39 results on '"Leff HS"'
Search Results
2. Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness.
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Cook JA, Razzano LA, Burke-Miller JK, Blyler CR, Leff HS, Mueser KT, Gold PB, Goldberg RW, Shafer MS, Onken SJ, McFarlane WR, Donegan K, Carey MA, Kaufmann C, and Grey DD
- Abstract
Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors. Individuals with any comorbidity had lower earnings and were less likely to work competitively. Those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impair ment, and human immunodeficiency virus/acquired immuno-deficiency syndrome. The experimental condition was positively related to all outcomes except disclosure. The results suggest that, with some exceptions, comorbidities affect employment outcomes, requiring tailored services and supports to promote vocational success. [ABSTRACT FROM AUTHOR]
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- 2007
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3. Demographic characteristics and employment among people with severe mental illness in a multisite study.
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Burke-Miller JK, Cook JA, Grey DD, Razzano LA, Blyler CR, Leff HS, Gold PB, Goldberg RW, Mueser KT, Cook WL, Hoppe SK, Stewart M, Blankertz L, Dudek K, Taylor AL, and Carey MA
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People with psychiatric disabilities experience disproportionately high rates of unemployment. As research evidence is mounting regarding effective vocational programs, interest is growing in identifying subgroup variations. Data from a multisite research and demonstration program were analyzed to identify demographic characteristics associated with employment outcomes, after adjusting for the effects of program, services, and study site. Longitudinal analyses found that people with more recent work history, younger age, and higher education were more likely to achieve competitive employment and to work more hours per month, while race and gender effects varied by employment outcome. Results provide strong evidence of demographic subgroup variation and need. [ABSTRACT FROM AUTHOR]
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- 2006
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4. Estimated payments to employment service providers for persons with mental illness in the Ticket to Work program.
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Cook JA, Leff HS, Blyler CR, Gold PB, Goldberg RW, Clark RE, Onken SJ, Shafer MS, Blankertz LE, McFarlane WR, Razzano LA, and Burke-Miller JK
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OBJECTIVE: The Ticket to Work and Work Incentives Improvement Act of 1999 removes work disincentives and promotes access to vocational services for people with disabilities. This study calculated the amount of payments that would have been made to employment service providers if study participants had been enrolled in the Ticket program. METHODS: Data were from 450 Social Security Disability Insurance beneficiaries with psychiatric disabilities enrolled in a multisite study of supported employment. Earnings over two years were used to calculate provider payments under two reimbursement formulas used in the Ticket program. RESULTS: Only a quarter of service recipients (26 percent) reached earnings levels that would have triggered provider payments under the first reimbursement formula. Only 4 percent would have completed their trial work period and left the rolls, generating payments under the second formula. CONCLUSIONS: The current provider payment systems of the Ticket to Work program do not reflect the reality of rehabilitation for individuals with severe mental illness. Reforms should take into account outcomes of return-to-work services for this population. [ABSTRACT FROM AUTHOR]
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- 2006
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5. Measuring service system implementation in a public mental health system through provider descriptions of employment service need and use.
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Leff HS and Wise M
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In a provider survey, 6654 consumers of mental health services were sampled from a public mental health system. Case managers or other principal clinicians completed forms for sampled consumers, providing data on services ideally needed and used by these consumers during a specified month. Data were analyzed for individual services and service groupings identified by cluster analysis. Field staff judged 47% of all persons in a public mental health service as needing one or more employment related services. According to the perceptions of field staff, only 22% of persons actually received employment services. The congruence between perceptions of amounts of service needed and received across all employment services (an indicator of service appropriateness) was 34%. Four service clusters were identified: skills training; TEP/Clubhouse, supported employment, and minimal services. Data on the congruence between prescribed and provided cluster are also presented. To the degree that the public mental health system studied is representative, these data indicate a need for increasing the amount of employment service received by persons in public mental health systems. [ABSTRACT FROM AUTHOR]
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- 1995
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6. Integration of mental health care and supported employment.
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Rosenheck R, Cook JA, Razzano LA, Pickett-Schenk SA, Grey DD, Lehman AF, McFarlane WR, Gold PB, Leff HS, Blyler C, Toprac MG, Blankertz L, and Shafer M
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- 2006
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7. Determinants of remote measurement-based care uptake in a safety net outpatient psychiatry department as part of learning health system transition.
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Aldis R, Rosenfeld LC, Mulvaney-Day N, Lanca M, Zona K, Lam JA, Asfour J, Meltzer JC, Leff HS, Fulwiler C, Wang P, and Progovac AM
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Introduction: Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation., Methods: This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites., Results: Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients., Conclusions: There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations., Competing Interests: The authors have no conflicts of interest with the work described., (© 2024 The Authors. Learning Health Systems published by Wiley Periodicals LLC on behalf of University of Michigan.)
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- 2024
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8. Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis.
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Lim CT, Caan MP, Kim CH, Chow CM, Leff HS, and Tepper MC
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- Adult, Ambulatory Care, Humans, Mental Disorders therapy
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Objective: Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness., Methods: A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs., Results: For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02)., Conclusions: Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.
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- 2022
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9. Assessing the Long-Term Effectiveness of a Behavioral Health Home for Adults With Bipolar and Psychotic Disorders.
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Johnson K, Tepper M, Leff HS, Mullin BO, Cook BL, and Progovac AM
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- Adult, Emergency Service, Hospital, Humans, Medicaid, Mental Health Services, Psychiatry, Psychotic Disorders therapy
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Objective: This study aimed to examine the impact of a behavioral health home (BHH) to better understand its potential to improve health for individuals with serious mental illness., Methods: Propensity score-weighted interrupted time series analysis was used to estimate service utilization and chronic disease management through 3.5 years after BHH implementation and to compre BHH enrollees (N=413) with other patients with serious mental illness in the same health system (N=1,929)., Results: Relative to control group members, BHH patients had an immediate increase in primary care visits (+0.18 visits/month), which remained higher throughout follow-up, and an immediate decrease in emergency department visits (-0.031 visits/month). Behavioral health outpatient visits, which were increasing for BHH participants before implementation, began decreasing postimplementation; this decrease (-0.016 visits/month) was significantly larger than for the control group. Inpatient and outpatient visits for general medical health were decreasing over time for both groups before implementation but decreased more slowly for BHH patients postimplementation. Although behavioral health inpatient visits decreased for both groups around the start of the BHH program and remained lower, this initial drop was larger for the non-BHH group. BHH participation was associated with decreases in hemoglobin A1c values but no shift in low-density lipoprotein cholesterol values., Conclusions: The results reflect the challenges of improving health for patients with serious mental illness, even as access to primary care is increased. Further study is needed about which complex interventions inside and outside of the health care system can help offset the 20- to 30-year mortality gap faced by this population.
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- 2022
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10. Changes in Psychiatric Emergency Room Visits Following the Boston Marathon Bombing.
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Frank A, Noy G, Chow C, and Leff HS
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- Adult, Aged, Aged, 80 and over, Boston, Emergency Service, Hospital organization & administration, Emergency Services, Psychiatric trends, Explosions, Female, Humans, Male, Marathon Running injuries, Marathon Running psychology, Middle Aged, Stress Disorders, Post-Traumatic psychology, Stress Disorders, Post-Traumatic therapy, Emergency Service, Hospital trends, Emergency Services, Psychiatric methods, Terrorism psychology
- Abstract
Objective: This study reviews patient encounters at a Boston-area community hospital Psychiatric Emergency Services (PES) following the Boston Marathon bombings, with the goal of describing the impact of terrorist attacks on PES encounters., Methods: All PES encounters for 2 months preceding and 2 months following the bombing were identified in the electronic medical record. Demographics, current and past psychiatric problems, and trauma history were assessed for all records. Encounters seen post-bombing were compared with those before the bombing., Results: Demographics, current and past psychiatric problems, and trauma history were not significantly different before versus after the bombing; 36 of 440 (8.2%) post-bombing encounters directly mentioned the bombings. New-onset posttraumatic stress disorder (PTSD) symptoms caused by the bombing occurred in only 4 encounters (0.9%)., Conclusions: PES encounters after a terrorist event are likely to mirror those seen before a terrorist event, with only a minority of encounters presenting for new PTSD or acute stress disorder.
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- 2020
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11. Mind the Gap: Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness.
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Tepper MC, Cohen AM, Progovac AM, Ault-Brutus A, Leff HS, Mullin B, Cunningham CM, and Cook BL
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- Adult, Electronic Health Records, Emergency Service, Hospital statistics & numerical data, Female, Hospitalization statistics & numerical data, Humans, Male, Middle Aged, Pilot Projects, Bipolar Disorder therapy, Delivery of Health Care, Integrated organization & administration, Glycated Hemoglobin analysis, Healthcare Disparities organization & administration, Mental Health Services organization & administration, Patient-Centered Care organization & administration, Psychotic Disorders therapy, Safety-net Providers organization & administration
- Abstract
Objective: This study evaluated the impact of an integrated behavioral health home (BHH) pilot on adults with psychotic and bipolar disorders., Methods: Quasi-experimental methods were used to compare outcomes before (September 2014-August 2015) and after the intervention (September 2015-August 2016) among ambulatory BHH patients and a control group. Electronic health records were compared between 424 BHH patients (N=369, psychotic disorder; N=55, bipolar disorder) and 1,521 individuals from the same urban, safety-net health system who were not enrolled in the BHH. Groups were weighted by propensity score on the basis of sex, age, race-ethnicity, language, 2010 U.S. Census block group characteristics, Medicare and Medicaid enrollment, and diabetes diagnosis., Results: BHH patients had fewer total psychiatric hospitalizations and fewer total emergency visits compared with the control group, a difference that was predominantly driven by patients with at least one psychiatric hospitalization or ED visit. There were no differences in medical hospitalizations. Although BHH patients were more likely to receive HbA1c screening, there were no differences between the groups in lipid monitoring. Regarding secondary outcomes, there were no significant differences in changes in metabolic monitoring parameters among patients with diabetes., Conclusions: Participation in a pilot ambulatory BHH program among patients with psychotic and bipolar disorders was associated with significant reductions in ED visits and psychiatric hospitalizations and increased HbA1c monitoring. This evaluation builds on prior research by specifying intervention details and the clinical target population, strengthening the evidence base for care integration to support further program dissemination.
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- 2017
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12. No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities.
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Leff HS, Chow CM, and Graves SC
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- Humans, Markov Chains, Mental Disorders therapy, Mental Health Services statistics & numerical data, Mentally Ill Persons statistics & numerical data
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Objective: A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ., Methods: Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations. Meta-regression was employed to explore associations between TPs and characteristics of service recipients and studies., Results: R systems performed better than M and B systems. However, M systems did not perform better than B systems. All systems showed negative as well as positive TPs. For approximately one-third of synthesized TPs, substantial interstudy heterogeneity was noted. Associations were found between TPs and service recipient and study variables Conclusions: Conceptualizing systems as B, M, and R has potential for improving scientific understanding and systems planning. R systems appear more effective than B and M systems, although there is no "magic bullet" system for all service recipients. Interstudy heterogeneity indicates need for common approaches to reporting service recipient states, time periods for TPs, service recipient attributes, and service system characteristics. TPs found should be used in Markov simulations to project system effectiveness and costs of over time.
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- 2017
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13. Measurement of Perceived and Technical Quality of Care for Depression in Racially and Ethnically Diverse Groups.
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Leff HS, Chow C, Wieman DA, Ostrow L, Cortés DE, and Harris T
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- Adult, Communication, Cultural Characteristics, Cultural Competency, Ethnicity psychology, Female, Focus Groups, Humans, Male, Middle Aged, Professional-Patient Relations, Racial Groups psychology, Time Factors, Depression ethnology, Depression therapy, Patient Satisfaction ethnology, Perception, Quality of Health Care standards
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Measurement of patient satisfaction is now considered essential for providing patient centered care and is an important tool for addressing health care disparities. However, little is known about how ethnically and racially diverse (ERD) groups differ in how they perceive quality, and widely used instruments for measuring perceived quality give little attention to cultural elements of care. This study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N = 160) and the technical quality of treatment for depression provided in four "culturally-specific" primary care clinics. Using data from the Experiences of Care and Health Outcomes survey, chart reviews and focus groups, the study addressed a set of questions related to the psychometric properties of perceived care measures and the technical quality of care. The groups differed in preferred cultural elements except all preferred inclusion of religion. They did not differ in overall perceived quality. Technical quality was higher for Portuguese and Haitians than for African Americans and Latinos. Implications of group differences for measuring quality are discussed.
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- 2016
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14. A menu with prices: Annual per person costs of programs addressing community integration.
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Leff HS, Cichocki B, Chow C, Salzer M, and Wieman D
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- Costs and Cost Analysis, Humans, Mental Health Services economics, Program Development, Program Evaluation, Social Work, Psychiatric economics, United States, Community Integration economics, Mental Disorders economics, Mental Disorders therapy, Mental Health Services organization & administration, Social Work, Psychiatric organization & administration
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Information on costs of programs addressing community integration for persons with serious mental illness in the United States, essential for program planning and evaluation, is largely lacking. To address this knowledge gap, community integration programs identified through directories and snowball sampling were sent an online survey addressing program costs and organizational attributes. 64 Responses were received for which annual per person costs (APPC) could be computed. Programs were categorized by type of services provided. Program types differed in median APPCs, though median APPCs identified were consistent with the ranges identified in the limited literature available. Multiple regression was used to identify organizational variables underlying APPCs such as psychosocial rehabilitation program type, provision of EBPs, number of volunteers, and percentage of budget spent on direct care staff, though effects sizes were moderate at best. This study adds tentative prices to the menu of community integration programs, and the implications of these findings for choosing, designing and evaluating programs addressing community integration are discussed., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
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- 2016
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15. The support for evidence-based training strategies.
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Chow C, Cichocki B, and Leff HS
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- Health Plan Implementation, Health Services Research, Humans, Outcome and Process Assessment, Health Care, Community Mental Health Services, Evidence-Based Practice, Inservice Training, Mental Disorders rehabilitation
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- 2009
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16. Does one size fit all? What we can and can't learn from a meta-analysis of housing models for persons with mental illness.
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Leff HS, Chow CM, Pepin R, Conley J, Allen IE, and Seaman CA
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- Adult, Female, Humans, Male, Middle Aged, Severity of Illness Index, Social Class, Housing, Mental Disorders rehabilitation, Models, Organizational
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Objective: Numerous studies have evaluated the impacts of community housing models on outcomes of persons with severe mental illness. The authors conducted a meta-analysis of 44 unique housing alternatives described in 30 studies, which they categorized as residential care and treatment, residential continuum, permanent supported housing, and nonmodel housing. Outcomes examined included housing stability, symptoms, hospitalization, and satisfaction., Methods: Outcome scores were converted to effect size measures appropriate to the data. Effect sizes were combined to estimate random effects for housing models, which were then compared., Results: All models achieved significantly greater housing stability than nonmodel housing. This effect was greatest for permanent supported housing (effect size=.63, p<.05). No differences between housing models were significant. For reduction of psychiatric symptoms, only residential care and treatment differed from nonmodel housing (effect size=.65, p<.05). For hospitalization reduction, both residential care and treatment and permanent supported housing differed from nonmodel housing (p<.05). Permanent supported housing achieved the highest effect size (.73) for satisfaction and differed from nonmodel housing and residential care and treatment (p<.001 and p<.05, respectively)., Conclusions: The meta-analysis provides quantitative evidence that compared with nonmodel housing, housing models contribute to stable housing and other favorable outcomes. The findings also support the theory that different housing models achieve different outcomes for different subgroups. Data were not sufficient to fully answer questions designed to enable program planners and providers to better meet consumers' needs. It is important to answer these questions with research that uses common measures and adheres to scientific conventions.
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- 2009
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17. The employment intervention demonstration program: major findings and policy implications.
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Cook JA, Blyler CR, Leff HS, McFarlane WR, Goldberg RW, Gold PB, Mueser KT, Shafer MS, Onken SJ, Donegan K, Carey MA, Kaufmann C, and Razzano LA
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- Employment, Supported legislation & jurisprudence, Evidence-Based Medicine, Female, Humans, Male, Mentally Ill Persons psychology, Outcome Assessment, Health Care, United States, Employment legislation & jurisprudence, Employment, Supported statistics & numerical data, Mental Disorders rehabilitation, Mentally Ill Persons legislation & jurisprudence, Public Policy
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This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. The study's results are discussed in the context of public policies designed to encourage return to work for those with a severe mental illness.
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- 2008
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18. Desired attributes of evidence assessments for evidence-based practices.
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Leff HS and Conley JA
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- Evidence-Based Medicine standards, Humans, Meta-Analysis as Topic, Narration, Outcome Assessment, Health Care standards, Registries, Review Literature as Topic, Sensitivity and Specificity, Evidence-Based Medicine methods, Mental Health Services standards, Outcome Assessment, Health Care methods
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In this paper we describe three approaches to assessing evidence for stakeholders interested in evidence-based practices: narrative reviews, systematic reviews (including meta-analyses), and registries. We then compare the approaches in terms of the degree to which they posses desired attributes of evidence assessments. Our review suggests that hybrid approaches that combined the best features of all three should be pursued to further the use of evidence-based practices, and that such hybrids are possible given the capacity of the World Wide Web. We conclude by stressing the need for empirical research on evidence assessments.
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- 2006
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19. Clinical factors associated with employment among people with severe mental illness: findings from the employment intervention demonstration program.
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Razzano LA, Cook JA, Burke-Miller JK, Mueser KT, Pickett-Schenk SA, Grey DD, Goldberg RW, Blyler CR, Gold PB, Leff HS, Lehman AF, Shafer MS, Blankertz LE, McFarlane WR, Toprac MG, and Ann Carey M
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- Adolescent, Adult, Aged, Employment, Supported methods, Female, Humans, Longitudinal Studies, Male, Mental Disorders diagnosis, Mental Disorders psychology, Middle Aged, Outcome Assessment, Health Care, Psychiatric Status Rating Scales, Regression Analysis, Rehabilitation, Vocational, Severity of Illness Index, Work Capacity Evaluation, Workload, Employment, Supported statistics & numerical data, Mental Disorders rehabilitation
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Research has shown that supported employment programs are effective in helping psychiatric outpatients achieve vocational outcomes, yet not all program participants are able to realize their employment goals. This study used 24 months of longitudinal data from a multisite study of supported employment interventions to examine the relationship of patient clinical factors to employment outcomes. Multivariate random regression analysis indicated that, even when controlling for an extensive series of demographic, study condition (experimental versus control), and work history covariates, clinical factors were associated with individuals' ability to achieve competitive jobs and to work 40 or more hours per month. Poor self-rated functioning, negative psychiatric symptoms, and recent hospitalizations were most consistently associated with failure to achieve these employment outcomes. These findings suggest ways that providers can tailor supported employment programs to achieve success with a diverse array of clinical subpopulations.
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- 2005
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20. Effects of job development and job support on competitive employment of persons with severe mental illness.
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Leff HS, Cook JA, Gold PB, Toprac M, Blyler C, Goldberg RW, McFarlane W, Shafer M, Allen IE, Camacho-Gonsalves T, and Raab B
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- Adult, Female, Humans, Male, Program Evaluation, Employment, Supported statistics & numerical data, Mental Disorders psychology, Program Development, Social Support
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Objectives: Few studies have sought to determine which specific supported employment services improve employment outcomes for people with pyschiatric disabilities. This study examined the effects of job development and job support among other services on acquisition and retention of competitive employment., Methods: Data used in the analysis came from seven sites of the Employment Intervention Demonstration Program. Employment data were collected weekly for a period up to 24 months for 1,340 participants. A random-effects meta-analysis was conducted., Results: Job development increased the probability of obtaining competitive employment. The effects of job development on job acquisition remained after the effects of other factors were controlled for. Job support was associated with more months in the first competitive job but not total hours worked. However, no evidence for the causal role of job support was found in analyses that tested the effects of job support after the job support was provided. The causal role of job support alone was also cast in doubt by the fact that a substantial overlap existed between individuals who received job support and vocational counseling., Conclusions: Job development is a very effective service when the goal is job acquisition. Job support is associated with retention of a first competitive job, but its causal role is questionable.
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- 2005
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21. Assessment of Medicaid managed behavioral health care for persons with serious mental illness.
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Leff HS, Wieman DA, McFarland BH, Morrissey JP, Rothbard A, Shern DL, Wylie AM, Boothroyd RA, Stroup TS, and Allen IE
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- Adult, Fee-for-Service Plans, Female, Florida, Hawaii, Humans, Male, Oregon, Pennsylvania, Severity of Illness Index, Surveys and Questionnaires, Virginia, Managed Care Programs standards, Medicaid standards, Mental Disorders psychology, Mental Disorders therapy, Mental Health Services standards, Quality of Health Care
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Objectives: This five-site study compared Medicaid managed behavioral health programs and fee-for-service programs on use and quality of services, satisfaction, and symptoms and functioning of adults with serious mental illness., Methods: Adults with serious mental illness in managed care programs (N=958) and fee-for-service programs (N=1,011) in five states were interviewed after the implementation of managed care and six months later. After a multiple regression to standardize the groups for case mix differences, a meta-analysis using a random-effects model was conducted, and bioequivalence methods were used to determine whether differences were significant for clinical or policy purposes., Results: A significantly smaller proportion of the managed care group received inpatient care (5.7 percent compared with 11.5 percent). The managed care group received significantly more hours of primary care (4.9 compared with 4.5 hours) and was significantly less healthy. However, none of these differences exceed the bioequivalence criterion of 5 percent. Managed care and fee for service were "not different but not equivalent" on 20 of 34 dependent variables. Cochrane's Q statistic, which measured intersite consistency, was significant for 20 variables., Conclusions: Managed care and fee-for-service Medicaid programs did not differ on most measures; however, a lack of sufficient power was evident for many measures. Full endorsement of managed care for vulnerable populations will require further research that assumes low penetration rates and intersite variability.
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- 2005
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22. Integration of psychiatric and vocational services: a multisite randomized, controlled trial of supported employment.
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Cook JA, Lehman AF, Drake R, McFarlane WR, Gold PB, Leff HS, Blyler C, Toprac MG, Razzano LA, Burke-Miller JK, Blankertz L, Shafer M, Pickett-Schenk SA, and Grey DD
- Subjects
- Adult, Ambulatory Care organization & administration, Community Mental Health Services, Educational Status, Employment, Employment, Supported organization & administration, Female, Follow-Up Studies, Humans, Male, Mental Disorders diagnosis, Patient Dropouts, Patient Participation, Psychiatric Status Rating Scales, Severity of Illness Index, Time Factors, Treatment Outcome, Ambulatory Care methods, Employment, Supported methods, Mental Disorders rehabilitation, Outcome Assessment, Health Care, Rehabilitation, Vocational methods
- Abstract
Objective: Although large-scale surveys indicate that patients with severe mental illness want to work, their unemployment rate is three to five times that of the general adult population. This multisite, randomized implementation effectiveness trial examined the impact of highly integrated psychiatric and vocational rehabilitation services on the likelihood of successful work outcomes., Method: At seven sites nationwide, 1,273 outpatients with severe mental illness were randomly assigned either to an experimental supported employment program or to a comparison/services-as-usual condition and followed for 24 months. Data collection involved monthly services tracking, semiannual in-person interviews, recording of all paid employment, and program ratings made by using a services-integration measure. The likelihood of competitive employment and working 40 or more hours per month was examined by using mixed-effects random regression analysis., Results: Subjects served by models that integrated psychiatric and vocational service delivery were more than twice as likely to be competitively employed and almost 1(1/2) times as likely to work at least 40 hours per month when the authors controlled for time, demographic, clinical, and work history confounds. In addition, higher cumulative amounts of vocational services were associated with better employment outcomes, whereas higher cumulative amounts of psychiatric services were associated with poorer outcomes., Conclusions: Supported employment models with high levels of integration of psychiatric and vocational services were more effective than models with low levels of service integration.
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- 2005
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23. Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness.
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Cook JA, Leff HS, Blyler CR, Gold PB, Goldberg RW, Mueser KT, Toprac MG, McFarlane WR, Shafer MS, Blankertz LE, Dudek K, Razzano LA, Grey DD, and Burke-Miller J
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- Adult, Ambulatory Care, Cohort Studies, Employment economics, Employment statistics & numerical data, Female, Follow-Up Studies, Humans, Insurance, Disability economics, Insurance, Disability statistics & numerical data, Male, Mental Disorders diagnosis, Mental Disorders psychology, Outcome Assessment, Health Care, Patient Selection, Rehabilitation, Vocational methods, Salaries and Fringe Benefits statistics & numerical data, Severity of Illness Index, Vocational Education methods, Employment, Supported methods, Mental Disorders rehabilitation
- Abstract
Context: National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment., Methods: We randomly assigned 1273 outpatients with severe mental illness from 7 states in the United States to an experimental SE program or to a comparison or a services-as-usual condition, with follow-up for 24 months. Participants were interviewed semiannually, paid employment was tracked weekly, and vocational and clinical services were measured monthly. Mixed-effects random regression analysis was used to predict the likelihood of competitive employment, working 40 or more hours in a given month, and monthly earnings., Results: Cumulative results during 24 months show that experimental group participants (359/648 [55%]) were more likely than those in the comparison programs (210/625 [34%]) to achieve competitive employment (chi(2) = 61.17; P<.001). Similarly, patients in experimental group programs (330/648 [51%]) were more likely than those in comparison programs (245/625 [39%]) to work 40 or more hours in a given month (chi(2) = 17.66; P<.001). Finally, participants in experimental group programs had significantly higher monthly earnings than those in the comparison programs (mean, US 122 dollars/mo [n=639] vs US 99 dollars/mo [n=622]); t(1259) = -2.04; P<.05). In the multivariate longitudinal analysis, experimental condition subjects were more likely than comparison group subjects to be competitively employed, work 40 or more hours in a given month, and have higher earnings, despite controlling for demographic, clinical, work history, disability beneficiary status, and study site confounders. Moreover, the advantage of experimental over comparison group participants increased during the 24-month study period., Conclusion: The SE models tailored by integrating clinical and vocational services were more effective than services as usual or unenhanced services.
- Published
- 2005
- Full Text
- View/download PDF
24. What is evidence?
- Author
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Drake RE, Latimer EA, Leff HS, McHugo GJ, and Burns BJ
- Subjects
- Adolescent, Adolescent Psychiatry, Child, Child Psychiatry, Humans, Practice Guidelines as Topic, Randomized Controlled Trials as Topic, Research Design, Treatment Outcome, Evidence-Based Medicine
- Abstract
The evidence-based practice movement rests on the premise that the scientific evidence regarding treatment should be used judiciously to inform treatment decisions. This article focuses on the most fundamental question regarding evidence-based practice: What is evidence? To address this question, the authors first review several of the definitions, criteria, and strategies that have been used to define scientific evidence. Second, a number of critical issues that have been raised regarding the nature of treatment evidence are discussed. Finally, suggestions for further consideration in the process of synthesizing evidence for clinicians are offered.
- Published
- 2004
- Full Text
- View/download PDF
25. Service quality as measured by service fit and mortality among public mental health system service recipients.
- Author
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Leff HS, McPartland JC, Banks S, Dembling B, Fisher W, and Allen IE
- Subjects
- Adult, Female, Health Services Needs and Demand, Humans, Male, Middle Aged, Risk Adjustment, United States epidemiology, Mental Health Services standards, Mortality, Public Sector, Quality of Health Care
- Abstract
Service fit, defined as consistency between mental health services judged needed and services received was measured for a random sample of service recipients in a public mental health system (N = 6588). A variant of small area analysis was used to measure the relationship between catchment area mortality rates from natural causes, suicide, and medicolegal causes and area fit scores for a variety of services. We tested the theory-based hypothesis that service fit would predict interarea variations in mortality better than simple measures of amount of service prescribed and received. We also tested the hypothesis that, controlling for relevant demographic and clinical factors, fit would be protective for mortality from all causes. Findings supported the first hypothesis. With respect to the second, service fit for only certain services was protective. Housing and clubhouses services were particularly protective, suggesting the importance of services providing social support.
- Published
- 2004
- Full Text
- View/download PDF
26. Toward a national consumer survey: evaluation of the CABHS and MHSIP instruments.
- Author
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Eisen SV, Shaul JA, Leff HS, Stringfellow V, Clarridge BR, and Cleary PD
- Subjects
- Adult, Factor Analysis, Statistical, Female, Humans, Male, Mental Health Services economics, Middle Aged, Quality Indicators, Health Care, Reproducibility of Results, Surveys and Questionnaires standards, United States, Health Care Surveys methods, Insurance, Psychiatric statistics & numerical data, Mental Health Services standards, Outcome and Process Assessment, Health Care methods, Patient Satisfaction statistics & numerical data
- Abstract
This article describes a study evaluating the Consumer Assessment of Behavioral Health Survey (CABHS) and the Mental Health Statistics Improvement Program (MHSIP) surveys. The purpose of the study was to provide data that could be used to develop recommendations for an improved instrument. Subjects were 3,443 adults in six behavioral health plans. The surveys did not differ significantly in response rate or consumer burden. Both surveys reliably assessed access to treatment and aspects of appropriateness and quality. The CABHS survey reliably assessed features of the insurance plan; the MHSIP survey reliably assessed treatment outcome. Analyses of comparable items suggested which survey items had greater validity. Results are discussed in terms of consistency with earlier research using these and other consumer surveys. Implications and recommendations for survey development, quality improvement, and national policy initiatives to evaluate health plan performance are presented.
- Published
- 2001
- Full Text
- View/download PDF
27. Use of consumer ratings for quality improvement in behavioral health insurance plans.
- Author
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Shaul JA, Eisen SV, Stringfellow VL, Clarridge BR, Hermann RC, Nelson D, Anderson E, Kubrin AI, Leff HS, and Cleary PD
- Subjects
- Adolescent, Adult, Behavioral Medicine economics, Behavioral Medicine standards, Female, Health Care Surveys, Humans, Insurance, Psychiatric standards, Male, Managed Care Programs economics, Mental Health Services economics, Middle Aged, Public Assistance standards, United States, Managed Care Programs standards, Mental Health Services standards, Patient Satisfaction statistics & numerical data, Total Quality Management
- Abstract
Background: The Consumer Assessment of Behavioral Healthcare Services (CABHS) survey collects consumers' reports about their health care plans and treatment. The use of the CABHS to identify opportunities for improvement, with specific attention to how organizations have used the survey information for quality improvement, is described., Methods: In 1998 and 1999, data were collected from five groups of adult patients in commercial health plans and five groups of adult patients in public assistance health plans with services received through four organizations (one of three managed behavioral health care organizations or a health system). Patients who received behavioral health care services during the previous year were mailed the CABHS survey. Non-respondents were contacted by telephone to complete the survey., Results: Response rates ranged from 49% to 65% for commercial patient groups and from 36% to 51% for public assistance patients. Promptly getting treatment from clinicians and aspects of care most influenced by health plan policies and operations, such as access to treatment and plan administrative services, received the least positive responses, whereas questions about communication received the most positive responses. In addition, questions about access- and plan-related aspects of quality showed the most interplan variability. Three of the organizations in this study focused quality improvement efforts on access to treatment., Discussion: Surveys such as the CABHS can identify aspects of the plan and treatment that are improvement priorities. Use of these data is likely to extend beyond the behavioral health plan to consumers, purchasers, regulators, and policymakers, particularly because the National Committee for Quality Assurance is encouraging behavioral health plans to use a similar survey for accreditation purposes.
- Published
- 2001
- Full Text
- View/download PDF
28. Implementing evidence-based practices in routine mental health service settings.
- Author
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Drake RE, Goldman HH, Leff HS, Lehman AF, Dixon L, Mueser KT, and Torrey WC
- Subjects
- Combined Modality Therapy, Humans, Outcome and Process Assessment, Health Care, Patient Care Team, Rehabilitation, Vocational, Evidence-Based Medicine, Health Plan Implementation, Mental Health Services, Schizophrenia rehabilitation
- Abstract
The authors describe the rationale for implementing evidence-based practices in routine mental health service settings. Evidence-based practices are interventions for which there is scientific evidence consistently showing that they improve client outcomes. Despite extensive evidence and agreement on effective mental health practices for persons with severe mental illness, research shows that routine mental health programs do not provide evidence-based practices to the great majority of their clients with these illnesses. The authors define the differences between evidence-based practices and related concepts, such as guidelines and algorithms. They discuss common concerns about the use of evidence-based practices, such as whether ethical values have a role in shaping such practices and how to deal with clinical situations for which no scientific evidence exists.
- Published
- 2001
- Full Text
- View/download PDF
29. Evidence-based treatment of schizophrenia.
- Author
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Drake RE, Mueser KT, Torrey WC, Miller AL, Lehman AF, Bond GR, Goldman HH, and Leff HS
- Subjects
- Employment, Supported, Family Health, Humans, Schizophrenia complications, Self Administration, Substance-Related Disorders complications, Substance-Related Disorders rehabilitation, Antipsychotic Agents therapeutic use, Evidence-Based Medicine, Schizophrenia therapy
- Abstract
People with schizophrenia can be helped greatly with pharmacologic and psychosocial interventions that are known to be effective. Several interventions are now supported by research: use of medications following specific guidelines, training in illness self-management, case management based on principles of assertive community treatment, family psychoeducation, supported employment, and integrated substance abuse treatment. However, few patients actually receive these evidence-based interventions because they are not provided in routine mental health settings. Therefore, implementing effective treatments in mental health treatment programs is a critical challenge for the field. We review the six areas of evidence-based treatment of schizophrenia, as well as knowledge regarding implementation of mental health programs in routine practice settings.
- Published
- 2000
- Full Text
- View/download PDF
30. A meta-analytic approach to growth curve analysis.
- Author
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Figueredo AJ, Brooks AJ, Leff HS, and Sechrest L
- Subjects
- Health Resources, Humans, Linear Models, Longitudinal Studies, Mental Disorders diagnosis, Pilot Projects, Severity of Illness Index, Capitation Fee statistics & numerical data, Health Care Rationing statistics & numerical data, Mental Disorders economics, Mental Disorders therapy
- Abstract
A meta-analytic approach to growth curve analysis is described and illustrated by applying it to the evaluation of the Arizona Pilot Project, an experimental project for financing the treatment of the severely mentally ill. In this approach to longitudinal data analysis, each individual subject for which repeated measures are obtained is initially treated as a separate case study for analysis. This approach has at least two distinct advantages. First, it does not assume a balanced design (equal numbers of repeated observations) across all subjects; to accommodate a variable number of observations for each subject, individual growth curve parameters are differentially weighted by the number of repeated measures on which they are based. Second, it does not assume homogeneity of treatment effects (equal slopes) across all subjects. Individual differences in growth curve parameters representing potentially unequal developmental rates through time are explicitly modeled. A meta-analytic approach to growth curve analysis may be the optimal analytical strategy for longitudinal studies where either (1) a balanced design is not feasible or (2) an assumption of homogeneity of treatment effects across all individuals is theoretically indefensible. In our evaluation of the Arizona Pilot Project, individual growth curve parameters were obtained for each of the 13 rationally derived subscales of the New York Functional Assessment Survey, over time, by linear regression analysis. The slopes, intercepts, and residuals obtained for each individual were then subjected to meta-analytic causal modeling. Using factor analytic models and then general linear models for the latent constructs, the growth curve parameters of all individuals were systematically related to each other via common factors and predicted based on hypothesized exogenous causal factors. The same two highly correlated common factors were found for all three growth curve parameters analyzed, a general psychological factor and a general functional factor. The factor patterns were found to be nearly identical across the separate analyses of individual intercepts, slopes, and residuals. Direct effects on the unique factors of each subscale of the New York Functional Assessment Survey were tested for each growth curve parameter by including the common factors as hierarchically prior predictors in the structural model for each of the indicator variables, thus statistically controlling for any indirect effect produced on the indicator through the common factors. The exogenous predictors modeled were theoretically specified orthogonal contrasts for Method of Payment (comparing Arizona Pilot Project treatment or "capitation" to traditional or "fee-for-service" care as a control), Treatment Administration Site (comparing various locations within treatment or control groups), Pretreatment Assessment (comparing general functional level at intake as assigned by an Outside Assessment Team), and various interactions among these main effects. The intercepts, representing the initial status of individual subjects on both the two common factors and the 13 unique factors of the subscales of the New York Functional Assessment Survey, were found to vary significantly across many of the various different treatment conditions, treatment administration sites, and pretreatment functional levels. This indicated a severe threat to the validity of the originally intended design of the Arizona Pilot Project as a randomized experiment. When the systematic variations were statistically controlled by including intercepts as hierarchically prior predictors in the structural models for slopes, recasting the experiment as a nonequivalent groups design, the effects of the intercepts on the slopes were found to be both statistically significant and substantial in magnitude. (ABSTRACT TRUNCATED)
- Published
- 2000
- Full Text
- View/download PDF
31. Quality measures for mental health care: results from a national inventory.
- Author
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Hermann RC, Leff HS, Palmer RH, Yang D, Teller T, Provost S, Jakubiak C, and Chan J
- Subjects
- Adult, Aged, Child, Humans, Marketing of Health Services, Models, Organizational, Needs Assessment, Reproducibility of Results, United States, United States Agency for Healthcare Research and Quality, Health Services Research, Mental Health Services standards, Outcome and Process Assessment, Health Care, Quality Indicators, Health Care
- Abstract
The National Inventory of Mental Health Quality Measures was funded by the Agency for Healthcare Research and Quality to (1) inventory process measures for assessing the quality of mental health care; (2) identify clinical, administrative, and quality domains where measures have been developed; and (3) identify areas where further research and development is needed. Among the 86 measures identified, most evaluated treatment of major mental disorders, for example, schizophrenia (24 percent) and major depression (21 percent). A small proportion focused on children (8 percent) or the elderly (9 percent). Domains of quality included treatment appropriateness (65 percent), continuity (26 percent), access (26 percent), coordination (13 percent), detection (12 percent), and prevention (6 percent). Few measures were evaluated for reliability (12 percent) or validity (3 percent). Measures imposing a lower burden were more likely to be in use (chi 2 = 4.41, p = .036). Further measures are needed to assess care for several priority clinical and demographic groups. Research should focus on measure validity, reliability, and implementation costs. In order to foster quality improvement activities and use of common measures and specifications for mental health care, the inventory of quality measures will be made available at www.challiance.org/cqaimh.
- Published
- 2000
- Full Text
- View/download PDF
32. Implementing outcome systems: lessons from a test of the BASIS-32 and the SF-36.
- Author
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Eisen SV, Leff HS, and Schaefer E
- Subjects
- Humans, Mental Disorders diagnosis, Mental Disorders psychology, Psychometrics, Reproducibility of Results, Behavior Therapy statistics & numerical data, Health Status, Mental Disorders rehabilitation, Outcome and Process Assessment, Health Care statistics & numerical data, Personality Assessment statistics & numerical data
- Abstract
With increasing pressure from third-party payers to assess client outcomes, clinical programs want to know how to implement outcome systems. This article focuses on practical and logistic questions involved in implementing an outcome assessment system in ambulatory behavioral healthcare settings. Study questions addressed outcome systems in general and the use of the Behavior and Symptom Identification Scale (BASIS-32) and the Short Form Health Status Profile (SF-36) in particular. General questions focused on obtaining provider buy-in, client consent and confidentiality, data collection methods, sampling, time points, maximizing client participation, clinical utility of outcome data, and resources needed for outcome assessment. Measure-specific questions focused on client acceptability of the instruments and applicability of measures to diverse populations. The article suggests several strategies for enhancing outcome assessment efforts and concludes that there remains a need for further understanding of ways to maximize the utility and value of outcome measurement.
- Published
- 1999
- Full Text
- View/download PDF
33. Assessing behavioral health outcomes in outpatient programs: reliability and validity of the BASIS-32.
- Author
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Eisen SV, Wilcox M, Leff HS, Schaefer E, and Culhane MA
- Subjects
- Adolescent, Adult, Aged, Ambulatory Care statistics & numerical data, Community Mental Health Services statistics & numerical data, Female, Follow-Up Studies, Humans, Male, Mental Disorders psychology, Middle Aged, Outpatient Clinics, Hospital statistics & numerical data, Psychometrics, Reproducibility of Results, Ambulatory Care psychology, Behavior Therapy statistics & numerical data, Mental Disorders rehabilitation, Outcome and Process Assessment, Health Care statistics & numerical data, Personality Inventory statistics & numerical data
- Abstract
The Behavior and Symptom Identification Scale (BASIS-32) was developed to assess mental health outcomes among patients with severe illness treated on inpatient programs. However, its applicability and utility to those treated in outpatient programs has not been determined. The objective of this study was to assess reliability, validity, and sensitivity to change of the BASIS-32 among mental health consumers treated in outpatient programs. A total of 407 outpatients completed the BASIS-32 and the Short Form Health Status Profile (SF-36) at the beginning of a treatment episode and again 30 to 90 days later. Outpatients reported less difficulty at intake than did inpatients, and the BASIS-32 detected statistically significant changes 30 to 90 days after beginning outpatient treatment. Factor structure and construct validity were partially confirmed on this sample of outpatient consumers. Analyses of data from a wide range of facilities and samples would add to validation efforts and to further refinement of the BASIS-32.
- Published
- 1999
- Full Text
- View/download PDF
34. Trends in the evaluation of managed mental health care.
- Author
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Leff HS and Woocher LS
- Subjects
- Humans, Research Design, United States, Health Services Research trends, Managed Care Programs standards, Mental Health Services organization & administration, Quality Assurance, Health Care trends
- Published
- 1998
- Full Text
- View/download PDF
35. Closing state mental hospitals in Massachusetts: policy, process, and impact.
- Author
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Upshur CC, Benson PR, Clemens E, Fisher WH, Leff HS, and Schutt R
- Subjects
- Adult, Aged, Attitude, Female, History, 19th Century, History, 20th Century, Hospitals, Psychiatric history, Humans, Male, Massachusetts, Mental Disorders rehabilitation, Middle Aged, Outcome Assessment, Health Care, Deinstitutionalization history, Health Facility Closure, Hospitals, Psychiatric organization & administration
- Published
- 1997
- Full Text
- View/download PDF
36. [Needs and utilization of mental health services in schizophrenia].
- Author
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Cormier HJ, Pinard G, Leff HS, and Lessard R
- Subjects
- Adolescent, Adult, Female, Hospitals, Psychiatric statistics & numerical data, Humans, Male, Middle Aged, Psychotherapy methods, Quebec, Schizophrenia drug therapy, Social Work, Psychiatric, Mental Health Services statistics & numerical data, Schizophrenia therapy
- Abstract
The planning of mental health treatment for people with severe mental disorders constitutes a major public health problem and an important social challenge. This study aims to identify the needs and to describe the utilisation of 20 services or modalities of mental health treatment among a schizophrenic population living in the Estrie region of Quebec. The results confirm that the needs are great and show that the most important deficiencies are in the psychosocial and readaptation services. The implications of these results with regard to the organisation of mental health services for schizophrenics are briefly discussed.
- Published
- 1986
37. DRGs are not enough.
- Author
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Leff HS and Bradley VJ
- Subjects
- Cost Control trends, Humans, Medicare economics, Prospective Payment System economics, United States, Diagnosis-Related Groups, Mental Disorders therapy
- Published
- 1986
- Full Text
- View/download PDF
38. A case study of scientists' opinions about the regulations of their work: opinions of the members of the Society for Psychophysiological Research about the regulation of biofeedback research and technology.
- Author
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Leff HS
- Subjects
- Adult, Humans, Legislation as Topic, Public Relations, United States, Attitude, Conditioning, Operant, Feedback, Psychophysiology, Research, Societies
- Published
- 1973
- Full Text
- View/download PDF
39. Effect of nurses' mode of dress on behavior of psychiatric patients differing in information-processing complexity.
- Author
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Leff HS, Nydegger RV, and Buck M
- Subjects
- Communication, Female, Humans, Male, Mental Disorders therapy, Clothing, Decision Making, Nurse-Patient Relations, Psychiatric Nursing, Social Perception
- Published
- 1970
- Full Text
- View/download PDF
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