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This exploratory paper presents a case study where a community based mental health organization forging a partnership with a local hospital system to establish a crisis stabilization unit (CSU) to address behavioral health emergency care. The study takes a mixed methods case study approach to address two research questions; (a) did this approach reduce the overall length of stay in the hospital emergency departments? (b) What challenges did the taskforce face in implementing this CSU model? The paper shares recommendation from the findings. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has presented a formidable challenge to care continuity for community mental health clients with serious mental illness and for providers who have had to quickly pivot the modes of delivering critical services. Despite these challenges, many of the changes implemented during the pandemic can and should be maintained. These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions. This paper represents the authors' collaborative attempt to both reflect the changes to clinical practice we have observed in CMHCs across the US during this pandemic and to suggest how these changes can align with best practices identified in the empirical literature. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team. [ABSTRACT FROM AUTHOR]

Dialectical behavior therapy (DBT) can be challenging to implement in community-based settings. Little guidance is available on models to evaluate the effectiveness or sustainability of training and implementation efforts. Residential programs have much to gain from introduction of evidence-based practices, but present their own challenges in implementation. This paper presents a low-cost process evaluation model to assess DBT training piloted in residential programs. The model targets staff and organizational factors associated with successful implementation of evidence-based practices and matches data collection to the four stages of the DBT training model. The strengths and limitations of the evaluation model are discussed. [ABSTRACT FROM AUTHOR]

Assertive Community Treatment (ACT) programs have been treating individuals with chronic and severe mental illness since the 1970s. While ACT programs were developed to address the treatment needs of severely mentally ill persons traditionally suffering from chronic mental illnesses, ACT programs are seeing a growing number of persons with co-morbid personality disorders. The efficacy of traditional ACT programs in treating individuals with co-occurring personality disorders is uncertain, in particular individuals with co-morbid Borderline Personality Disorder (BPD). Dialectical Behavior Therapy (DBT) has been proposed as an effective approach to treating clients with BPD in this setting. The purpose of this paper is to examine the value of DBT for individuals with BPD in ACT programs. The writers discuss the prevalence of Borderline Personality Disorders in ACT populations, briefly review the literature on DBT in ACT, address the feasibility of implementing DBT in an ACT model, examine potential barriers to this implementation, and highlight potential areas for future research.

The Graduated Recovery Intervention Program (GRIP) is a novel cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. In this paper, the treatment development process of GRIP is described and data from an open feasibility trial are presented. Findings suggest clinical and psychosocial benefits associated with GRIP, and the treatment was well-received by clients and therapists. The retention rate of 67%, however, suggests the need for protocol modifications to improve engagement. Initial data on the efficacy of GRIP are encouraging, although the study design precludes more robust conclusions at this time. [ABSTRACT FROM AUTHOR]

People with intellectual and developmental disabilities (IDD) have higher incidences of mental health conditions and behavioral support needs than people without IDD but may not receive needed care from community providers. We examined rates of co-occurring conditions in a representative sample of adults with IDD who use state funded services in Virginia. Using data from two datasets, we identified four categories of mental health and behavioral conditions. We used these categories to examine differences in individual- and system-level factors in people with and without co-occurring conditions. We found high rates of co-occurring conditions in our sample. We found important disability factors and system-level characteristics that were associated with having a diagnosed mental health condition or behavioral support needs. Differing patterns of diagnosis and treatment for co-occurring conditions suggests more work needs to be done to support people with IDD and co-occurring mental health conditions living in the community. [ABSTRACT FROM AUTHOR]

This paper briefly reviews the original concept of the community mental health movement; points to ways in which current service delivery systems deviate from this; offers and alternative framework for service delivery, that is, a behavioral model; and argues that its implementation would move community services closer to this conception. The implications of this model for intervention in the natural environment as well as for transitional and prosthetic facilities are described and examples given of its use. Emphasis is placed on working in the natural environment whenever possible via the use and cultivation of significant others as well as via provision of training in self-directed behavior change in addition to the blending of case management with careful evaluation of service.

Due to value orientations, lack of knowledge, or exposure, the behavioral approach has been avoided by many professionals in the community mental health field. This is unfortunate, because many concepts of behavior analysis are identical to some of the guiding principles of the community mental health movement. Furthermore, the methods derived from a behavioral framework can help implement the community mental health idiology. This paper identifies possible linkages in the areas of treatment, client population, and evaluation.

Group desensitization is an effective, efficient anxiety-reduction therapy that, nonetheless, is not applicable in most mental health settings. This paper outlines several procedural modifications that make possible the desensitization of diverse anxieties within a single group and thus make group desensitization a more practical strategy.

Dialectical behavior therapy (DBT) is an evidence-based treatment for borderline personality disorder. The DBT Intensive Training™ is widely used to train community clinicians to deliver DBT, but little is known about its effectiveness. This study prospectively evaluated predictors of adoption and reach of DBT among 52 community teams (212 clinicians) after DBT Intensive Training™. Pre-post training questionnaires were completed by trainees and a follow-up survey by team leaders approximately 8 months later. Overall, 75% of teams adopted all DBT modes and delivered DBT to an average of 118 clients. Lower training and program needs, fewer bachelor's-level clinicians, and greater prior DBT experience predicted adoption of more DBT modes. More prior DBT experience, smaller team size, more negative team functioning, and staff with lower job satisfaction, growth, efficacy, and influence predicted greater DBT reach. DBT Intensive Training™ appears effective in promoting DBT adoption and reach in routine clinical practice settings. [ABSTRACT FROM AUTHOR]

Several independent meta-analytic reviews suggest a relationship between vitamin D (VTD) deficiency and depressive symptoms. Theoretically, behavioural withdrawal (staying home, discontinuing outdoor activities etc.) is likely to exacerbate VTD deficiency. This pilot study assessed the efficacy of a modified form of behavioral therapy designed to simultaneously target VTD deficiency and depressive symptoms. College women (N = 114), all citizens of the United Arab Emirates, were screened for depressive symptoms and VTD deficiency. Those participants who were severely VTD deficient and experiencing clinically significant depressive symptoms, were randomly allocated to either a 12-week program of behavioral activation, emphasizing safe-sun exposure (N = 10), or a waiting list control group (N = 10). At time 2 the sun exposure and behavioral activation (SEBA) group showed a significant increases in 25-hydroxyvitamin D and were, on average, no longer VTD deficient, whereas the control group deteriorated in terms of VTD. Similarly positive results were observed for depressive symptoms. Sun exposure and behavioral activation (SEBA) may be an effective approach to improving VTD status and alleviating depressive symptoms. [ABSTRACT FROM AUTHOR]

We present an evidence-based review of post-trauma interventions used to prevent posttraumatic stress disorder (PTSD). Literature search of PubMed from 1988 to March 2016 using keywords 'Early Intervention AND Prevention of PTSD' yielded 142 articles, of which 52 intervention studies and 6 meta-analyses were included in our review. Trauma-focused cognitive behavioral therapy and modified prolonged exposure delivered within weeks of a potentially traumatic event for people showing signs of distress have the most evidence in the treatment of acute stress and early PTSD symptoms, and the prevention of PTSD. Even though several pharmacological agents have been tried, only hydrocortisone prior to high-risk surgery, severe traumatic injury, or during acute sepsis has adequate evidence for effectiveness in the reduction of acute stress symptoms and prevention of PTSD. There is an urgent need to determine the best targets for interventions after trauma to accelerate recovery and prevent PTSD. [ABSTRACT FROM AUTHOR]

Little is known about the capacity of community providers to provide military informed evidence based services for posttraumatic stress disorder (PTSD). We conducted a regional, web-based survey of 352 community mental health care providers that sought to identify clinical practices, training needs, and predictors of evidence based treatment (EBT) use for PTSD. Overall, 49 % of providers indicated they seldom or never use a validated PTSD screening instrument. Familiarity with EBTs, specifically prolonged exposure (PE; χ(4) = 14.68, p < .01) and cognitive processing therapy (CPT; χ(4) = 4.55, p < .05), differed by provider type. Of providers who received training in PE or CPT (N = 121), 75 % reported using treatment in their practice, which was associated with having received clinical supervision (χ (1) = 20.16, p < .001). Widely disseminated trainings in empirically supported PTSD assessment and treatment, and implementation of case supervision in community settings are needed. [ABSTRACT FROM AUTHOR]

Research has shown that cognitive-behavioral therapy (CBT) is effective in the treatment of schizophrenia (Wykes et al. in Schizophr Bull 34(3):523–537, ). The majority of this research has been conducted in the United Kingdom (Beck and Rector in Am J Psychother 54:291–300, ) where the National Health Service recommends that CBT be delivered to all people with schizophrenia (NICE in Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care (update). , ). In contrast, the corresponding American Psychiatric Association guidelines describe CBT as an adjunctive technique that “may benefit” patients (Lehman et al. in Am J Psychiatry 161:1–56, , p. 35). Anecdotal evidence also suggests a difference between UK and US clinicians’ use of and views on CBT with schizophrenia (Tarrier in Clinical handbook of psychological disorders: a step-by-step treatment manual. Guilford, New York, ). In the present study 214 clinicians in the UK and US completed an internet survey examining this apparent discrepancy. UK and US participants were equally aware that empirical research supports the efficacy of CBT with schizophrenia. However, UK participants were more likely to practice CBT, rated CBT effectiveness more highly, and were more optimistic about the chances of recovery. These findings suggest fundamental differences in the attitudes and practices of UK and US clinicians. [ABSTRACT FROM AUTHOR]