Rockville, MD, United States
Rockville, MD, United States

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Chinman M.,Mental Illness Research | George P.,Westat | Dougherty R.H.,DMA Inc | Daniels A.S.,Westat | And 3 more authors.
Psychiatric Services | Year: 2014

Objective: This review assessed the level of evidence and effectiveness of peer support services delivered by individuals in recovery to those with serious mental illnesses or co-occurring mental and substance use disorders. Methods: Authors searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature for outcome studies of peer support services from 1995 through 2012. They found 20 studies across three service types: peers added to traditional services, peers in existing clinical roles, and peers delivering structured curricula. Authors judged the methodological quality of the studies using three levels of evidence (high, moderate, and low). They also described the evidence of service effectiveness. Results: The level of evidence for each type of peer support service was moderate.Many studies hadmethodological shortcomings, and outcome measures varied. The effectiveness varied by service type. Across the range of methodological rigor, a majority of studies of two service types - peers added and peers delivering curricula - showed some improvement favoring peers. Compared with professional staff, peers were better able to reduce inpatient use and improve a range of recovery outcomes, although one study found a negative impact. Effectiveness of peers in existing clinical roles was mixed. Conclusions: Peer support services have demonstrated many notable outcomes. However, studies that better differentiate the contributions of the peer role and are conducted with greater specificity, consistency, and rigor would strengthen the evidence.


Marshall T.,Westat | Goldberg R.W.,Care Network | Braude L.,DMA Inc | Dougherty R.H.,DMA Inc | And 4 more authors.
Psychiatric Services | Year: 2014

Objective: Supported employment is a direct service with multiple components designed to help adults with mental disorders or co-occurring mental and substance use disorders choose, acquire, and maintain competitive employment. This article describes supported employment and assesses the evidence base for this service. Methods: Authors reviewed meta-analyses, research reviews, and individual studies from 1995 through 2012. Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. Authors chose fromthree levels of evidence (high, moderate, and low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence for service effectiveness. Results: The level of research evidence for supported employment was graded as high, based on 12 systematic reviews and 17 randomized controlled trials of the individual placement and support model. Supported employment consistently demonstrated positive outcomes for individuals with mental disorders, including higher rates of competitive employment, fewer days to the first competitive job, more hours and weeks worked, and higher wages. There was also strong evidence supporting the effectiveness of individual elements of the model. Conclusions: Substantial evidence demonstrates the effectiveness of supported employment. Policy makers should consider including it as a covered service. Future research is needed for subgroups such as young adults, older adults, people with primary substance use disorders, and those from various cultural, racial, and ethnic backgrounds.


Rog D.J.,Westat | Marshall T.,Westat | Dougherty R.H.,DMA Inc | George P.,Westat | And 3 more authors.
Psychiatric Services | Year: 2014

Objectives: Permanent supportive housing provides safe, stable housing for people with mental and substance use disorders who are homeless or disabled. This article describes permanent supportive housing and reviews research. Methods: Authors reviewed individual studies and literature reviews from 1995 through 2012. Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. The authors chose from three levels of evidence (high, moderate, and low) on the basis of benchmarks for the number of studies and quality of their methodology. They also described the evidence of service effectiveness. Results: The level of evidence for permanent supportive housing was graded as moderate. Substantial literature, including seven randomized controlled trials, demonstrated that components of the model reduced homelessness, increased housing tenure, and decreased emergency room visits and hospitalization. Consumers consistently rated this model more positively than other housing models. Methodological flaws limited the ability to draw firm conclusions. Results were stronger for studies that compared permanent supportive housing with treatment as usual or no housing rather than with other models. Conclusions: The moderate level of evidence indicates that permanent supportive housing is promising, but research is needed to clarify the model and determine the most effective elements for various subpopulations. Policy makers should consider including permanent supportive housing as a covered service for individuals with mental and substance use disorders. An evaluation component is needed to continue building its evidence base.


Dougherty R.H.,DMA Inc | Lyman D.R.,DMA Inc | George P.,Westat | Ghose S.S.,Westat | And 2 more authors.
Psychiatric Services | Year: 2014

Health care reform offers the opportunity for federal and state agencies to work with private and nonprofit sectors to transform the American health care system through development of a comprehensive set of community-based, recovery-oriented, and evidence-based services for people with mental and substance use disorders. This Assessing the Evidence Base Series (AEB Series) provides science-supported information about selected mental health and substance abuse services for health care leaders as they implement new health benefit packages as a part of health care reform. Series authors conducted reviews of research on 14 behavioral health services: behavioral management for children and adolescents, trauma-focused cognitive-behavioral therapy for children and adolescents, recovery housing, residential treatment for individuals with substance use disorders, peer support services for individuals with serious mental illnesses, peer recovery support for individuals with substance use disorders, permanent supportive housing, supported employment, substance abuse intensive outpatient programs, skill building, intensive case management, consumer and family psychoeducation, medication-assisted treatment with methadone, and medication-assisted treatment with buprenorphine. The goal of the AEB Series is to provide a framework for decision makers to build a modern addictions and mental health service systemfor the people who use these services and the people who provide them. The framework is intended to support decisions about the services that are likely to be most effective. This introduction to the AEB Series explains the methods used to conduct the reviews, rate the research evidence, and describe the effectiveness of the services. The rationale underlying recommendations for implementation of the services is also discussed, and suggestions are offered for future research.


Mark T.L.,Thomson Reuters | Vandivort-Warren R.,Samhsa Inc.
Drug and Alcohol Dependence | Year: 2012

Background: From 1986 to 2003, substance abuse spending covered by private insurance fell in nominal dollars from $2444 million to $2239 million. The present study updated this literature to determine recent spending and utilization trends and provides a baseline for assessing the effects of recent health care policy changes. Methods: We used insurance claims data from Thomson Reuters MarketScan Commercial Claims and Encounters Database to study approximately 100 large, self-insured employers and millions of enrollees. We examined patterns in substance abuse treatment utilization and spending from 2001 through 2009. Results: The study revealed that substance abuse spending remained a relatively constant share of all health spending, comprising about 0.4% of all health spending in 2009. The share of substance abuse spending on medications increased from 1% to 14%, but remained a small share of all health spending at about $2.45 per-member per-year. Conclusions: The study has implications for anticipating the effects of the federal parity law, in that the low share of substance abuse treatment means that even large increases in substance abuse utilization and spending are unlikely to have a significant impact on total health care costs. © 2012 Elsevier Ireland Ltd.


Hedden S.L.,Samhsa Inc. | Gfroerer J.C.,Samhsa Inc.
Addictive Behaviors | Year: 2011

Although millions of adults meet criteria for substance use disorder (SUD) in the U.S., only a fraction receive treatment. This may be due to individuals with SUD not perceiving a need for treatment. In order to distinguish persons with SUD who perceive a need for treatment from those who do not, correlates for the perceived need for treatment were assessed for respondents with alcohol use disorder only, drug use disorder only and both alcohol and drug use disorder. Data were from the combined 2005-2009 datasets of the National Survey on Drug Use and Health. Logistic regression models were used to calculate odds ratio and 95% confidence intervals. Results demonstrated that among respondents who need treatment but did not receive treatment for alcohol use disorder, drug use disorder and both alcohol and drug use disorders, 3.3%, 8.3% and 12.4% perceived a need for treatment, respectively. No single socio-demographic correlate was predictive of perceiving a need across the three subpopulations suggesting that screenings for substance use disorder should be done in a setting where the general population may be accessed, e.g. primary care settings. Correlates associated with perceiving a need for treatment for all three subpopulations included psychological distress, disorder severity and substance type. Although respondents with greater disorder severity were more likely to perceive a need for treatment, a large proportion of those still do not perceive a need for treatment. Screening and brief interventions would facilitate treatment entry among those with the most severe disorders. © 2011.


Since 2002, the Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded 30 grants through its Older Adults Mental Health Targeted Capacity Expansion (OA TCE) program. These grants are designed to increase, develop, and implement mental health services for individuals older than age 60 and to build infrastructure to support the service system using Evidence-Based Practices (EBPs). The most recent funding cycle awarded ten grants in 2008. These grants will fund projects for up to 3 years at approximately $400,000 per year. This article describes the OA TCE program and reviews SAMHSA's support of EBP through various other initiatives. © 2010 American Society on Aging.


Steadman H.J.,Policy Research Associates Inc. | Morrissette D.,Samhsa Inc.
Psychiatric Services | Year: 2016

Since 1988, a major development to reduce lethal encounters between police and persons displaying signs of mental illness has been the adoption by many police departments of crisis intervention teams (CITs). Created inMemphis, Tennessee, CIT programs incorporate deescalation training, police-friendly drop-off centers, and linkage to community treatment programs. The authors summarize issues discussed at a recent Substance Abuse and Mental Health Services Administration workshop at which participants highlighted the importance of going beyond CIT training to most effectively include police in a crisis care continuum model. Such an approach focuses on how police can be engaged as partners with behavioral health providers who are designing and implementing services in the crisis care continuum. Reframing the approach to police responses to persons in mental health crises offers the prospect of improving both public health and public safety goals.


Lee H.K.,Catholic University of Korea | Han B.,Samhsa Inc. | Gfroerer J.C.,Samhsa Inc.
Addictive Behaviors | Year: 2013

Background: This study (1) estimated the prevalence of alcohol and binge alcohol use among adult Asian Americans by sub-ethnicity; (2) examined alcohol drinking patterns among these subpopulations; and (3) investigated sub-ethnic differences in characteristics associated with alcohol and binge alcohol use. Method: Data from 8900 Asian Americans aged 18 or older who participated in the 2002-2008 National Surveys on Drug Use and Health (NSDUHs) were analyzed. Descriptive analyses and multivariate logistic regression modeling were applied. Results: Korean Americans (51.8%) and Japanese Americans (49.7%) reported higher rates of past-month alcohol use than Chinese Americans (42.0%), Filipino Americans (37.9%), and Asian Indian Americans (34.0%). Korean Americans (24.6%) reported the highest rate of past-month binge alcohol use, followed by Filipino Americans (14.5%), Japanese Americans (14.2%), Asian Indian Americans (10.1%), and Chinese Americans (8.1%). Among these examined Asian Americans, foreign-born Chinese, Filipino, and Asian Indian Americans were less likely to have past-month alcohol use than their corresponding U.S. born counterparts; and only foreign-born Asian Indian Americans were less likely to have past-month binge alcohol use than their U.S. born counterparts. Males were 3-5 times more likely to have binge alcohol use than females among examined Asian American subpopulations except for Korean Americans. Korean Americans were more likely to have binge alcohol use than the other examined sub-ethnic Asian Americans. Conclusions: Adult Asian Americans are heterogeneous in sociodemographic characteristics and alcohol and binge alcohol use. These differences suggest the need for sub-ethnically specific prevention and treatment programs for alcohol use problems among Asian American subpopulations. © 2012.


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