Caroline Bonham

Understanding the goals of service learning and community-based medical education: a systematic review.

Purpose To understand the educational goals of projects described as “service learning” or “community-based medical education” and to learn how relationships between medical schools and community members are discussed in these projects. Method In 2008, the authors performed a systematic qualitative content analysis of 57 articles, published since 1990, that addressed community placements for U.S. medical students. After the initial analysis, the academic-based authors conveyed their findings to their community partner and coauthor, received input on relevance and priority of themes, and then refined their analysis accordingly. Results The authors identified five main findings: (1) Considerable heterogeneity existed across projects, (2) although medical schools aimed to improve the health of the community, they did not routinely involve community members in the identification of local health priorities, (3) educators were enthusiastic about community-based education as a method for teaching complicated ideas such as social determinants of health, (4) many authors emphasized community placements as being equivalent to traditional curricula, and (5) the articles did not emphasize the concept of reciprocal knowledge transfer. Conclusions The authors found little emphasis on the reciprocal nature of partnerships between communities and medical schools. They propose that the principle of community partnership within medical education could train a cohort of medical students prepared to practice in the rapidly changing health care environment—one that now includes an important new agenda of community accountability.

Perspectives on trauma-informed care from mothers with a history of childhood maltreatment: A qualitative study

Women who experienced abuse or neglect as children are more likely to have health problems during pregnancy and postpartum, but can be reluctant to seek help due to a lack of trauma-informed services. As part of a larger mixed method study, this component aimed to obtain qualitative data from trauma-exposed new mothers about their health care preferences during the perinatal period with the ultimate goal to design personalized, supportive interventions. Fifty-two trauma-exposed mothers completed a semi-structured interview at seven months postpartum about health care preferences including ideas for programs that promote wellness, thoughts about the influences of being a new mother and possible names for a program serving trauma-exposed mothers. Interviews were transcribed and coded using N-Vivo. Participants described ambivalence about seeking help but also a sincere desire for healing, coupled with hope for the future. This tension was apparent in the discussions highlighting the importance of access to experienced, nonjudgmental, and knowledgeable health and social care staff and volunteers, the wish for both formal, integrated physical and mental health services, and for informal opportunities to meet other trauma-exposed mothers in a non-stigmatizing, child-friendly setting. Finally, positive relationship-building, respect, and safety were identified as key elements of services critical to counteract trauma-related shame and mistrust in others. Services for trauma-exposed mothers should acknowledge the normal ambivalence surrounding seeking help, but promote hope-affirming practices in a family-centered, safe, non-clinical setting that involves children, builds social support, and provides peer interaction. Program names should reflect optimism and healing rather than trauma.

Organizational Factors Influencing Implementation of Evidence-Based Practices for Integrated Treatment in Behavioral Health Agencies

Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities.

A cost comparison of travel models and behavioural telemedicine for rural, Native American populations in New Mexico.

Objective The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care. Methods Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies. Results The average per-patient cost of providing behavioural healthcare via telehealth was US

Telemental Health in Primary Care

138.34, and the average per-patient travel cost was US

Disability and comorbidity: diagnoses and symptoms associated with disability in a clinical population with panic disorder.

169.76 for physicians and US

State Legislative Approach to Enumerating Behavioral Health Workforce Shortages: Lessons Learned in New Mexico

333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found. Conclusion Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease.

Creating a National Native Telebehavioral Health Network: The IHS Telebehavioral Health Center of Excellence

Collaborative models of care are being examined in multiple settings as a means to improve care for chronic medical and psychiatric conditions and to strengthen the hand of primary care physicians in treating mental health and behavioral health problems. However, these new ventures are predominantly being examined for adults in urban settings served by large group practices. Telemental health (TMH) offers the opportunity to build collaborative models of care in primary care practices across diverse settings. This chapter will discuss evolving approaches to using TMH to bring mental and behavioral health treatments to medical settings, including models that serve youth and minority populations.

Severe Diphenhydramine Dependence and Withdrawal : Case Report

Background. Anxiety disorders are associated with considerable disability in the domains of (1) work, (2) social, and (3) family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions.

Are Second Generation Antipsychotics a Distinct Class

Nationally, the behavioral health workforce is in crisis because of a lack of resources, culturally responsive services, quality clinical supervision, sufficient training in evidence-based practices, and targeted recruitment and retention. Disparities in access to behavioral health care are particularly significant in New Mexico, where 25% of the population live in rural areas, and behavioral health shortages are among the highest in the nation. Additionally, as a Medicaid expansion state, New Mexico providers experience increased demand for services at a time when the state is challenged with limited workforce capacity. To address this issue, the Health Care Work Force Data Collection, Analysis and Policy Act was legislatively enacted in 2011 to systematically survey all state licensed health professionals to determine reasons for the healthcare shortage and address the shortage through policy. The Act was amended in 2012 to transfer all data to the University of New Mexico Health Sciences Center. In 2015, a total of 4,488 behavioral health providers completed a survey as a mandatory part of their license renewal. Findings from the survey indicate a dearth of licensed behavioral health providers representative of the populations served, limited access to services via Medicaid and Medicare payer sources, limited access to providers working in public health settings, and limited access to Health Information Technology. This paper describes the workforce context in New Mexico, the purpose of the legislation, the analytic findings from the survey, the policies implemented as a result of these efforts, lessons learned, and a discussion of the relevancy of the New Mexico model for other states. SUPPLEMENT INFORMATION This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.