Episodi
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Simon Graham, M.B.Ch.B., M.R.C.Psych., and Kathy Curtis (Spring House Psychotherapy and Personality Disorder Service) join Dr. Dixon and Dr. Berezin to discuss the use of a local case management team and a combined day treatment and crisis service for patients with borderline personality disorder in Liverpool, United Kingdom.
Transcript
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Elizabeth Bromley, M.D., Ph.D. (University of California, Los Angeles) joins Dr. Dixon and Dr. Berezin to discuss the use of outpatient conservatorship in the effort to address mental health disability among unsheltered homeless persons in Los Angeles County, California.
00:00 Introduction 03:04 Homelessness in Los Angeles County, California 09:04 The paper and services 11:39 Lanterman-Petris-Short (LPS) conservatorship 13:44 Outpatient conservatorship (OPC) pilot program 15:54 Skepticism 18:48 Beyond conservatorship: other aspects of the program 22:34 Initial evaluation 25:21 Quantitative measures 28:33 CoordinationTranscript
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Episodi mancanti?
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Gregory E. Simon, M.D., M.P.H. (Kaiser Permanente Washington Health Research Institute, Seattle) join Dr. Dixon and Dr. Berezin to discuss the use of machine learning models to analyze electronic health records to predict antidepressant treatment response.
00:00 Introduction
02:31 Focus on practical research
04:55 Population studied
05:57 Predicting outcomes
07:20 Using diagnostic codes, not personalized notes
08:04 What three data items might be more helpful?
08:49 What key indicators are we missing in clinical care?
11:35 A billing tool, not a clinical tool
12:57 Is suicide a predictable event based on electronic health record data?
14:48 âMachine learning and artificial intelligenceâ
16:15 Methods
18:59 Can we do a better job clarifying what we mean by depression?
22:32 How can we use a predictive model in clinical practice?
28:20 Predictive models, probability, the weather, and communicating
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Misty C. Richards, M.D., M.S. (University of California, Los Angeles), and Nicole Kozloff, M.D. (University of Toronto), join Dr. Dixon and Dr. Berezin to discuss the need to remodel our systems and provision of mental health services for children and adolescents.
00:00 Introduction 01:18 Impetus 05:45 What constitutes a mental health crisis? 11:14 âRemodelingâ 16:21 Differences by location 18:28 Remodeling primary care 21:25 Virtual care 27:19 New service models 32:19 Are we moving in the right direction?Transcript
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Andrew D. Carlo, M.D., M.P.H. (Northwestern University Feinberg School of Medicine, Chicago) joins Dr. Dixon and Dr. Berezin to discuss the insurance acceptance rates of psychiatric practitioners compared with other medical disciplines.
00:00 Introduction 01:04 Background and Motivation 02:46 Data Set and Methodology 05:12 Restricted Data Set and Privacy Concerns 06:08 Research Questions and Goals 10:04 Findings: Insurance Acceptance Rates 11:29 Factors Influencing Insurance Acceptance 14:23 Magnitude of the Gap in Insurance Acceptance 15:44 Factors Affecting Insurance Acceptance for Psychiatrists 18:08 Challenges in Enforcing Mental Health Parity 19:27 Market Power of Psychiatrists 22:48 Impact on Other Mental Health Professionals 24:16 Importance and Implications 25:11 Potential Solutions and Policy Changes 29:31 ConclusionTranscript
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Eliza Hallett, M.S., (Oregon Health & Science University, Portland, Oregon) joins Dr. Dixon and Dr. Berezin to discuss the challenges faced by staff and behavioral health service providers, including low wages, traumatic work environments, low wages, and physical and administrative infrastructure.
Workforce crisis in behavioral health care [01:33] How representative of the country is Oregon? [03:45] Who were you talking to? [05:32] A figure on radio [06:30] Generating a theoretical framework from the responses [08:01] Qualitative methods [09:30] The five factors [10:33] Wages [14:05] Infrastructure [14:40] Are these issues unique to behavioral health services? [19:11] Legislative changes in Oregon [21:25] Feeling supported matters [23:39] Did the pandemic exacerbate the problem? [27:04] Take home [29:08]Access the complete Behavioral Health Workforce Report to the Oregon Health Authority and State Legislature here.
Transcript
Figure 1. Factors influencing turnover and attrition in the public behavioral health system workforce in Oregona
a Interviewees identified factors across three levelsâsystem, organizational, and individualâthat contribute to the direct drivers of workforce turnover and attrition.
https://ps.psychiatryonline.org/pb-assets/podcasts/transcripts/PS/PS_Chung_August_2023_transcript.pdf
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Henry Chung, M.D., (Albert Einstein College of Medicine, Bronx, New York City) joins Dr. Dixon and Dr. Berezin to discuss the differences between the collaborative care model and the colocation model, and the impact on Medicaid costs and utilization, for the treatment of patients with depression.
Chung interview [00:58] A bridge between clinical and research work [02:32] The colocation model and the collaborative care model [03:44] What populations are you working with? [07:21] Differences in service utilization and cost [10:25] Methodology [10:47] Concentration on depression instead of other psychiatric disorders [13:59] Findings [15:11] Choosing between models [20:21] Impact of COVID [24:06] Final thoughts [28:21]Transcript
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Joseph Parks, M.D., joins Dr. Dixon and Dr. Berezin to discuss guidelines for clinicians on how to deal with the increased prevalence of drugs adulterated with fentanyl and similar potent fentanyl analogs.
MDI publications can be found here.
Parks interview [00:53] The National Council for Mental Wellbeing [01:21] Guidelines [03:50] Contemplation [05:02] A back-to-basics approach [07:13] Fentanyl test strips and harm reduction [08:37] Spillover [10:06] Issues with fentanyl [12:05] Incremental behavioral changes [13:44] Things people should know about fentanyl [16:29] Training for professionals [18:03] How things are moving [19:55]See the Psychiatric Services Editor's Choice collection, "Responding to the Opioid Crisis."
Transcript
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Eric P. Slade, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss the complex and often confusing world of dual eligibility for Medicare and Medicaid coverage when it comes to mental health services, in particular Dual Eligible Special Needs Plans (D-SNPs), a type of Medicare Advantage plan designed around those eligible for both programs.
Slade interview [00:59] Medicare and Medicaid [02:24] Eligibility for each, and both [06:36] Dual eligibility [08:09] Who pays for care? [09:51] Managed care [11:13] Trade offs between traditional insurance and HMO plans [15:47] Medicare Advantage [18:17] Dual Eligible Special Needs Plans (D-SNPs) [19:06] D-SNPs from the perspective of consumers [21:34] Provider networks [24:50] Findings [27:07] Why do D-SNPs not have larger psychiatrist networks than traditional Medicare? [30:02] Mental health care and insurance coverage [33:47] What should policymakers take from this? [36:37] What should clinicians take from this? [39:56]
Transcript
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Lauren Southwick, M.P.H., and Sharath Guntuku, Ph.D., join Dr. Dixon and Dr. Berezin to discuss whether using a digital dashboard maintained by patients to track social media and other digital data usage had an impact on mental health therapy outcomes.
âą Southwick and Guntuku interview [01:37]
âą What led you to this study design? [03:06]
âą What did you think this would look like in a therapy setting? [08:00]
âą Amount of data patients contributed varied widely [09:39]
âą The dashboard [10:12]
âą What were the effects of sharing digital data with therapists? [12:31]
âą The Hawthorne effect [15:25]
âą Whatâs next for your research? [18:23]
âą Recruitment [20:46]
âą COVID and peopleâs interactions with digital media and mental health [23:29]
âą ChatGPT [26:50]Transcript
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Breanna C. Keepers, M.D., M.B.A., and Ish P. Bhalla, M.D., M.S., join Dr. Dixon and Dr. Berezin to discuss the results of a survey of mental healthcare providers and their usage of measurement-based care. Dr. Keepers is in the Department of Psychiatry at New York-Presbyterian Hospital, and Dr. Bhalla is Medical Director of Behavioral Health Value Transformation at Blue Cross-Blue Shield of North Carolina.
âą Keepers and Bhalla interview [00:50]
âą Incentivizing provider behavior changes [03:01]
âą Measurement instruments [05:30]
âą Measurement-based care from the care recipientâs perspective [06:27]
âą Study design [09:16]
âą Clinical utility and measurement-based care [11:31]
âą Are we using the right measure? [14:45]
âą Heterogeneity in provider perceptions of measurement-based care [16:08]
âą Training providers [17:25]
âą Providing care is hard [19:36]
âą Whatâs next for your research? [22:10]Transcript
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Navdep Kaur, M.P.H., joins Dr. Dixon and Dr. Berezin to discuss persistent racial and ethnic disparities in mental health treatment access and outcomes prior to and following the passage of the 2010 Affordable Care Act. Ms. Kaur is a predoctoral fellow at the Columbia University Mailman School of Public Health in New York.
Kaur interview [01:01] Connecting your work with your passion [03:09] Affordable Care Act and mental health [05:39] What did you look at to study this? [09:11] What are we talking about when we talk about distress? [10:06] How do you define treatment usage? [11:30] What are your hypotheses for why your findings on mental health treatment usage look the way they do? [13:11] Disaggregating data for disparate groups [14:40] Has the amount of treatment change overall differed between subgroups and the whole population? [17:42] How do you categorize the various levels of stigma and attitudes towards treatment? [19:16] Sources of market failure â lack of providers, insurance, access [21:21] What would a data set that could answer your questions look like? [22:22] What are you working on next? [24:34] Has your passion survived contact with sample sizes, measures, and the nitty gritty of data sets? [25:20]Transcript
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Howard H. Goldman, M.D., PH.D. (PS emeritus Editor-in-Chief) and Alison Cuellar, Ph.D., (George Mason University, Fairfax, Virginia) joins current PS Editor-in-Chief Dr. Lisa Dixon to discuss the peer review process from the perspective of both reviewers and editors.
Transcript
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Nathaniel P. Morris, M.D., joins Dr. Dixon and Dr. Berezin to discuss an evidence-based approach to involuntary psychiatric hospitalization. Dr. Morris is an Assistant Professor of Psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco.
How did you get interested in this topic? [00:51] What is involuntary psychiatric hospitalization? [02:28] How does it vary by state and nationally? [04:46] What don't we know about the evidence behind involuntary psychiatric hospitalization? [05:46] What are the challenges of investigating involuntary hospitalization? [07:32] What is meant by âinvoluntaryâ [09:49] Lack of evidence [11:55] How do you approach studying this subject? [14:12] Alternatives to involuntary hospitalization [17:33] Who gets hospitalized? [19:27] Open Forum [21:30] What does public tracking mean? [22:50] How can we manage this if we don't even know anything about the practice across this country? [23:58]Transcript
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Shalini Lal, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss the perspective of patients related to recovery, treatment, and relapse following first-episode psychosis. Dr. Lal is the Canada Research Chair in Innovation and Technology for Youth Mental Health Services and an associate professor at the School of Rehabilitation, University of Montreal, Montreal, Canada.
How did you get interested in this topic? [01:26] What do we mean by the word ârelapseâ? [04:33] Whatâs the perspective of an occupational therapist on first episode psychosis? [06:21] Questions for the focus groups [07:55] Moving beyond the relapse binary [09:10] Categorizing and summarizing [12:44] Four factors [14:20] The complications of technology [15:01] Positives and negatives [17:01] Social environment [19:20] Relationships with healthcare providers [21:43] How did participants understand the meaning of relapse [22:12] The value of qualitative research [25:35] Whatâs next [28:52]Transcript
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Dr. Bonnie Zima, M.D., M.P.H., joins Dr. Dixon and Dr. Berezin to discuss trends in child emergency department discharges, hospitalization, and mental health care utilization before and after statewide school closure orders due to the COVID-19 pandemic. Dr. Zima is a Professor-in-Residence in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles.
How did you get interested in this topic? [01:06] Study design [02:26] The team [03:25] The data set: Pediatric Health Information System (PHIS) [06:51] Whatâs in the data? [08:06] Looking at data from 2019 and 2020 [09:27] Medical data as a baseline [10:10] Changes are relative [12:07] Stratification by psychiatric disorder [12:35] Untangling the effects of the pandemic [15:53] Examining the co-occurrence of medical and mental health disorders [17:13] What are the important take home lessons [19:12] IS there a correlation between the severity of the outbreak and service utilization? [22:36] Whatâs next for this research? [23:23] Research and COVID [26:08]Transcript
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Dr. George Pro, Ph.D., M.P.H., joins Dr. Dixon and Dr. Berezin to discuss the downward trend in the provision of mental health services in Spanish across the US, despite the rapidly increasing Hispanic population. Dr. Pro is an Assistant Professor in the College of Public Health at the University of Arkansas for Medical Sciences.
How did you get involved in this research? [01:04] What are the demographic challenges and what do we know about services provision in this population? [02:20] The level of mental health care service utilization [04:45] Why focus on language access? [05:39] What did you find? [06:48] The National Mental Health Services Survey [08:25] National results [10:24] The importance of data visualization [12:39] Figures and how they convey information [17:02] Ohio and North Dakota: rate of change, not overall population [20:07] What are the limitations to this approach? [21:43] Communicating data to policy makers [23:26] Whatâs next for your research? [24:45]Figures from the article:
Figure 1
Figure 2
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Courtney von Hippel, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss burnout and negative job attitudes, and how lived experience might help provide a buffer in mental health workers. Dr. von Hippel is an Associate Professor of Health and Behavioural Sciences at the University of Queensland in Brisbane, Australia.
How did you get involved in this research? [01:16] A profession with a huge amount of burnout [03:20] What does burnout lead to? [05:45] Private versus public practice [08:07] How does a providerâs lived experience change their experience with the job? [11:03] Who did you look at and what did you ask? [14:57] What did you find? [19:17] Was there anything about your findings that was surprising to you? [20:52] Lived experience versus self-disclosure [22:22] Do different kinds of lived experience translate? [24:03] Next steps for research [25:54]Subscribe to the podcast here.
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Mark Savill, Ph.D., joins Dr. Dixon and Dr. Berezin to discuss using online psychosis screening data to see what can be learned about the population taking the assessment, what can be done to close the gap between screening and treatment, and to reduce the duration of untreated psychosis. Dr. Savill is a professor in the Department of Psychiatry and Behavioral Sciences at University of California, Davis.
Whatâs your background? [01:17] Prodromal Questionnaire Brief (PQ-B) [03:03] Duration of Untreated Psychosis (DUP) [03:40] What does the beginning of treatment mean? [05:22] How can the internet help to decrease the time from symptoms to treatment? [07:20] What are people looking for and what are they finding? [10:05] Mental Health America screening [11:00] Where does the PQ-B fit? What did you investigate? [14:33] Getting people into treatment â from A to B, or from A to L? [18:53] What did you learn? [19:50] The numbers [25:02] Further research [23:24]Subscribe to the podcast here.
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Daniel M. Blonigen, Ph.D. joins Dr. Dixon and Dr. Berezin to discuss implementing moral reconation therapy (MRT) in a noncorrectional setting among justice-involved veterans receiving residential mental health treatment in the U.S. Veterans Health Administration with an aim towards reducing criminal recidivism. Dr. Blonigen is an Associate Director at the Center for Innovation to Implementation, VA Palo Alto Health Care System, in Palo Alto, California.
Blonigen interview [00:55] Veterans Justice programs [02:29] Moral reconation therapy (MRT) [03:18] Treatments for criminal recidivism? [04:24] A group based, cognitive behavioral intervention [05:13] The structure of MRT [06:22] How does MRT avoid implying thereâs one right way to live? [10:10] MRT in a residential mental health setting [12:58] A hybrid trial design [15:47] Bringing together research and implementation [18:38] What did the participants think of MRT? [19:09] Listening to people who didnât engage [20:34] Barriers to MRT implementation [23:23] Does MRT overlap with other treatments in residential settings? [25:30] Whatâs the next step? [27:16]Subscribe to the podcast here.
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