... collaborative depression care in a specialty physical health clinic setting with a population that has a high prevalence of depression and mental health comorbidity. The paper describes: the formative evaluation conducted prior to implementation; the process used to adapt the primary care collaborative care model for depression to specialty HIV clinics; and the intervention itself. Baseline assessments were
This paper describes the evaluation of collaborative depression care in HIV clinics in a project called HIV Translating Initiatives for Depression into Effective Solutions (HITIDES), a randomised trial in United States Department of Veterans Affairs HIV clinics comparing the depression collaborative care intervention to usual depression care. The HITIDES study provided the opportunity to evaluate collaborative depression care in a specialty physical health clinic setting with a population that has a high prevalence of depression and mental health comorbidity. The paper describes: the formative evaluation conducted prior to implementation; the process used to adapt the primary care collaborative care model for depression to specialty HIV clinics; and the intervention itself. Baseline assessments were completed by 249 depressed HIV participants. Summaries of key interviews with eight HIV patients who were receiving depression treatment and 25 HIV or mental health providers were presented to each site. Evidence-based quality improvement methods were used to tailor the HITIDES intervention to each site while following the evidence base for depression collaborative care.
Subject terms:
HIV AIDS, intervention, multidisciplinary services, depression, evaluation, health care, comorbidity;
Children and Youth Services Review, 108, 2020, p.104606.
Publisher:
Elsevier
Background: Several challenges exist when making a diagnosis of Fetal Alcohol Spectrum Disorder (FASD) and identifying co-morbid psychiatric illness, particularly for children and youth accessing child welfare services. Here, the study describes an integrated three-phase approach to the identification of FASD and psychiatric co-morbidity for children and youth in care, consisting of: (1) completion of a standardised neurobehavioral screening tool by a child protection worker (CPW); (2) assessment by a paediatrician, including facial measurements and; (3) integration of findings in a psychiatric assessment. Main Findings: The majority of participants (14/18, 78%) of youth who were suspected by a CPW and paediatrician of a diagnosis of FASD using the screening tool were determined to have met criteria. A diagnosis was made in all cases where there was confirmed history of prenatal exposure and a majority of these youth were found to have sentinel facial features of FASD. Psychiatric co-morbidity was diagnosed and treatment recommendations made for all children and youth referred. Conclusions: This study supports the utility of an integrated community approach to diagnosing and treating co-morbid psychiatric disorders in FASD by employing existing child protection and physician services in a community setting. Based on these preliminary findings, the study encourages that youth who access formal care systems be screened for FASD by their CPW and are provided with appropriate paediatric and psychiatric assessments to clarify the diagnosis, while also identifying co-morbid psychiatric illness to target appropriate interventions.
(Edited publisher abstract)
Background: Several challenges exist when making a diagnosis of Fetal Alcohol Spectrum Disorder (FASD) and identifying co-morbid psychiatric illness, particularly for children and youth accessing child welfare services. Here, the study describes an integrated three-phase approach to the identification of FASD and psychiatric co-morbidity for children and youth in care, consisting of: (1) completion of a standardised neurobehavioral screening tool by a child protection worker (CPW); (2) assessment by a paediatrician, including facial measurements and; (3) integration of findings in a psychiatric assessment. Main Findings: The majority of participants (14/18, 78%) of youth who were suspected by a CPW and paediatrician of a diagnosis of FASD using the screening tool were determined to have met criteria. A diagnosis was made in all cases where there was confirmed history of prenatal exposure and a majority of these youth were found to have sentinel facial features of FASD. Psychiatric co-morbidity was diagnosed and treatment recommendations made for all children and youth referred. Conclusions: This study supports the utility of an integrated community approach to diagnosing and treating co-morbid psychiatric disorders in FASD by employing existing child protection and physician services in a community setting. Based on these preliminary findings, the study encourages that youth who access formal care systems be screened for FASD by their CPW and are provided with appropriate paediatric and psychiatric assessments to clarify the diagnosis, while also identifying co-morbid psychiatric illness to target appropriate interventions.
(Edited publisher abstract)
Subject terms:
foetal alcohol syndrome, comorbidity, looked after children, diagnosis, treatment, mental health, pregnancy, psychiatry, children, young people, assessment, child protection, health professionals, community health care, multidisciplinary services;
... pathways and interventions; treating comorbidity; and planned completion and transfer of care.
These standards were written to support the response that young people with substance misuse problems and other co-existing difficulties receive from a wide range of practitioners, workers, professionals and services. They bring together guidance based on the available evidence and emphasise the need for a sensitive, non-judgemental and collaborative approach to identifying risk, assessing all needs, and offering help and support. Because complexity is common there is a strong focus on multi-agency approaches. The importance of developing trusting relationships, involving young people’s family or carers, and working with practitioners who are already engaged with the young person is promoted and highlighted throughout. The standards were developed in consultation with stakeholders across health, education, social and voluntary sectors. They were also informed by consultations with the young advisors for the CAMHS standards developed at the Royal College of Psychiatrists College for Quality Improvement (CCQI). Topics covered in the standards include: identification and brief assessment; misuse screening and assessment instruments; interviewing young people; integrated care planning, pathways and interventions; treating comorbidity; and planned completion and transfer of care.
Subject terms:
multidisciplinary services, smoking, social work approaches, staff-user relationships, standards, young people, assessment, alcohol misuse, care planning, drug misuse, families, comorbidity;
International Journal of Geriatric Psychiatry, 26(7), July 2011, pp.758-764.
Publisher:
Wiley
Depressed patients with comorbid PTSD are more functionally impaired and may take longer to respond to treatment than those without PTSD. This study examined the long-term effects of PTSD on depression severity, treatment response, and health care costs among older adults. Patients were recruited from 18 primary care clinics in five US states. A total of 1801 patients aged 60 years or more with major depression or dysthymia were randomised to Improving Mood Promoting Access to Collaborative Treatment (IMPACT), a stepped care approach delivered by a multidisciplinary team, or usual care; 191 (10.6%) of subjects screened positive for PTSD. Depression severity (Hopkins Depression Symptom Checklist) was used to estimate depression-free days (DFDs) over 24 months. Total health care costs included inpatient, outpatient, and pharmacy costs. Comorbid patients had greater depression severity than patients without PTSD symptoms at baseline. Over 2 years, intervention patients with PTSD symptoms had similar benefits from collaborative care (99 more DFDs than usual care patients) as patients without PTSD (108 more DFDs than usual care). Total health care costs did not differ significantly between the groups. Depressed older adults with PTSD symptoms were more depressed at baseline, but collaborative care (compared to usual care) produced similar improvements in depression severity in both groups.
Depressed patients with comorbid PTSD are more functionally impaired and may take longer to respond to treatment than those without PTSD. This study examined the long-term effects of PTSD on depression severity, treatment response, and health care costs among older adults. Patients were recruited from 18 primary care clinics in five US states. A total of 1801 patients aged 60 years or more with major depression or dysthymia were randomised to Improving Mood Promoting Access to Collaborative Treatment (IMPACT), a stepped care approach delivered by a multidisciplinary team, or usual care; 191 (10.6%) of subjects screened positive for PTSD. Depression severity (Hopkins Depression Symptom Checklist) was used to estimate depression-free days (DFDs) over 24 months. Total health care costs included inpatient, outpatient, and pharmacy costs. Comorbid patients had greater depression severity than patients without PTSD symptoms at baseline. Over 2 years, intervention patients with PTSD symptoms had similar benefits from collaborative care (99 more DFDs than usual care patients) as patients without PTSD (108 more DFDs than usual care). Total health care costs did not differ significantly between the groups. Depressed older adults with PTSD symptoms were more depressed at baseline, but collaborative care (compared to usual care) produced similar improvements in depression severity in both groups.
Subject terms:
long term outcomes, multidisciplinary services, older people, post traumatic stress disorder, primary care, treatment, therapy and treatment, collaboration, cost effectiveness, dementia, comorbidity;
British Journal of Psychiatry, 183(10), October 2003, pp.304-313.
Publisher:
Cambridge University Press
Improved management of mental illness and substance misuse comorbidity is a National Health Service priority, but little is known about its prevalence and current management. This research measures the prevalence of comorbidity among patients of community mental health teams (CMHTs) and substance misuse services, and to assess the potential for joint management. Of CMHT patients, 44% (95% CI 38.1-49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2-80.2) of drug service and 85% of alcohol service patients (95% CI 74.2-93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention. Comorbidity is highly prevalent
Improved management of mental illness and substance misuse comorbidity is a National Health Service priority, but little is known about its prevalence and current management. This research measures the prevalence of comorbidity among patients of community mental health teams (CMHTs) and substance misuse services, and to assess the potential for joint management. Of CMHT patients, 44% (95% CI 38.1-49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2-80.2) of drug service and 85% of alcohol service patients (95% CI 74.2-93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention. Comorbidity is highly prevalent in CMHT, drug and alcohol treatment populations, but may be difficult to manage by cross-referral psychiatric and substance misuse services as currently configured and resourced.
Subject terms:
intervention, mental health problems, multidisciplinary services, psychiatry, social care provision, alcohol misuse, community mental health services, community mental health teams, diagnosis, drug misuse, dual diagnosis, comorbidity;
The purpose of this research was to determine if differences in service use exist between dementia patients with and without psychiatric comorbidity. Examination of 2-year health service use revealed that, after adjusting for demographic and medical comorbidity differences, dementia patients with psychiatric comorbidity had increased medical and psychiatric inpatient days of care and more psychiatric outpatient visits compared with patients without psychiatric comorbidity. A coordinated system of care with interdisciplinary teamwork may provide both cost-effective and optimal treatment for dementia patients.
The purpose of this research was to determine if differences in service use exist between dementia patients with and without psychiatric comorbidity. Examination of 2-year health service use revealed that, after adjusting for demographic and medical comorbidity differences, dementia patients with psychiatric comorbidity had increased medical and psychiatric inpatient days of care and more psychiatric outpatient visits compared with patients without psychiatric comorbidity. A coordinated system of care with interdisciplinary teamwork may provide both cost-effective and optimal treatment for dementia patients.
Subject terms:
joint working, intermediate care, mental health problems, multidisciplinary services, older people, hospital readmission, acute psychiatric care, dementia, diagnosis, health care, comorbidity;