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Abstract

Objective:

State mental health authorities (SMHAs) in all U.S. states and territories administer the Mental Health Block Grant (MHBG) set-aside funding for first-episode psychosis. Funds support implementation of coordinated specialty care (CSC) programs. The authors investigated the relationship between the level of SMHA involvement with CSC programs and clinical outcomes of clients in these programs.

Methods:

As part of a mixed-methods study of 34 CSC programs, SMHAs from 21 states and one U.S. territory associated with the 34 CSC programs participated in a 1-hour interview (between November 2018 and May 2019) focused on SMHA involvement in administration of MHBG set-aside funds and the SMHA’s ongoing relationship with funded CSC programs. SMHA involvement was rated on a scale of 1 to 5, with 5 indicating the highest involvement. Client outcome data were collected at the 34 study sites over an 18-month period. Multilevel random-effect modeling was used, controlling for response propensity (propensity score), client demographic variables, and program-level covariates (i.e., fidelity score, staff turnover rates, service area urbanicity, and number of clients enrolled).

Results:

Clients in CSC programs with SMHAs that were the most involved (level 5) had significantly improved symptoms, social functioning, and role functioning, compared with clients in programs with which SMHAs were least involved (level 1).

Conclusions:

The findings suggest that increased SMHA involvement in CSC programs is relevant for positive client outcomes. Levels of first-episode psychosis funding doubled in 2021 and 2022, and it is important to identify how SMHAs affect the success of CSC programs and the individuals served.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 250 - 256
PubMed: 36128698

History

Received: 29 November 2021
Revision received: 29 March 2022
Accepted: 2 June 2022
Published online: 21 September 2022
Published in print: March 01, 2023

Keywords

  1. Early intervention
  2. Early psychosis
  3. Coordinated specialty care
  4. State mental health policy
  5. Public policy issues
  6. First-episode psychosis

Authors

Details

Sushmita Shoma Ghose, Ph.D. [email protected]
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).
Preethy George, Ph.D.
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).
Howard H. Goldman, M.D., Ph.D.
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).
Tamara Cohen Daley, Ph.D.
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).
Lisa B. Dixon, M.D., M.P.H.
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).
Weijia Ren, Ph.D.
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).
Xiaoshu Zhu, Ph.D.
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).
Abram Rosenblatt, Ph.D.
Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon).

Notes

Send correspondence to Dr. Ghose ([email protected]). Dr. Dixon is the Editor of the journal. Marvin S. Swartz, M.D., served as decision editor on the manuscript.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

The Mental Health Block Grant 10% Study was supported by the Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health (task order HHSS283201200011I/HHSS28342008T, reference no. 283-12-1108).

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