generalisable.FundingThe research reported here was commissioned and funded by the Health Services and Delivery Research programme as part of a series of evidence syntheses under project number 13/05/11. For more information visitwww.nets.nihr.ac.uk/projects/hsdr/130511.

Providing physical health care for people accessing mental health services: Clinicians’ perceptions of their role

2018 ◽  
Vol 28 (1) ◽  
pp. 256-267 ◽  
Author(s):  
Richard Clancy ◽  
Terry J. Lewin ◽  
Jenny A. Bowman ◽  
Brian J. Kelly ◽  
Antony D. Mullen ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Physical Health ◽  
Physical Health Care

scholarly journals Costs of physical health care for self-injuring patients

1997 ◽  
Vol 21 (9) ◽  
pp. 538-541 ◽  
Author(s):  
Mark Swinton ◽  
Sarah Smith
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Physical Health ◽  
Clinical Problem ◽  
The Body ◽  
Extensive Literature ◽  
Self Injury ◽  
Physical Health Care ◽  
Special Hospitals ◽  
Major Clinical Problem

Self-injury is a major clinical problem on the women's wards at Ashworth Hospital. Ashworth Hospital is one of three special hospitals within England and Wales that provides assessment, treatment and rehabilitation for those legally detained patients under the Mental Health Act (1983) who suffer from a mental disorder and require conditions of special security because of their dangerousness. There is extensive literature on the psychological aspects of serf-injury. However, since patients with self-injury present with damage to the body, it is surprising that there is little information on the physical health care and associated resource costs of this behaviour.

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