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OBJECTIVE: Although specialized early intervention services (EISs) for psychosis promote engagement in care, a substantial number of individuals who receive these services are discharged from care earlier than expected. The main goal of this study was to examine predictors of early discharge in a large sample of individuals enrolled in an EIS program in the United States.METHODS: This cohort study (N=1,349) used programmatic data from OnTrackNY, an EIS program that delivers evidence-based interventions to youths across New York State experiencing a first episode of nonaffective psychosis. The main outcome was "early discharge," which was operationalized as discharge prior to completing 12 months of treatment. Cox proportional hazard regression models were used to assess the association between sociodemographic, clinical, and support system predictors and early discharge.RESULTS: The estimated probability of discharge before 1 year was 32%. Participants who at baseline had poor medication adherence, had no health insurance, were living alone or with nonparental family, or were using cannabis were at higher risk of leaving services within the first 12 months after enrollment. Individuals with higher social functioning were at lower risk of being discharged early from OnTrackNY, but those with higher occupational functioning were at a higher risk.CONCLUSIONS: Predictors of early discharge from EISs largely overlapped with previously identified predictors of poor prognosis in early psychosis. However, the association between early discharge and high occupational functioning indicates that trajectories leading up to discharge are heterogeneous.

The prevalence of smoking is higher among individuals with serious mental illnesses than the general population. Evidence-based practices exist for tobacco cessation, but little is known about mental health clinics' tobacco cessation treatment practices/protocols. Mental health clinics in New York State were surveyed about their tobacco use treatment protocols and outdoor-smoking policies. One-third of clinics were not providing individual counseling for tobacco use disorder, 39% were not prescribing nicotine replacement therapy, and nearly half reported not prescribing bupropion or varenicline. Even smaller proportions reported implementing other clinical practice guidelines, with only 25.2% providing staff training and 20.3% having a dedicated staff member for coordinating tobacco use disorder treatment. Regarding outdoor smoke-free policies, 38% of clinics reported not allowing any tobacco use anywhere on grounds. Despite some successes, many clinics do not provide evidence-based tobacco use treatments, meaning important opportunities exist for mental health clinics and oversight agencies to standardize practices.

Worldwide, early intervention services for young people with recent-onset psychosis have been associated with improvements in outcomes, including reductions in hospitalization, symptoms, and improvements in treatment engagement and work/school participation. States have received federal mental health block grant funding to implement team-based, multi-element, evidence-based early intervention services, now called coordinated specialty care (CSC) in the USA. New York State’s CSC program, OnTrackNY, has grown into a 23-site, statewide network, serving over 1800 individuals since its 2013 inception. A state-supported intermediary organization, OnTrackCentral, has overseen the growth of OnTrackNY. OnTrackNY has been committed to quality improvement since its inception. In 2019, OnTrackNY was awarded a regional hub within the National Institute of Mental Health-sponsored Early Psychosis Intervention Network (EPINET). The participation in the national EPINET initiative reframes and expands OnTrackNY’s quality improvement activities. The national EPINET initiative aims to develop a learning healthcare system (LHS); OnTrackNY’s participation will facilitate the development of infrastructure, including a systematic approach to facilitating stakeholder input and enhancing the data and informatics infrastructure to promote quality improvement. Additionally, this infrastructure will support practice-based research to improve care. The investment of the EPINET network to build regional and national LHSs will accelerate innovations to improve quality of care.

This analysis examined the distribution of four social determinants of health among recipients of state-licensed mental health services and analyzed relationships between determinants and individuals' clinical and demographic characteristics.With data from the New York State Office of Mental Health 2017 Patient Characteristics Survey (N=103,416), prevalences of four social determinants (education, employment, housing, and criminal legal involvement) among mental health service recipients were described. Results were stratified to explore differences by diagnosis, gender, race and ethnicity, and region of residence.High proportions had low education (20.9%), unemployment (79.1%), homelessness (8.2%), and criminal legal involvement (12.2%), surpassing statistics for the general state population. Prevalences of alcohol-related, drug-related, and psychotic disorders were higher among these groups than were prevalences of other diagnoses. People of color and male recipients were overrepresented among those with adverse social determinants.Results highlight the magnitude of social adversity among those receiving mental health services, as well as potential inequities.

Individuals with serious mental illness are at increased risk of severe COVID-19 infection. Several psychotropic medications have been identified as potential therapeutic agents to prevent or treat COVID-19 but have not been systematically examined in this population.To evaluate the associations between the use of psychotropic medications and the risk of COVID-19 infection among adults with serious mental illness receiving long-term inpatient psychiatric treatment.This retrospective cohort study assessed adults with serious mental illness hospitalized in a statewide psychiatric hospital system in New York between March 8 and July 1, 2020. The final date of follow-up was December 1, 2020. The study included 1958 consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who received testing for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction or antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical discharge or July 1, 2020.Psychotropic medications prescribed prior to COVID-19 testing.COVID-19 infection was the primary outcome, defined by a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction or antibody test result. The secondary outcome was COVID-19-related death among patients with laboratory-confirmed infection.Of the 2087 adult inpatients with serious mental illness continuously hospitalized during the study period, 1958 (93.8%) underwent testing and were included in the study; 1442 (73.6%) were men, and the mean (SD) age was 51.4 (14.3) years. A total of 969 patients (49.5%) had laboratory-confirmed COVID-19 infection that occurred while they were hospitalized; of those, 38 (3.9%) died. The use of second-generation antipsychotic medications, as a class, was associated with decreased odds of infection (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), whereas the use of mood stabilizers was associated with increased odds of infection (OR, 1.23; 95% CI, 1.03-1.47). In a multivariable model of individual medications, the use of paliperidone was associated with decreased odds of infection (OR, 0.59; 95% CI, 0.41-0.84), and the use of valproic acid was associated with increased odds of infection (OR, 1.39; 95% CI, 1.10-1.76). Clozapine use was associated with reduced odds of mortality in unadjusted analyses (unadjusted OR, 0.25; 95% CI, 0.10-0.62; fully adjusted OR, 0.43; 95% CI, 0.17-1.12).In this cohort study of adults hospitalized with serious mental illness, the use of second-generation antipsychotic medications was associated with decreased risk of COVID-19 infection, whereas the use of valproic acid was associated with increased risk. Further research is needed to assess the mechanisms that underlie these findings.

Readmission after inpatient care for a psychiatric condition is associated with a range of adverse events including suicide and all-cause mortality. This study estimated 30-day readmission rates in a large cohort of inpatient psychiatric admissions in New York State and examined how these rates varied by patient, hospital, and service system characteristics. Data were obtained from Medicaid claims records, and clinician, hospital, and region data, for individuals with a diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. Psychiatric readmission was defined as any unplanned inpatient stay with a mental health diagnosis with an admission date within 30 days of being discharged. Unadjusted and adjusted odds ratios of being readmitted within 30 days were estimated using logistic regression analyses. Over 15% of individuals discharged from inpatient units between 2012 and 2013 were readmitted within 30 days. Patients who were readmitted were more likely to be homeless, have a schizoaffective disorder or schizophrenia, and have medical comorbidity. Readmission rates varied in this cohort mainly because of individual-level characteristics. Homeless patients were at the highest risk of being readmitted after discharge.

Individuals with serious mental illnesses and poorly managed medical conditions known as serious medical-psychiatric illnesses (SMPIs) are vulnerable to disruptions in care, resulting in poor outcomes. Intensive integrated care management approaches are indicated when these individuals are hospitalized on medical-surgical inpatient units in order to ensure continuity of medical and psychiatric services. This column describes a manualized intervention for hospitalized individuals with SMPIs that was developed in a National Institute of Mental Health ALACRITY research center. The approach uses a critical time intervention model incorporating motivational interviewing and shared decision making to maximize engagement and continuity of care for individuals with SMPIs.

OBJECTIVES: People with severe mental illness (SMI) are ten times more likely to have HIV/AIDS than the general population, yet little is known about the characteristics and frequency of recognition of pre-existing HIV/AIDS diagnoses among inpatients with SMI. This study examines documentation rates of pre-existing HIV/AIDS among inpatients within psychiatric hospitals in New York State. DESIGN: Retrospective cohort study to examine recognition of pre-existing HIV/AIDS among psychiatric inpatients. METHODS: Patient-level Medicaid claims records were linked with hospital and regional data for people admitted to psychiatric inpatient units in New York State. Presence of HIV/AIDS diagnoses prior to psychiatric hospitalization was coded for each inpatient (n=14,602). Adjusted odds ratios (aORs) of undocumented HIV/AIDS diagnoses at the time of discharge were calculated using logistic regression analyses. RESULTS: 5.1% (741/14,602) of unique psychiatric inpatients had pre-existing HIV/AIDS diagnoses. Of these inpatients, 58.3% (432/741) were not coded as having HIV/AIDS upon discharge. Higher rates of missed detection were associated with younger age, non-Hispanic white race/ethnicity, shorter length of stay, more distal coding of an HIV/AIDS diagnosis, and fewer HIV/AIDS-related Medicaid claims in the past year. Hospitals with higher re-admission rates also had higher rates of undetected HIV/AIDS diagnoses. CONCLUSION: Over half of inpatients previously diagnosed with HIV/AIDS did not have their HIV-positive status noted upon discharge from psychiatric hospitalization. This finding underscores how frequently clinically significant medical comorbidities fail to be incorporated into psychiatric treatment and treatment planning. Inpatient clinicians are missing important opportunities to optimize HIV/AIDS treatment and reduce morbidity and mortality.

Synopsis Numerous reports describe how individual hospitals responded to the COVID-19 pandemic, but few describe how these changes occurred across a large public health system of care. As the early epicenter of the pandemic, New York State’s response, particularly the New York City metropolitan area, included a range of coordinated planning and regulatory efforts to preserve and create medical and intensive care unit capacity where needed; maintain access to acute psychiatric services; and redefine inpatient psychiatric care through strict infection control, easing of regulatory requirements, and use of telehealth. These strategies reflected similar efforts across the United States. Integration of public and not-for-profit hospital systems with each other and the residential and outpatient community remain key challenges.

Pea aphids (Acyrthosiphon pisum) are insects containing genes of bacterial origin with putative functions in peptidoglycan (PGN) metabolism. Of these,rlpA1-5,amiD, andldcAare highly expressed in bacteriocytes, specialized aphid cells that harbor the obligate bacterial symbiontBuchnera aphidicola, required for amino acid supplementation of the host’s nutrient-poor diet. Despite genome reduction associated with endosymbiosis, pea aphidBuchneraretains genes for the synthesis of PGN whileBuchneraof many other aphid species partially or completely lack these genes. To explore the evolution of aphid horizontally-transferred genes (HTGs) and to elucidate how host and symbiont genes contribute to PGN production, we sequenced genomes from four deeply branching lineages, such that paired aphid andBuchneragenomes are now available for 17 species representing eight subfamilies. We identified all host and symbiont genes putatively involved in PGN metabolism. Phylogenetic analyses indicate that each HTG family was present in the aphid shared ancestor, but that each underwent a unique pattern of gene loss or duplication in descendant lineages. While four aphidrlpAgene subfamilies show no relation to symbiont PGN gene repertoire, the loss of aphidamiDandldcAHTGs coincides with the loss of symbiont PGN metabolism genes. In particular, the coincident loss of hostamiDand symbiontmurCEFin tribe Aphidini, in contrast to tribe Macrosiphini, suggests either 1) functional linkage between these host and symbiont genes, or 2) Aphidini has lost functional PGN synthesis and other retained PGN pathway genes are non-functional. To test these hypotheses experimentally, we used cell-wall labeling methods involving ad-alanine probe and found that both Macrosiphini and Aphidini retainBuchneraPGN synthesis. Our results imply that compensatory adaptations can preserve PGN synthesis despite the loss of some genes considered essential for this pathway, highlighting the importance of the cell wall in these symbioses.

OBJECTIVE: This study examined whether communications between inpatient and outpatient mental health providers during patients’ inpatient stays were associated with attendance at post-hospital discharge appointments. METHODS: One-hundred-eighty-nine psychiatric inpatient medical records of Medicaid recipients at two hospitals were reviewed to document whether inpatient staff communicated with current or prior outpatient providers. Medicaid claims provided demographic, clinical, and outpatient attendance data. Analyses evaluated the association between provider communications and follow-up care for patients who had/had not received outpatient mental health care within 30 days prior to admission. RESULTS: Inpatient staff communicated with outpatient providers for 118 (62%) patients. For patients who did not receive outpatient care within 30 days of admission, communication was associated with increased odds of attending timely outpatient appointments post discharge (OR:2.73, 95% CI:1.09–6.84). CONCLUSIONS: Communicating with outpatient providers may be especially important for patients who were not engaged in outpatient care prior to admission.

Genome structural variations, including duplications, deletions, insertions, and inversions, are central in the evolution of eukaryotic genomes. However, structural variations present challenges for high-quality genome assembly, hampering efforts to understand the evolution of gene families and genome architecture. An example is the genome of the pea aphid (Acyrthosiphon pisum) for which the current assembly is composed of thousands of short scaffolds, many of which are known to be misassembled. Here, we present an improved version of the A. pisum genome based on the use of two long-range proximity ligation methods. The new assembly contains four long scaffolds (40–170 Mb), corresponding to the three autosomes and the X chromosome of A. pisum, and encompassing 86% of the new assembly. Assembly accuracy is supported by several quality assessments. Using this assembly, we identify the chromosomal locations and relative ages of duplication events, and the locations of horizontally acquired genes. The improved assembly illuminates the mode of gene family evolution by providing proximity information between paralogs. By estimating nucleotide polymorphism and coverage depth from resequencing data, we determined that many short scaffolds not assembling to chromosomes represent hemizygous regions, which are especially frequent on the highly repetitive X chromosome. Aligning the X-linked aphicarus region, responsible for male wing dimorphism, to the new assembly revealed a 50-kb deletion that cosegregates with the winged male phenotype in some clones. These results show that long-range scaffolding methods can substantially improve assemblies of repetitive genomes and facilitate study of gene family evolution and structural variation.

Financial therapy is used to address the psychological, emotional, and behavioral components involved in the process of learning and utilizing new financial literacy skills. This study describes the use of a manualized financial therapy financial therapy intervention, the Five-Step Model, as it is piloted in a group setting. Current economic theories support the use of an intervention model that differs from traditional financial literacy teachings. Behavioral economics and the Transtheoretical Model of Behavior Change is used as a foundation for the Five-Step Model. A case study illustrates the key principles and effectiveness of the intervention model. Reflections and feedback from the members of the group are provided, along with a discussion of implications and directions for further inquiry.

Background Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. Methods The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. Discussion Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. Trial registration www.ClinicalTrials.govNCT04247711. Registered 30 January 2020. Trial status The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).

Social determinants are receiving renewed attention as research demonstrates the effects of social factors on individuals’ physical and mental health and elucidates the biological and psychological mechanisms underlying those effects. Through spheres of influence from policy and regulation development to direct service provision, state mental health agencies are in a unique position to lead primary and secondary prevention efforts aimed at addressing social determinants with both client-level and structural-level interventions. A survey of social determinants-related activity was sent to the Medical Directors of the state offices of mental health in all 50 states. The survey results suggest consensus among respondents as to the importance of addressing specific social determinants. However, few state mental health agencies have taken on a comprehensive and intentional approach to addressing social determinants as a unique area of activity. Specific activities are reviewed, and implications for future work is discussed.

OBJECTIVE: Therapeutic benefits associated with early services for psychosis are influenced by the degree to which participants engage in treatment. The main objective of this review was to analyze rates of disengagement in early psychosis services and identify predictors of disengagement in these settings.METHODS: A systematic search for studies published in the 1966-2019 period was conducted in PubMed, Google Scholar, EBSCO, Ovid, and Embase. The Observational Cohort and Cross-Sectional Studies scale was used to assess the methodological quality of reports identified in this search. A revised version of the behavioral model of health service use was employed to evaluate and understand predictors of disengagement (categorized as predisposing, enabling, and need factors) identified in the studies with the highest quality.RESULTS: Twenty studies met the inclusion criteria. Disengagement rates (12% to 53%) and definitions of disengagement varied widely across these studies. Most did not find a compelling association between predisposing factors (e.g., age) and disengagement. Enabling factors, such as lack of family support and living alone, were consistently found to be related to increased disengagement across studies. Finally, need factors, such as lower medication adherence and higher drug misuse, were associated with higher risk for disengagement.CONCLUSIONS: Enabling and need factors seemed to be the most predictive of disengagement from early psychosis services. Substantial between-study variation in identified predictors of disengagement may be addressed by developing and applying a consensus definition of disengagement in future research.

Patients diagnosed with basal-like breast cancer suffer from poor prognosis and limited treatment options. There is an urgent need to identify new targets that can benefit patients with basal-like and claudin-low (BL-CL) breast cancers. We screened fractions from our Marine Invertebrate Compound Library (MICL) to identify compounds that specifically target BL-CL breast cancers. We identified a previously unreported trisulfated sterol, i.e., topsentinol L trisulfate (TLT), which exhibited increased efficacy against BL-CL breast cancers relative to luminal/HER2+ breast cancer. Biochemical investigation of the effects of TLT on BL-CL cell lines revealed its ability to inhibit activation of AMP-activated protein kinase (AMPK) and checkpoint kinase 1 (CHK1) and to promote activation of p38. The importance of targeting AMPK and CHK1 in BL-CL cell lines was validated by treating a panel of breast cancer cell lines with known small molecule inhibitors of AMPK (dorsomorphin) and CHK1 (Ly2603618) and recording the increased effectiveness against BL-CL breast cancers as compared with luminal/HER2+ breast cancer. Finally, we generated a drug response gene-expression signature and projected it against a human tumor panel of 12 different cancer types to identify other cancer types sensitive to the compound. The TLT sensitivity gene-expression signature identified breast and bladder cancer as the most sensitive to TLT, while glioblastoma multiforme was the least sensitive.

This chapter looks at the role of interventional pain treatments within a biopsychosocial approach to pain management. Interventions may be used both for diagnosis and for treatment. Indications and contraindications of procedures for spinal pain, neuropathic pain, and musculoskeletal pain are discussed. Common procedures—facet joint procedures, epidural procedures, and peripheral nerve blocks are covered. In addition, more advanced treatments including autonomic blocks, pulsed radiofrequency, Racz catheter epidurolysis, spinal endoscopy, capsaicin patch application, botoxin injections, spinal cord stimulation, and intrathecal pumps are covered. The importance of patient selection, of determining goals for interventions, of assessing outcomes, and of considering cost-effectiveness is discussed.

The names of faculty employed by the 76 member social work programs of the Group for the Advancement of Doctoral Education in Social Work were retrieved via a web-search. This resulted in a list of...

BackgroundBreast cancer is a heterogeneous disease. Genomic studies have revealed five different intrinsic subtypes - Luminal A, Luminal B, HER2-enriched, Claudin-low, and Basal-like. Patients diagnosed with Basal-like or Claudin-low breast cancer (BL-CL) suffer from poor prognosis and limited treatment options. Hence, there is an urgent need to identify a new therapeutic lead that can benefit patients with BL-CL breast cancer.MethodsWe used a step-wise screening approach to screen 2778 HP20 fractions from our Marine Invertebrate Compound Library (MICL) to identify compounds that specifically target BL-CL breast cancer. We also performed biochemical investigations to study the effect of the compound in the signaling pathway. Finally, we generated a drug response gene-expression signature and projected it against a human tumor panel of 12 different cancer types to identify other cancer types sensitive to the compound.ResultsWe identified a previously unreported trisulfated sterol, topsentinol L trisulfate (TLT) that exhibits increased efficacy against BL-CL relative to Luminal/HER2+ breast cancer. Biochemical investigation of the effects of TLT on BL-CL revealed its ability to inhibit activation of AMPK and CHK1 and promote activation of p38. The importance of targeting AMPK and CHK1 in BL-CL was validated by treating a panel of breast cancer cell lines with known small molecule inhibitors of AMPK (Dorsomorphin) and CHK1 (Ly2603618) and recording the increased effectiveness against BL-CL compared to Luminal/HER2+ breast cancer. The TLT sensitivity gene-expression signature identified breast and bladder cancer as the most sensitive to TLT while glioblastoma multiforme as least sensitive.ConclusionsOur study identified TLT, a previously uncharacterized trisulfated sterol, as a potential therapeutic selective against BL-CL. Our results also showed that inhibition of AMPK and/or CHK1 might be an effective therapy in BL-CL.

The prevalence of smoking is higher among individuals with serious mental illnesses than the general population. Evidence-based practices exist for tobacco cessation, but little is known about mental health clinics' tobacco cessation treatment practices/protocols. Mental health clinics in New York State were surveyed about their tobacco use treatment protocols and outdoor-smoking policies. One-third of clinics were not providing individual counseling for tobacco use disorder, 39% were not prescribing nicotine replacement therapy, and nearly half reported not prescribing bupropion or varenicline. Even smaller proportions reported implementing other clinical practice guidelines, with only 25.2% providing staff training and 20.3% having a dedicated staff member for coordinating tobacco use disorder treatment. Regarding outdoor smoke-free policies, 38% of clinics reported not allowing any tobacco use anywhere on grounds. Despite some successes, many clinics do not provide evidence-based tobacco use treatments, meaning important opportunities exist for mental health clinics and oversight agencies to standardize practices.

Objective This study examined a cohort of 15,520 inpatient psychiatric discharges to determine associations between scheduling an outpatient mental health appointment as part of discharge planning and attending outpatient care following discharge after control for patient, hospital, and system characteristics. Methods 2012-2013 New York State Medicaid and other administrative databases were used to examine patients who were aged under 65 years, admitted to an inpatient psychiatric unit, and discharged to the community. Outcomes included attending an outpatient mental health service within 7 and 30 days following inpatient discharge. Scheduling a mental health outpatient appointment as part of the discharge plan was the primary predictor variable, and potentially confounding covariates were addressed by adjusting for propensity scores estimating the likelihood of having an outpatient appointment scheduled. Results Among 15,520 discharged patients, 11,945 (77%) had an outpatient appointment scheduled with a mental health provider as part of their discharge planning. After adjustment for propensity scores, patients who had an outpatient appointment scheduled were significantly more likely to attend an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) compared to patients who did not have an appointment scheduled. Even among those with a low propensity to have an appointment scheduled, scheduling an outpatient appointment was associated with attending outpatient services. Conclusions Scheduling an outpatient mental health appointment is an effective and low-resource discharge planning practice that should be an important target for inpatient psychiatric clinical quality measurement and improvement.

The current study aimed to describe financial well-being and physical health-related quality of life (HRQoL) in a convenience sample of incarcerated persons attenuated by gender and minorit...

Purpose This study builds on previous investigations on the scholarship of social work faculty using h-index scores. The purpose of this paper is to compare two methods of determining the excellence of social work doctoral programs. Design/methodology/approach This study compared rankings in 75 social work doctoral programs using h-index vs the US News and World Report (USNWR) list. The accuracy of predicting scholarly productivity from USNWR rankings was determined by joint membership in the same quantile block. Information on USNWR rankings, h-index, years of experience, academic rank, and faculty gender were collected. Regression analysis was used in creating a predictive model. Findings Only 39 percent of USNWR rankings accurately predicted which programs had their reputation and scholarly productivity in the same rating block. Conversely, 41 percent of programs had reputations in a higher block than their scholarly productivity would suggest. The regression model showed that while h-index was a strong predictor of USNWR rank (b=0.07, 95% CI: 0.05, 0.08), additional variance was explained by the unique contributions of faculty size (b=0.01, 95% CI: 0.01, 0.02), college age (b=0.002, 95% CI: b=−0.22, 95% CI: −0.39, −0.06). Originality/value For many programs, reputation and scholarly productivity coincide. Other programs have markedly different results between the two ranking systems. Although mean program h-indices are the best predictor of USNWR rankings, caution should be used in making statements about inclusion in the “top 10” or “top 20” programs.

Chemistry drives many biological interactions between the microbiota and host animals, yet it is often challenging to identify the chemicals involved. This poses a problem, as such small molecules are excellent sources of potential pharmaceuticals, pretested by nature for animal compatibility. We discovered anti-HIV compounds from small, marine tunicates from the Eastern Fields of Papua New Guinea. Tunicates are a reservoir for novel bioactive chemicals, yet their small size often impedes identification or even detection of the chemicals within. We solved this problem by combining chemistry, metagenomics, and synthetic biology to directly identify and synthesize the natural products. We show that these anti-HIV compounds, the divamides, are a novel family of lanthipeptides produced by symbiotic bacteria living in the tunicate. Neighboring animal colonies contain structurally related divamides that differ starkly in their biological properties, suggesting a role for biosynthetic plasticity in a native context where biological interactions take place.

Social work clients need financial literacy skills. Many clients are faced with the task of overcoming increasingly complex and challenging financial obstacles that can take a dire toll on their physical and environmental stability and mental well-being. Social workers who lack skills in financial literacy are at a disadvantage when helping their clients overcome economic hardships. Financial therapy is an emerging intervention that merges techniques of psychotherapy with financial education. This integrated approach can be used by social workers in generalist settings to promote financial problem solving. Few baccalaureate social work (BSW) programs provide students with education about financial problem solving from this angle. A curriculum model and overview of a pilot course introducing BSW students to a manualized form of this approach is presented. Overall, students found the course beneficial and expressed interest in using this intervention in practice. Student feedback is reviewed, along with directions for further study.

OBJECTIVE The study aimed to clarify the potential role and impact of behavioral health peer support providers on community hospital acute inpatient psychiatric units. METHOD Qualitative interviews were conducted to examine perspectives of peer support providers (peers) and individuals who initially received peer services (recipients) during an inpatient stay on a community hospital psychiatric unit. Interviews elicited perspectives on interactions between peers and recipients, the role of peers vis-a-vis the clinical treatment team, and involvement of peers in discharge planning and transitions to community-based care. Fourteen interviews were completed (6 peers and 8 recipients of peer services); all were recorded, transcribed, and coded using a thematic analysis approach. RESULTS Emergent themes were grouped into 3 domains: (a) initial impressions and client engagement, (b) peer interventions to support discharge planning, and (c) shared or sharing experiences in an inpatient setting. Recipients described inpatient experiences as disempowering and humiliating and reported powerful positive initial reactions to peers who had had similar experiences but who also displayed competence and professionalism. Peers and recipients described strong emotional connections that differed from traditional attitudes and relationships with clinical staff. Peers described challenges and obstacles related to interactions with the clinical treatment team, and both peers and recipients strongly endorsed the role of peers in facilitating successful care transitions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Behavioral health peers can play important roles in acute inpatient psychiatric care, supplementing clinical treatment team activities and filling important gaps related to engagement, discharge planning, and care transitions. (PsycINFO Database Record

This article discusses a case study implementing a manualized financial therapy intervention in an online setting. The benefits of financial therapy are discussed, and the pros and cons of online therapy are contrasted. A description the intervention is provided. At the conclusion of the intervention, the client and other family members reported satisfaction with this form of therapy. Using financial therapy in an online format may help reduce the service barriers that are often encountered by requiring therapy sessions to be conducted in-person, thus providing wider access to low-income clients who are most in need of these types of interventions.

A manualized form of financial therapy for families is proposed to decrease tensions caused by conflict arising on family members' understanding of money. When used with families, financial therapy goes beyond financial education by addressing individual behaviors and attitudes toward personal finance within the dynamics of a family system. To address a therapist's lack of formal training in family systems and/or financial therapy, a manualized form of financial therapy is introduced. A case example is presented to illustrate the benefits of this approach. This article demonstrates that therapists can use a manualized format of financial therapy for families to promote positive changes in a family's dynamics and behaviors in regards to finances.

Background Scheduling timely appointments for outpatient follow-up care is a discharge planning practice widely accepted as a standard of care for inpatient treatment. Despite these endorsements, however, rates of hospital providers completing these practices vary widely. Timely scheduling of initial outpatient visits following discharge has been associated with improved rates of attending outpatient psychiatric services, although negative findings have also been reported. Nearly all prior studies were single-site case reports that did not use an experimental design and more rigorous research is needed. In this report, we aimed to examine the association between receiving care transition practices and attending outpatient care after controlling for patient, hospital, and system characteristics in a large cohort of inpatient psychiatric admissions in New York State. We hypothesized that patients for whom hospital providers scheduled a mental health outpatient appointment had a higher likelihood of receiving an initial outpatient psychiatric service following discharge after controlling for the aforementioned covariates. Methods This is a retrospective cohort study that used 2012–2013 New York State Medicaid claims data for psychiatric inpatients, who were under 65 years, admitted to an inpatient psychiatric unit with a principal diagnosis of a mental disorder and discharged to the community. The outcome variable was defined as attending to outpatient psychiatric services within 7 and 30 days following discharge from an inpatient psychiatric unit. Scheduling a mental health outpatient appointment as a discharge planning was the primary independent variable. To address the wide range of potentially confounding covariates, propensity scores for regression models were estimated based on patient, hospital, and service system factors. Results Before matching by propensity scores, those who had an outpatient mental health appointment scheduled were less likely to be homeless at admission, have a co-occurring substance use diagnosis, and live in large central metro areas, and were more likely to be previously engaged in psychiatric outpatient services. After matching, however, most systematic differences between those who had and those who did not have a mental health outpatient appointment scheduled were substantially diminished (standardized differences of In the adjusted models including propensity scores, patients who had a mental health outpatient appointment scheduled were more likely to be in treatment in aftercare services compared to patients who did not have an outpatient appointment at both 7 and 30 days following discharge. Discussion Scheduling an outpatient mental health appointment increases aftercare attendance following a psychiatric discharge. This effect was noted across all 5 propensity strata, indicating that discharge planning has a positive impact regardless of the presence of other factors highly predictive of failure to attend aftercare appointments.

Objective Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings. Methods Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses. Results 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18–24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35–0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals. Conclusions A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.

Involving family in the care of inpatients with serious mental illness is known to be beneficial. This study examined frequencies of involvement by family in the care and discharge planning for 179 psychiatric inpatients.Involvement by family in care and discharge planning was assessed from randomly selected medical records of inpatients with Medicaid and severe mental illness at two New York hospitals from 2012 to 2013. "Family" also included anyone close to the patient who provided support. Medicaid claims were reviewed for patient demographic and clinical characteristics and for postdischarge outpatient attendance data. Multiple regression models were used to test whether involvement by family was associated with comprehensive discharge planning (contacting outpatient providers, scheduling follow-up appointments, and forwarding a discharge summary to a provider) and initiation of outpatient treatment.Inpatient staff contacted a family member for 134 (75%) patients. Sixty-seven (37%) patients received comprehensive discharge planning, and 96 (53%) and 139 (78%) attended an outpatient appointment within 7 and 30 days of discharge, respectively. Inpatient staff contacting family, communicating about the patient's health and/or mental health, and communicating about the discharge plan were significantly associated with entry into follow-up care by 7 and 30 days postdischarge. Family phone calls and/or visits with patients, attendance at family therapy sessions, and communication with inpatient staff about services available to families were significantly associated with patients receiving comprehensive discharge planning. When analyses controlled for demographic and clinical factors, having any involvement between family members and inpatient staff was significantly associated with patients' attending an outpatient appointment by 7 days (odds ratio [OR]=2.79, 95% confidence interval [CI]=1.28-6.08) or 30 days (OR=3.07, 95% CI=1.29-7.32) after discharge.The association of family involvement with comprehensive discharge planning and prompt entry into outpatient care underscores the importance of family contact and communication with staff during inpatient hospitalizations.

Early intervention services for psychotic disorders were first tested in Australia and Europe in the 1990s. These efforts stimulated interest to develop early intervention programs in the United States and in 2016 the National Institute of Mental Health identified a treatment model called Coordinated Specialty Care (CSC). This team-based approach includes psychotherapy, medication management, family education and support, case management, and work or education support, and is the foundation for nationwide efforts to support early intervention services for individuals with a first episode psychosis (FEP). This chapter focuses on the following key policy questions related to early intervention services for FEP and in particular the CSC model: What has been the impact of CSC programs? What strategies can most effectively support implementation of these programs? How should quality of care be assessed in CSC programs? and How can they be financially sustained? For each area, specific questions are posed, prior relevant studies are summarized, and future directions for research are proposed along with recommendations for policy makers. Other key issues reviewed include the importance of decreasing the duration of untreated psychosis, whether CSC programs should be offered to clinical high-risk populations before the advent of psychosis, and strategies for sustaining good outcomes following receipt of CSC services.

As coordinated specialty care for first-episode psychosis is implemented nationally, questions arise regarding financial sustainability. To address this, New York State undertook a time study in which 13 coordinated specialty care sites reported all activities provided to 75 randomly selected Medicaid clients with first-episode psychosis over a 2-week period. The average estimated cost was $1,375 per client per month, yet under optimal billing conditions, estimated revenues were only $662 per client per month, or 48% of the costs. These results underscore the need for continued subsidies and novel payment schemes for coordinated specialty care.

Results from the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH) have indicated that approximately 8% of responding adolescents ages 12–17 engaged in illicit substance use during the past year; the most commonly reported substance used was marijuana (Substance Abuse and Mental Health Services Administration (SAMHSA), NSDUH series H-44, HHS publication no. (SMA) 12-4713, Substance Abuse and Mental Health Services Administration, Rockville, MD, 2012). Importantly, marijuana use places adolescents at risk of arrest when found in possession of cannabis. Drug abuse violations are associated with multiple consequences for the youth, their families, and communities. Policy makers, therefore, have encouraged the use of civil citations to reduce drug abuse related arrests for youth. Purpose: The current study sought to identify and describe civil citations use for youth marijuana possession. Methods: Using a secondary dataset, we examined aggregate arrests in a Central Florida county. Results: During a 3-year period, 1635 arrests were made for cannabis possession. The vast majority of such arrests were for multiple charges (n = 1272; 78%). For those arrested due to cannabis possession alone (n = 363; 22%), over 75% were adults (n = 281). Therefore, only 82 youth were arrested under the charge, accounting for less than one quarter of all arrests for F.S. §893.13.6b (2013). However, the majority of these youth were detained in juvenile assessment centers (65%, n = 59); a rate markedly higher than their adult counterparts (37%, n = 105). Discussion: Due to the concerns associated with arrest and detainment, the authors contend efforts should be made to increase use of civil citations for youth with cannabis possession when possible. Implications for policy are presented.

The introduction of prevention-oriented financial therapy in foster care is presented. Consideration of emotional demands in financial literacy and therapy is examined and remedies provided that address them. Revisions to the five-step model of financial therapy are considered in terms of the needs of foster care client populations. A pared down prevention model provides aging out foster children with a means of successfully navigating lifestyle challenges. The need to empirically evaluate the prevention model is advised to demonstrate its value with this population.

This study examined discharge planning practices by hospital providers for 17,053 psychiatric discharges in New York's statewide Medicaid program.Claims data were linked to information reported to New York State by managed behavioral health care organizations (MBHOs) conducting inpatient utilization reviews. MBHOs documented hospital providers' reports of the presence of three discharge planning practices for each discharge: communicating with an outpatient provider prior to discharge, scheduling an aftercare appointment, and forwarding a discharge summary.Hospital providers reported completing at least one of the three discharge planning practices for 85% of discharges. Individuals who received all three discharge planning practices had a higher likelihood of follow-up and kept their first outpatient follow-up visit at almost twice the speed compared with individuals who received none of the practices (hazard ratio=1.96, p.001).This study provided baseline information concerning routine discharge planning practices and their relationship to timeliness of care transitions.

This paper explores the official and social connections of Xu Mi 許謐 (303-376), one of the founders of the Shangqing 上清 or Higher Clarity movement in Daoism, with the aim of developing a clearer narrative for what was occurring in his social network in the 360s, around the time that his spirit-medium Yang Xi 楊羲 (330-386) was having his visions. Although certain aspects of these connections have been explored by scholars such as Yoshikawa Tadao (1998) and Kamitsuka Yoshiko (1999), among others, these do not fully explain how a relatively minor official like Xu Mi, together with Yang Xi, could attract a steady stream of highranking official visitors seeking advice, medicines, and scriptures, as described in the eighth fascicle of Zhen’gao . This paper examines the life and extensive connections of Xi Mi’s older brother Xu Mai 許邁 (b. 301), as well as both Xu Mai and Yang Xi’s connections with Sima Yu 司馬昱 (320-372) when the latter was still Prince of Kuaiji 會稽 before becoming Emperor Jianwen of Jin 晉簡文帝 (r. 372). It also examines a hitherto overlooked historical record of Xu Mi’s participation in a court debate, which illustrates one way in which Xu Mi was attempting to give support to the Sima family. With this background, the paper then analyzes the list of Xu Mi’s visitors. A recent archaeological discovery also sheds new light on a connection between two of these visitors. This paper concludes that Xu Mi’s visitors were drawn to his home after Yang Xi, during his brief service under Sima Yu, had convinced them of his abilities through a very public demonstration of his spiritual powers. Furthermore, several of these visitors were already putting the new Higher Clarity teachings into practice when they asked for assistance.

This study examined the adherence of psychiatrists to the Schedule of Recommended First and Second Line Antipsychotic Medications ("Antipsychotic Schedule"), which was implemented in two Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program Implementation and Evaluation Study clinics.Sixty-five individuals with a first episode of psychosis were enrolled in the RAISE Connection Program clinics. Two psychiatrists received training and ongoing consultation on use of a shared decision-making approach to prescribing antipsychotic medications according to the Antipsychotic Schedule. Information about participants, prescribed antipsychotic medications, and completion of side-effect assessments were obtained from standardized research assessments and chart extractions. Descriptive statistics were used to characterize the extent to which patterns of antipsychotic prescribing and side-effect monitoring were consistent with the Antipsychotic Schedule.Ninety-two percent of participants were prescribed an antipsychotic medication and received the medication on 76%±35% of the days they were in treatment. Seventy-seven percent of participants were prescribed at least one Antipsychotic Schedule first-line antipsychotic, 20% were prescribed olanzapine, and 10% received a trial of clozapine. Regarding monitoring for metabolic side effects, 92% of participants had at least one weight recorded, 72% had at least one blood glucose measure recorded, and 62% had at least one lipid profile recorded.In the context of a study in which training and ongoing clinical supervision by experts was provided to psychiatrists and shared decision making was encouraged, antipsychotic prescribing patterns closely adhered to recommendations established by the RAISE Connection Program.

OnTrackNY is a coordinated specialty care program that delivers early intervention services to youths experiencing a first episode of nonaffective psychosis. Treatment aims to help individuals improve their mental health and achieve personal goals related to work, school, and social relationships. This column describes OnTrackNY's progression from a research project to real-world implementation. The authors describe the treatment model, approach to training and dissemination, and procedures for collecting and sharing data with OnTrackNY teams and provide data on client characteristics and selected outcomes.

The New York State Medicaid program is pursuing reforms that would shift reimbursement from fee-for-service to value-based models. Behavioral health populations and services are key to these reforms, but important gaps exist in the breadth and relevance of available quality measures for the behavioral health field. This column describes how the state addressed these gaps by using both inter- and intra-agency collaborations. As part of this effort, the state convened a panel of consultants, including academics, providers, and consumers, to develop a behavioral health quality measurement agenda. Panel recommendations and ongoing partnerships are described as a model for states considering similar value-based reform initiatives.

Chapter details how the proliferation of imperial progressivism in transatlantic reformer discourse was seized upon by Pan-African activists at the turn of the twentieth century, in order to challenge the harsh dichotomy of the ethnographic other, claim subjectivity for African peoples, and invoke a host of expansive rights central to valid and meaningful participation in modern society. It also briefly discusses Pan-Africanism during the interwar years, notably the participation of many activists in a burgeoning transatlantic print culture. The chapter argues that while turn-of-the-century Pan-African activism did not stop imperialism, racialized violence, paternalism, or crass racism, it did establish a recognisable transatlantic network which helped to keep alive the promise of humanist equality and laid the groundwork for later activism that continued to challenge its deferment.

This study prospectively evaluated outcomes of OnTrackNY, a statewide coordinated specialty care (CSC) program for treatment of early psychosis in community settings, as well as predictors of outcomes.The sample included 325 individuals ages 16-30 with recent-onset nonaffective psychosis who were enrolled in OnTrackNY and who had at least one three-month follow-up. Clinicians provided data at baseline and quarterly up to one year. Domains assessed included demographic and clinical characteristics, social and occupational functioning, medications, suicidality and violence, hospitalization, and time to intervention. Primary outcomes included the symptoms, occupational functioning, and social functioning scales of the Global Assessment of Functioning (GAF), as adapted by the U.S. Department of Veterans Affairs Mental Illness Research, Education and Clinical Center; education and employment status; and psychiatric hospitalization rate.Education and employment rates increased from 40% to 80% by six months, hospitalization rates decreased from 70% to 10% by three months, and improvement in GAF scores continued for 12 months. Female gender, non-Hispanic white race-ethnicity, and more education at baseline predicted better education and employment status at follow-up.Individuals with early psychosis receiving CSC achieved significant improvements in education and employment and experienced a decrease in hospitalization rate. Demographic variables and baseline education predicted education and employment outcomes. CSC teams should make particular effort to support the occupational goals of individuals at increased risk of not engaging in work or school, including male participants and participants from racial and ethnic minority groups.

Conflicts over finances are a key reason why marital relationships dissolve. Financial literacy interventions provide a strategy to ameliorate this conflict. Because financial literacy interventions have a mixed history of success, a new model of financial counseling is presented. The model described in this article has three components: transtheoretical indicators of readiness for change, solution-focused therapeutic techniques in negotiating the stages of change, and a five step model of financial therapy. Implications for refining the practice model are given.