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Clinical Programs
Enhancing Quality and Utilization in Psychosis (EQUIP)
Patient Assessment System
Staff Supporting Skills for Self-Help(SSSSH)
Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS)
Errorless Learning in Schizophrenia
Pharmacotherapy and Supported Employment in Schizophreniap
Lack of Appropriate Care for Depression and Anxiety Disorders
Implement and evaluate new care models for improving the quality of care based on a chronic care model for schizophrenia. Clinical technologies such as supported employment, family psychoeducation and clozapine substantially improve patient outcomes, yet are typically not used. In the VA HSR&D EQUIP project, Young and colleagues developed methods for improving care for schizophrenia based on proven chronic illness management principles. These methods included information systems to support care improvement, protocols for managing the quality of care, and methods for implementing specific clinical technologies.
Reference
Young AS, Mintz J, Cohen AN, Chinman MJ: A network-based system to improve care for schizophrenia: the medical informatics network tool (MINT). J Am Med Inform Assoc. 2004; 11: 358-67.
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Patient Assessment System (PAS)
A web-based, audio computer assested self-interviewing system utilizing a touch-screen computer. Provides an accurate and efficient way to gather outcome information from patients. This project compared
computerized assessment to interviewer assessment using instruments such as the BASIS-R. Ratings using the two approaches were very similar, and patients generally preferred the computerized assessment.
Demonstration Slide
Reference
Chinman, M., A.S. Young, T. Schell, et al., Computer-assisted self-assessment in persons with severe mental illness. J Clin Psychiatry, 2004. 65(10): p. 1343-51.
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Staff Supporting Skills for Self-Help (SSSSH)
Developed by two leading mental health consumers and designed to improve provider competencies, facilitate mutual support, and move mental health clinics towards a recovery model of care. We previously conducted a national expert panel process that developed a set of competencies that providers need to possess to deliver high-quality care. We then developed an instrument that accurately measures such competencies. In this study, we conducted a controlled trial of SSSSH at five large public mental health provider organizations. The study demonstrated that this intervention improves critical recovery-oriented competencies, leads to the formation of mutual support groups, and moves service provision towards a recovery model.
Reference
Young, A.S., M. Chinman, S.L. Forquer, et al., Use of a consumer-led intervention to improve provider competencies. Psychiatr Serv, 2005. 56(8): p. 967-75.
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Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS)
MIRECC members recently led an NIMH initiative to support the development of innovative medications for improving neurocognition in schizophrenia. The first step in the process involved identifying a set of tests to measure cognition in clinical trials. An additional step was to determine which brain chemicals to target when developing these new medications. A third step is to develop a method whereby academia, government, and industry can collaborate for the development of innovative new drugs.
Reference
Green MF, Nuechterlein KH: The MATRICS initiative: developing a consensus cognitive battery for clinical trials. Schizophr Res 2004; 72(1):1-3
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Errorless Learning in Schizophrenia
Errorless learning is an approach to rehabilitation for schizophrenia that takes cognitive deficits into account. This approach modifies the training methods in a way that minimizes commission of errors and relies less on episodic memory. In a MIRECC affiliated study, we found that errorless learning yielded better success in teaching veterans how to conduct job tasks compared with a standard training approach.
Reference
Kern RS, Green MF, Mitchell S, Kopelowicz A, Mintz J, Liberman RP: Extensions of errorless learning for social problem-solving deficits in schizophrenia. Am J Psychiatry 2005; 162(3):513-9
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Pharmacotherapy and Supported Employment in Schizophrenia
We found that social skills training is more effective when combined with optimal drug treatment in an NIMH supported study that evaluated the addition of community based social skills training with skills training that only took place in our clinic. Patients also participated in a double-blind comparison of risperidone and haloperidol. The findings indicate that the addition of community based skills training increased its effectiveness and this treatment was more effective in patients who received risperidone.
Reference
Marder SR, Glynn SM, Wirshing WC, Wirshing DA, Ross D, Widmark C, Mintz J, Liberman RP, Blair KE: Maintenance treatment of schizophrenia with risperidone or haloperidol: 2-year outcomes. Am J Psychiatry 2003; 160(8):1405-12
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Lack of Appropriate Care for Depression and Anxiety Disorders
In a recent study published in the Archives of General Psychiatry, Vol
58, Jan 2001, Dr. Alexander S. Young, and colleagues
studied data from a cross-sectional telephone survey conducted nationally between
1997 and 1998. Their findings indicate that although 83 percent of adults with
a probable depressive or anxiety disorder visited a health-care provider, only
30 percent received appropriate treatment. The majority of patients were seen
by primary care providers only. Those who did visit a mental health specialist,
were given appropriate care ninety percent of the time compared with just 19
percent of those who visited a primary care provider only. The study also indicated
that appropriate treatment was less likely to occur among males who are black,
less educated and younger than 30 or older than 59. Insurance and income had
no effect on whether or not patients received appropriate care.
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This web site, is offered as a public service and is not intended to substitute for professional medical care.
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