Active Research and Funded Activities
- Michael Blank
- Dennis Culhane
- Jeffery Draine
- Trevor Hadley
- David Mandell
- Aileen Rothbard
- Mark Salzer
- Sara-Ann Steber
- Cynthia Zubritsky
HIV Prevention Among Substance Abusing SMI
CMHPSR participants: Michael Blank, Ph.D., Phyllis Solomon Ph.D., Julie Tennille, MSW, LSW
Funding Source: NIDA RO1
Preventing AIDS Through Health (PATH) is a translation of two HIV prevention programs proven effective in the general population and among substance users. The RESPECT program was developed by CDC and is the first HIV prevention program to show one-on-one counseling can reduce at-risk sexual behavior in a multi-site demonstration. The NIDA Community-Based Outreach Model (CBOM) was designed to reduce the risk of HIV and other blood-borne infections in drug users. Both are highly structured, manualized interventions. PATH uses mental health case managers (CM’s) from Hall-Mercer Mental Health Center to draw on features of both interventions depending on individual consumer risk profiles. These CM’s have specialized expertise in providing services to this population. We believe that this expertise, prior relationships with these persons, and an ability to regularly reinforce the intervention will result in significantly reduced risk. There are two sets of research participants, the persons with SMI as well as case managers themselves. Informed consent will be obtained from both sets of participants. Blood testing will identify those who are HIV positive at baseline. Breathalyzer and urine testing will supplement clinical interviews and other measures to identify substance abuse co-morbidity. Using a longitudinal experimental and control group design, we will randomly assign case managers to deliver the intervention to consenting participants in their caseloads who meet inclusion criteria. Participants will be in treatment at a large CMHC in Philadelphia. Independent interviews will be conducted with case managers and consumers before the intervention, and again at 3, 6 and 12-months post intervention and focus on changes in risk behaviors, fidelity of translation of the intervention, cost and outcomes. Breathalyzer and urine tests at 12-months will supplement self-reports of use of alcohol, cocaine, marijuana, benzodiazapines, and opiates. The study has enrolled over 275 study participants to date. The research team is concluding a qualitative analysis and finishing subject interviews before beginning the analysis phase of the study.
Nursing Intervention for HIV Regimen Adherence Among SMI
CMHPSR/Penn participants: Michael Blank, Ph.D., Aileen Rothbard, Ph.D., Linda Aiken Ph.D. Robert Gross, MD, Janet Hines, MD, James Coyne PhD, Tom TenHave, Ph.D, Julie Tennille, MSW, LSW
Funding Source: NINR RO1
Involvement of advance practice nurses (APN's) has been previously shown to improve outcomes for persons with HIV/AIDS. Since case managers (CM's) are already involved with coordinating mental health, social, and other services for this population and have specialized expertise in providing those services, we believe that an integrated services model that integrates nursing and case management will result in demonstrably better HIV treatment outcomes using CD4 and viral load as indicators, and significantly reduced risk behaviors using standardized behavioral self-reports. Participants have been recruited from among those already in treatment for SMI in Philadelphia. Using a longitudinal (baseline, 6,12, and 24 months) experimental and control group design, we randomly assigned over 260 participants to the intervention or control groups. Participants were screened for active substance abuse and depression, randomized, and experimental participants received an integrated intervention tailored to their communication and comprehension levels which included memory aid devices, education regarding side effects and other treatment aspects, and active community outreach. For those who failed to adhere using the basic intervention, a treatment cascade that increases in intensity was implemented. Using 80% adherence as a target, the cascade included involvement of family and significant others in prompting participants through use of beepers, cell phones, and for those who still fell short of 80% adherence, directly observed therapy. They were randomized into experimental and control groups. Each participant was followed for 24 months. Experimental subjects received the intervention for 12 months, followed by a 12 month period during which decay of the intervention was observed. Control subjects were also observed for 24 months. Over 260 study participants have been enrolled to date. The research team is beginning report writing and analysis.
Multi-Site Rapid HIV Testing in Urban Community Mental Health Settings
CMHPSR/Penn participants: Michael Blank, Ph.D., David Metzger, Ph.D., Trevor Hadley, Ph.D., John Jemmott, Ph.D., Martin Fishbein, Ph.D., Charles Dackis, M.D., Julie Tennille, MSW
University of Maryland participants: Lisa Dixon, M.D., Seth Himmelhoch, M.D.
CDC contact persons: Jeffrey Schulden, M.D., James Heffelfinger, MD, MPH
Funding Source: CDC under program announcement PS-07-005
This protocol outlines plans to implement a multi-site program designed to increase HIV testing and improve linkage to care for persons diagnosed with HIV in urban mental health settings serving African American communities. The project will take place in Philadelphia, PA and Baltimore, MD through a CDC collaboration with the University of Pennsylvania and the University of Maryland. In each city, the project will be implemented in three types of settings: community mental health centers (CMHCs), university-based inpatient psychiatric units, and mobile assertive community treatment (ACT) programs. In each of the settings, clients will be offered HIV testing and a brief survey to assess HIV risk behaviors, psychiatric symptoms, and HIV testing history. Abstraction of data from client medical records will provide additional information on diagnoses and recent clinical course. No subjects have been enrolled to date.
Philadelphia Homeless Diversion Project
CMHPSR/Penn participants: Dennis Culhane, PhD, Steve Poulin, PhD
Funding Source: Neighborhood Transformation Initiative tax-exempt bond proceeds that will be administered by AS/OSH
This Project will 1) assess the benefits and cost efficiency of providing short shelter stays followed by subsidized housing and move-in assistance as an alternative to the provision of shelter only to homeless families, and 2) explore the circumstances of homeless families whose head of household applied for shelter but was able to make his or her own living arrangements (MOA). CMHPSR staff will identify the factors associated with MOA families requesting shelter again, and comparing the stability and well-being of the experimental and control group high risk families. One-half of the 150 high risk families will be randomly assigned to an experimental group that is placed into subsidized housing and the other half will be assigned to a control group that receives normal shelter services. The families in the experimental group will receive housing assistance from an -contracted non-profit organization that includes placement into an affordable and appropriate subsidized housing unit soon after shelter admission.
Office of Supportive Housing (OSH) Annual Children’s Report Card for Safe and Sound
Dennis Culhane, Ph.D. Principal Investigator
This project provides an annual count of families (households with children) and children served in Philadelphia shelters within a calendar year, and average length of stay for families and children.
Homelessness and the Child Welfare System
Dennis Culhane, PhD Principal Investigator
Dates: Terminating 12/07
Funding Source: Conrad Hilton Foundation
This study will examine 1) the prevalence and associated factors of public homeless shelter use among young adults with histories of out-of-home care or non-placement preventive services, and 2) the extent and risk factors of child welfare system involvement among children in homeless families. This study will be based on data from the Philadelphia child welfare and homeless assistance systems.
The Typology and Costs of Family Homelessness
Dennis Culhane, PhD, Principal Investigator
Dates: Terminating 12/07
Funding Source: Conrad Hilton foundation
This study aims to 1) investigate the existence of subpopulations of homeless families based on their patterns of shelter utilization and 2) examine whether subgroups of homeless families have differential utilization of public services. The research questions will be addressed by integrating data for child welfare records, Medicaid inpatient and outpatient files, and special education data from the City of Philadelphia.
Cohort Effect or Risk Period: The Changing Age Distribution of Homelessness
Dennis Culhane, PhD, Principal Investigator
Dates: Terminating 05/06
Funding Source: None
Sorting homeless shelter users (adults) by date of birth and date of shelter admission, and showing the trend over time (from 1990 through 2004) to examine the aging of the homeless population, and risk period for family homelessness.
The Cost of Chronic Homelessness 2000-2002
City of Philadelphia Contact Person: Dr. Marcella Maguire
CMHPSR Contact: Steve Poulin, 215 615-0399
Using data available from the Office of Supportive Housing, winter shelter programs, and street outreach programs, Dr. Marcella Maguire of the Department of Behavioral Health compiled a list of persons who were chronically homeless (i.e. continually homeless for more than one year or had been homeless more than three times) between 2000 and 2002. These persons were matched to mental health and substance abuse services utilization data to estimate the cost of chronic homelessness. The costs are being compared among persons who had been street homeless only, sheltered homeless only, or had been on both the street and in shelter. Jail data is being obtained for matching with this population.
Kids Integrated Data System (KIDS)
CMHPSR contact: Dennis Culhane
Funding Source: William Penn Foundation and grantees
KIDS is a partnership between the City of Philadelphia and the University of Pennsylvania to created an integrated database of children's health, education and social services. This on-going project involves the construction annually of data on children’s mental health derived from CMHPSR's data files obtained from the Philadelphia Department of Mental Health. These data will be available to researchers to examine a variety of issues related to children's mental health and other social services.
New Keys Evaluation of ACT and Housing First Interventions for Homeless Persons
PI: Jeffrey Drain, PhD
Dates: Terminating 01/07
Funding Source: SAMHSA/CSAT
This project is an evaluation of an Assertive Community Treatment and Housing First Program for street homeless people. Data on OSH service use, including outreach, is used to both identify clients and comparison condition participants for the evaluation, and to provide service use and outcome data. Project is funded by SAMHSA/CSAT and is a collaboration of the City of Philadelphia (Marcella Maguire et al), Horizon House, 1260 Housing and CMHPSR.
Financial Impact of the Gaudenzia FIR-St. Residential Treatment Program in the Context of Prison Release and Community Outcomes for Released State Prisoners with Mental Illness in Philadelphia
City of Philadelphia Contact Person: Arthur Evans
CMHPSR Contact: Steve Metraux, 215 596-7612
Dates: Current, Terminating 01/07
Funding Source: Commonwealth of Pennsylvania
This project will look at the use of criminal justice, homeless, behavioral health and other health services among persons diagnosed with mental illness who are released from Pennsylvania prisons, and will also focus on persons who participated in a residential rehabilitation program run by Gaudenzia, Inc. Analyses for this project will merge administrative data from six data sources: the Pennsylvania Department of Corrections; Gaudenzia FIR-St; the Philadelphia Prison System; Philadelphia Community Behavioral Health; the City of Philadelphia Police Department; and the Philadelphia Office of supportive Housing. Merging these data represent an accurate and practical means of collecting longitudinal data on services use across systems for large numbers of people. Datasets will be merged on the basis of matching unique identifiers such as social security number or some combination of name, date of birth, race and sex.
Mental illness, Substance Abuse, and Jail Re-entry
Jeffrey Draine, Trevor Hadley, Steve Metraux, Amy Blank
Funding Source: Philadelphia Department of Behavioral Health
Project Dates: 2007
We are analyzing the patterns of service use prior to jail entry, pathways through jail, and service use after jail release for individuals entering and leaving Philadelphia jails.
Evaluation of Crisis Intervention Teams in Philadelphia
CMHPSR Contact Person: Jeffrey Draine
Funding Source: Bureau of Justice Assistance
Project Dates: Sept 2006 to Sept 2008
With Melissa Morabito (a post doc of the Center for Mental Health Services and Criminal Justice Research at Rutgers), we will use police data in conjunction with data about CRCs (emergency room) and case management services to evaluate the impact of implementing CIT in the Eastern Division of the Philadelphia Police Department.
Medicaid Service Utilization for persons discharged from county prison system
Steve Metraux, PhD, Jeffrey Draine, PhD, Trevor Hadley, PhD
Funding Source: Philadelphia DBH
Project Dates: 2006- 2007
This study matches admission and discharge data from the county prison system with Medicaid eligibility and service use. In particular, we could examine the temporal proximity of psychiatric crisis episodes to arrests and/or homeless shelter use.
The Philadelphia Consortium on Psychiatric Disparities: Reducing Disparity for Severely Mentally Ill African Americans
Participants: Trevor Hadley, Ph.D. (PI), Aileen Rothbard, Sc.D. (Co-PI), Mark Salzer, Ph.D., Cynthia Zubritsky, Ph.D., Eri Kuno, Ph.D., Szabi-Zee, Ph.D., Frank Worts, MSW, Virginia Smith, Ph.D.
Dates: terminating March 2007
Funding Source: Pa Department of Health
This project, commonly known as the Health Disparities Project, is a four-year research initiative at four participating agencies with four main components related to reducing psychiatric disparities in mental health treatment. The Philadelphia Consortium on Psychiatric Disparities (PCPD) is conceived as building long-term collaborative relationships among these six entities to assist agencies in optimally meeting the needs of their clients. The intent is for members of the PCPD to continue to collaborate on mutually beneficial projects in the future that will ultimately improve the health and well-being of the populations served by these agencies. Data from the research projects are currently being analyzed. They will examine the impact of electronic prescribing and a self care intervention on quality of care and reduction of racial disparities. CBH/Medicaid data will be used to see if there are prescribing differences between the agencies that are in the consortium and those in the rest of the city. Philadelphia pharmacy claims from DPW will be examined.
Healthcare Use for Children in Homeless Families
Trevor Hadley, PhD, Dennis Culhane, PhD, David Mandell, ScD
Funding Source: National Institutes of Health
This study will examine 1) whether children's health service use changes before, during and after their initial homeless episode and 2) whether children who become homeless differ from other low-income housed children in their healthcare use before their first homeless episode, afterwards, and whether there are differences in the change in use around the homeless episode relative to housed children. This study aims to improve healthcare and coordination of care among children in homeless families, which will lead to improving health outcomes in this vulnerable population.
Understanding the Delay in the Diagnosis of Autism
PI: David Mandell, ScD
NIMH 04/01/05 - 03/31/10
The purpose of this study is to quantitatively and qualitatively determine factors associated with delayed diagnosis among children with autism. A state survey was administered to over 1000 caregivers in Pennsylvania. Information available from these sources were used to identify factors associated with the age at which children with autism are diagnosed and enter treatment. The data collected was presented at a conference to discuss intervention services. In the next phase, information from families will be collected using semi-structured interviews. Families will be asked to describe their experiences related to their children's autism, what precipitated their concerns, and experiences related to getting screened, diagnosed and treated. Both quantitative and qualitative data will be collected from families who will be followed from the time their child is diagnosed for 6-12 months. Data will be gathered on stress, sources of support, and their decisions about whether and how to engage in treatment. The results from this study may inform our understanding of factors affecting the early and appropriate diagnosis of other psychiatric and developmental disorders of childhood, leading to the development of broader interventions to expedite appropriate diagnosis.
Interstate variation in healthcare utilization among children with ASD
PI: David Mandell, ScD
04/01/07 - 03/31/12
This R01 application requests support to conduct a large national study that will comprehensively identify the impact of state policies on the healthcare service utilization of families of children with autism spectrum disorders. Recent studies have reported an increase in the number of children with autism and it has been suggested that medical expenditures related to autism will rise accordingly. The purpose of the present study was twofold: first, to estimate Medicaid expenditures associated with a diagnosis of autism for a sample of children 0 through 21 years of age (n = 298) in a large, metropolitan county of Pennsylvania over the years 1994 to 1999; and, second, to compare these expenditures to those of other similarly aged Medicaid-eligible children without autism from the same county during the same time period. Results from this study suggest that children diagnosed with autism had Medicaid reimbursed expenditures that were approximately 10 times greater than those of other Medicaid-eligible children. Although average annual expenditures for the two groups remained relatively similar in areas such as ambulatory physical care and emergency physical care, average annual expenditures varied markedly in other areas such as inpatient physical health care. Major cost differences were observed in outpatient mental health care, as expenditures for children with autism decreased over the six-year period from $4,100 (1994) to $2,632 (1999), yet increased for other children, $58 (1994) to $114 (1999). Average inpatient mental health expenditures over the same time period followed a less discernable pattern. While the number of children with autism served each year in the Medicaid system remained relatively stable during this time period, per person expenditures actually decreased somewhat, phenomena that were believed attributable to decreases in average outpatient and inpatient mental health expenditures.
Center of Excellence for the Epidemiology of Autism
PI: Ellen Giarelli
This multi-site project is designed to estimate the prevalence of autism, and enroll participants into case control studies to determine the etiology of this disorder. Autism spectrum disorders (ASDs) are defined by unusual and pervasive developmental problems in social interaction, communication, imagination and range of interests or behaviors. Both the epidemiology and etiology of these serious developmental disorders are poorly understood. Estimates of population prevalence vary widely within the U.S. and abroad. Two primary factors contributing to this wide variation in prevalence estimates are 1) differences in case finding and ascertainment methods, and 2) lack of standardization in evaluating diagnostic criteria for ASDs. A more precise estimate of the public health impact of ASDs would serve to inform appropriate and well-coordinated responses by planners at the local and national level. The objective of this study is to describe a multiple-source surveillance methodology being implemented by investigators in the 18-state ADDM CADDRE Network for the purpose of determining population prevalence and characteristics of ASDs and other developmental disabilities. The ADDM CADDRE Network is implementing active ASD surveillance that does not rely on professional or family reporting of children's recorded ASD classification and/or diagnosis. Rather, children's files are abstracted at multiple clinical and educational sources and systematically reviewed by an independent team of clinicians in order to determine case status. These results present the Network's methodology for identifying suspected cases, abstracting source records, and determining case status. Selected process evaluation data are also presented. Coordinated public health surveillance of ASDs provides an ongoing source of high-quality data to examine the magnitude and characteristics of ASDs in the population. This activity will inform appropriate responses to community and political concerns, promote planning for health and educational services, and generate descriptive data that can foster continued research on ASDs.
PA Autism Taskforce Projects
Estimating of the number of people with autism served by Pennsylvania
Currently, there is no comprehensive list individuals with autism served in Pennsylvania or the public agencies through which they receive care. Understanding how and from whom people with autism receive care has important implications for policy development, service planning and resource allocation. Under the direction of the Department of Public Welfare, we are coordinating the efforts of state level agencies including the Office of Medical Assistance Programs, the Office of Mental Retardation, Office of Child Development and the Office of Mental Health and Substance Abuse Services and county level agencies such as MH/MR Programs and County Assistance Offices to determine an estimate of the number of individuals affected by autism in Pennsylvania. David Mandell, ScD was the Co-Chair for the Pennsylvania Autism Taskforce in 2004, and serves as a consultant for this project.
An Analysis of the Mental Health Resource Capacity in Pennsylvania
Aileen Rothbard, ScD
Funding Source: Pennsylvania DPW OMHSAS
Time Frame: 2006-2008
As a result of the downsizing and closure of state psychiatric hospitals, there are concerns that adequate resources exist to ensure the safe transition and recovery of individuals in the community. Additionally, questions are raised as to whether there are sufficient resources available for individuals who were not formerly in institutional settings but may require community based care. The purpose of this study is to examine mental health treatment capacity in Pennsylvania counties that have closed or reduced the number of state hospital beds. A longitudinal descriptive analysis of mental health resource capacity by county will be done beginning in 1990 showing the number of state hospital, acute and sub-acute community hospital beds; community residential rehabilitation beds, supported housing, personal care boarding home beds; and per capita mental health expenditures from public sources such as Medicaid and state block grant funds. An analytic model will also be developed explaining total mental health resource capacity as a function of changes in the previous factors.
Cost Analysis of Persons with SMI and HIV/AIDS
Aileen Rothbard, Michael Blank
Funding Source: NIDA grant
Time Frame: 2006-2008
This study examines the cost of HIV/SMI care for Medicaid clients in Philadelphia in 2003 and is a follow-up to a 1996 study showing changes in cost and utilization patterns. PA Medicaid data files on mental health, physical health and pharmacy as well as well as county data are used to ascertain costs in Philadelphia. Data from 2003 is being used as a comparison with 1996 to look at the extent of care that persons with SMI and HIV receive with the introduction of HAART.
Simulation Model for Residential Bed Capacity Planning
Eri Kuno, Ph.D., Aileen Rothbard, Sc.D. Cynthia Zubritsky, Ph.D.
Funding Source: NIMH RO1
This is the second NIMH funded grant to explore model development for planning residential service systems. The objective of this project is to refine the original model that was based on the Philadelphia mental health system. Model input parameters were originally derived from empirical data on the public sector sub-acute inpatient and residential service utilization records. In the current project, we will improve on the client flow decision support tool as follows: 1) We will employ a new approach to model demand for services based on client need. A functional status classification scale will be applied to assign appropriate "levels of care" among clients in need of hospital and residential services. Transition patterns showing changes in client functioning between levels of care will be incorporated into the model, using a local expert panel to estimate change rates; 2) The effect of high intensity outpatient services such as Assertive Community Treatment (ACT) and Intensive Case Management (ICM) programs on demand for hospital and residential services will be incorporated into the model with the objective to reduce demand for staffed residential services. 3) Finally, we will add a cost component to the planning model in order to project what monetary funds are needed. Secondary data from the Philadelphia mental health system will be used (CBH, CRS, Person Plus, etc.).
Methods of Determining Psychiatric Prevalence Rates Using Medicaid Claims data
Aileen Rothbard, Sc.D., Liz Noll, MA
The purpose of this study is to show the variability in estimates of mental health disorders using Medicaid claims data based on the methodology used to label subjects by diagnostic category . The need to standardize the method for determining which diagnostic category an individual is placed is important given the need to compare results across the growing number of research studies using Medicaid data as well as its increasing use for state and county service planning. Since 54% of psychiatrically disabled adults are enrolled in a Medicaid health program, analysis of these data can provide important information on prior and current utilization patterns, cost estimations and quality of care measures. However, one of the challenges presented by the data is related to multiple records associated with visits containing different diagnoses for the same individual during any one year period. This makes it difficult to categorize the patient for various analysis as it is unclear which diagnosis is primary and which is secondary.
Racial Disparities in Treatment of Behavioral Health Disorders in Philadelphia
Aileen Rothbard, Sc.D., Liz Noll, MA, Trevor Hadley, PhD
Funding Source: Phila Department of Behavioral Health (DBH)
In a study done in 1993 using Philadelphia Medicaid data, African Americans (AA) had less access and intensity (volume) of inpatient and outpatient services than whites. Additionally, AA were less likely to receive psychotropic medications or to receive psychiatric services from a physician. In other studies, the rate at which second generation antipsychotics are prescribed to AA lags behind whites. This is true for antidepressants as well and occurs in medical settings as well as community sites. This study will examine the extent that racial disparities continue to exist in the Philadelphia public mental health system for 2003 -2006.
Trends in Psychotherapy Treatment for Medicaid clients with Depression
Aileen Rothbard, Sc.D., Liz Noll, MA, Mary Beth Gibbons, PhD
Funding Source: NIMH K award (Gibbons)
This project examines trends in outpatient psychotherapy for adults over the last ten years in public sector programs. Evidenced based practices for persons with major depression, with respect to duration of treatment, combination pharmacology and therapy will be investigated. The focus will be on Philadelphia County with an examination of treatment by race and gender.
National Perinatal Study of Persons with Serious Mental Illness
Aileen Rothbard, Sc.D., Liz Noll, MA, Trevor Hadley, PhD
Funding Source: Stanley Foundation
This study will identify new cases of individuals in the Philadelphia Perinatal database (n=9236) that have been treated for a mental health problem in the public mental health system between 1995 and 2003 (05). An original study (Cannon) using Philadelphia Medicaid and CRS mental health files found ~ 250 persons from the perinatal data base that had a treatment related visit with a diagnosis of schizophrenia and major depressive disorder. Clinical chart reviews were done on a sample of these individuals by identifying their most reason provider visit and contacting the provider agencies to request a validation of the diagnosis. This study is a follow-up to identify new cases since 1995 and determine the feasibility of doing an interview with a sample of these individuals.
Community Integration for People with Psychiatric Disabilities:
The mission of the RRTC is to research, develop, and promote strategies to reduce barriers to community integration and enhance supports associated with community integration that will result in better quality of life among people with psychiatric disabilities. Barriers and supports associated with community integration are understood to occur at multiple levels (Cultural/Societal, local community, organizational, programmatic, and individual). Examples of barriers include stigma, policies that limit integration, staff training about integration, the availability of program supports, and individual internalization of hopelessness and low perceived empowerment. Examples of supports include policies and programmatic supports that facilitate community integration, and peer support.
The overall goal of the RRTC is to be a center of excellence in research, training, technical assistance, and dissemination on community integration for people with psychiatric disabilities. Specific objectives include:
- Conduct cutting edge research to enhance knowledge and understanding about community integration for people with psychiatric disabilities, barriers to community integration, and supportive strategies for enhancing community integration.
- Develop and offer an extensive array of training and technical assistance to a broad range of stakeholders that will provide based on current research in the field, including research already being conducted by those involved in the proposed RRTC, as well as future research findings.
- Disseminate research findings of relevance to community integration, including results from the proposed RRTC research efforts, as well as training and technical assistance materials to a broad audience using state of the art dissemination models and technology.
Internet Peer Support for Breast Cancer
Peer support is consistently and unambiguously recognized as benefiting persons with serious mental illnesses in their recovery and promotion of self-care (i.e., treatment adherence, self-efficacy, motivation). In the face of these findings it is disconcerting that face-to-face peer support interventions, such as self-help groups, may be underutilized due to travel needed to get to such groups, time investment, fatigue, stigma, and other factors that may limit participation. The Internet has emerged as an exciting and potentially valuable tool in delivering psychosocial and educational interventions to persons with severe mental illnesses, including being used as a conduit for peer support. Internet peer support is accessible 24 hours a day, seven days a week, features that plausibly increase the accessibility and utilization of peer support for those who do not attend face-to-face support. This R21 application proposes to conduct an exploratory/developmental study to obtain preliminary data on impact of Internet peer support on various psychosocial outcomes and self-care attitudes and behaviors of persons with serious mental illnesses. The proposed randomized study will provide data on the potential effectiveness of Internet peer support that, if promising, will serve as the basis for a future R01 proposal. A secondary aim of this developmental study is to assess the feasibility of various methods for understanding the Internet peer support process. The proposed process study will examine a number of key issues, including: 1) Level of participation in the online peer support intervention; 2) analysis of the online peer support communications; and 3) assessment of participant perceptions of the online support process. The products from this effort will serve as a basis for planning future intervention research project grant applications (R01) based on the information gathered.
Cost-Effectiveness of Friends Connection
CMHPSR contacts: Mark Salzer, Ph.D.
Funding Source: SAMHSA Center Mental Health Services (CMHS)
We are involved in a multisite study funded by the Center for Mental Health Services of consumer-operated services. This randomized wait-list study will, among other things, examine service utilization for both those who get Friends Connection services right away and those who wait for up to one-year for such services. This project remains on-going
HIV/AIDS and Substance Abuse Prevention among Women of Color
Sponsored by the Center for Substance Abuse Prevention
Sara-Ann Steber, PhD serves as the Evaluator on an HIV/AIDs prevention project operated by the Community Prevention Partnership of Berks County (CPPBC). The CPPBC received funding to support the development and implementation of the Neighborhood Unity Program (NUP) a community outreach and educational intervention targeting Hispanic women in Reading Pennsylvania. The NUP employs individual, group and community prevention strategies designed to reduce the risk of HIV/AIDS and substance abuse among participants, their families and their communities. The intervention occurs in two public housing developments and two areas in Reading’s Weed & Seed neighborhood. The NUP employs an Information-Motivation-Behavioral Skills (Fisher & Fisher, 1992) prevention model for program participants. The intervention has three components. The first component is a 12-week educational program that includes sessions covering HIV/AIDS and substance abuse prevention as well as sessions on conflict resolution, family relationships, self-esteem, stress management and accessing resources. The second component is the development of a Women’s Health Council (WHC) (Sikkema et al, 2000) in each of the four study sites. Women who have completed the educational program are recruited to serve on the WHC and participate in a specialized train the trainer program "Talking to your Kids about AIDS" curriculum (Meschke et al, 1999). They then serve as peer educators to teach their neighbors how to talk to their children about substance abuse and AIDS. They also assist with community education on HIV/AIDS and substance abuse prevention through community events and activities aimed at adults, young adults, families, and youth. The final component is the development of a Berks County HIV/AIDS and Substance Abuse Service Providers Committee, to increase the coordination of and access to HIV/AIDS, substance abuse and other community services for the Hispanic population in the City of Reading that is increasingly isolated and marginalized in prevention and treatment programs and services.
Primary Care Research In Substance Abuse and Mental Health for Elderly
Funding Source: SAMHSA, HRSA, VA
The Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) is a multi-site, randomized trial comparing two types of care models for delivery of mental health services to elderly people through primary care. Older adults aged 65 and above were screened at primary care clinics from 10 study sites throughout the U.S.A. Those who met diagnostic criteria for depression, anxiety, and/or at-risk alcohol consumption were randomly assigned to two different models of care: integrated mental health and primary care or enhanced specialty care. This is the largest study of older adults and mental health that has been completed in the U.S.
National Outcomes Roundtable for Children and Families
Co-Investigator Funding: SAMHSA
The Outcomes Roundtable for Children and Families, is sponsored by the Center for Mental Health Services (CMHS), Substance Abuse Mental Health Services Administration (SAMHSA). The mission of the Outcomes Roundtable is to bring together multiple perspectives and expertise to provide leadership that stimulates culturally competent and data driven improvements in policy, practice and research for children and adolescents with emotional and behavioral health needs and their families. This mission underscores the Roundtable’s current focus on the development of an appropriate outcome accountability system within child service systems. Presently, there is little unity across child service systems on how to accomplish this, and virtually no means of sharing information across these systems. In response to this dilemma, the Roundtable is working to identify of a parsimonious, consensus-based set of behavioral health (mental health and substance abuse) performance measures that can be implemented and commonly shared across child service systems in both the public and private sectors. This proposed set of common performance measures builds on a variety of existing frameworks and systems, for example, the Institute of Medicine (Crossing the Quality Chasm), NCQA/HEDIS, FACCT (Foundation for Accountability), the American College of Mental Health Administration (ACHMA), Washington Circle Group, NASMHPD, as well as other groups. The meaningfulness and scientific soundness of each measure, as well as the feasibility of implementing the performance measure are used as criteria for selecting the proposed performance measures.
Health Related Quality of Life
Co-Investigator School of Nursing
Funding: NIH 2006-2011
The Health Related Quality of Life study will assess and follow 500 people through a variety of long term care facilities, including assisted living and nursing homes. The goal of the study is to determine the components of care that contribute to a high quality of life for persons as they transition through care settings.
Pennsylvania Co-Occurring Systems Integration Grant (COSIG)
The PA COSIG grant was an initiative to integrate mental health and substance abuse treatment through the development and implementation of state level infrastructure for co-occurring disorders. This activity used the knowledge and experience gained through previously state-funded MISA pilots at the county level; and funded six pilot enhancement activities to develop a comprehensive, integrated approach to serving persons with co-occurring disorders. Infrastructure development goals targeted: 1) Screening and Assessment; 2) Training; 3) Evaluation; and 4) Treatment. Six service pilot sites were evaluated to determine the effectiveness of different service models and tested the feasibility and effectiveness of particular infrastructure enhancement strategies. The approach used planning strategies that are already in place in Pennsylvania by leveraging and building upon the experience currently available at the county level.
Beaver County’s System of Care: Optimizing Resources, Education and Supports (BC-SCORES)
BC-SCORES is a system of care grant that will develop a comprehensive system of care for adolescents (14 to 21), involved with the juvenile justice system who have a co-occurring mental health/substance abuse disorder. Adolescents entering the juvenile justice system are assessed for a co-occurring mental health and substance abuse disorders. Individuals with this disorder who agree to participate are entered into a system of care and followed for three years. This community based system of care builds on the strength and potential of each adolescent and family by developing a single integrated plan for treatment and a new type of case coordination (system coach) which links agencies and families. Services include Multi-systemic Therapy or an enhanced Family Based Team. System coaches will ensure coordination among treatment, juvenile justice, education, vocational training, transition planning, physical health care and empowerment of youth and his/her family members in accessing and receiving services tailored to their individual needs. Targeted outcomes of BC-SCORES include: creation and continuation of a system of care for the targeted population; increased awareness of the impact cultural issues have on treatment; timely and accurate screening for co-occurring disorders, integrated service planning; improved clinical outcomes related to mental health status and substance use; reduced involvement with the juvenile justice systems; reduced incarceration and out-of-home placement; and improved school success as indicated by attendance, school performance, and rates of suspension.