Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

McGinty, Emma E.; Thompson, David A.; Murphy, Karly A.; Stuart, Elizabeth A.; Wang, Nae Yuh; Dalcin, Arlene; Mace, Elizabeth; Gennusa, Joseph V.; Daumit, Gail L.

doi:10.1186/s43058-021-00129-6

Cited by 4 publications

(4 citation statements)

References 45 publications

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“…Health coaches can help individuals with SMI learn how to identify their health goals and to self-manage cardiometabolic conditions [69••]. One ongoing intervention is training direct care staff at specialty mental health clinics to conduct evidence-based CVD care coordination through a team-based implementation strategy [87]. All may use motivational interviewing to deliver this educational material [88].…”

Section: Leverage Multi-disciplinary Teamsmentioning

confidence: 99%

Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness

Murphy

Daumit²

2023

Curr Cardiol Rep

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Purpose of Review Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. Recent Findings Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Summary Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.

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Section: Leverage Multi-disciplinary Teamsmentioning

confidence: 99%

Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness

Murphy

Daumit²

2023

Curr Cardiol Rep

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“…Counselors and prescribers will be encouraged to use MI to understand their patients' smoking behavior and engage them in smoking cessation treatment. RHYTHM (A Quality Improvement Process to Support Delivery of Cardiovascular Care in Community Mental Health Organizations) is a pretest-posttest design-based 12-month pilot study examining the effects of an adapted 5-step Comprehensive Unit-Based Safety Program implemented during care coordination aimed at reducing CVD risk for patients participating in behavioral health home programs [36]. Behavioral health home staff will receive the training necessary to implement the program, which will include the use of MI as a way of interacting with patients as they discuss various aspects of their patients' CVD care.…”

Section: Achieve-d (Adapting An Evidenced-based Weight Management Int...mentioning

confidence: 99%

Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies

Dalcin¹,

Yuan²,

Jerome³

et al. 2023

JMIR Res Protoc

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Background Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of participants with SMI showed improvement. Given the disproportionate burden of CVD in this population, practitioners who provide somatic and mental health care to persons with SMI are ideally positioned to deliver patient-centered CVD risk reduction interventions. However, the time for MI training (traditionally 16-24 hours), follow-up feedback, and the coaching required to develop and maintain patient-centered skills are significant barriers to incorporating MI when scaling up these evidence-based practices. Objective We describe the design and development of the following 2 scalable MI training approaches for community mental health practitioners: real-time brief workshops and follow-up asynchronous avatar training. These approaches are being used in 3 different pilot implementation research projects that address weight loss, smoking cessation, and CVD risk reduction in people with SMI who are a part of ALACRITY Center, a research-to-practice translation center funded by the National Institute of Mental Health. Methods Clinicians and staff in community mental health clinics across Maryland were trained to deliver 3 distinct evidence-based physical health lifestyle interventions using an MI approach to persons with SMI. The real-time brief MI workshop training for ACHIEVE-D weight loss coaches was 4 hours; IMPACT smoking cessation counselors received 2-hour workshops and prescribers received 1-hour workshops; and RHYTHM CVD risk reduction program staff received 4 hours of MI. All workshop trainings occurred over videoconference. The asynchronous avatar training includes 1 common didactic instructional module for the 3 projects and 1 conversation simulation unique to each study’s target behavior. Avatar training is accessible on a commercial website. We plan to assess practitioners’ attitudes and beliefs about MI and evaluate the impact of the 2 MI training approaches on their MI skills 3, 6, and 12 months after training using the MI Treatment Integrity 4.2.1 coding tool and the data generated by the avatar-automated scoring system. Results The ALACRITY Center was funded in August 2018. We have implemented the MI training for 126 practitioners who are currently delivering the 3 implementation projects. We expect the studies to be complete in May 2023. Conclusions This study will contribute to knowledge about the effect of brief real-time training augmented with avatar skills practice on clinician MI skills. If MI Treatment Integrity scoring shows it to be effective, brief videoconference trainings supplemented with avatar skills practice could be used to train busy community mental health practitioners to use an MI approach when implementing physical health interventions. International Registered Report Identifier (IRRID) DERR1-10.2196/44830

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“…The third project, RHYTHM, is a 12-month care coordination intervention that aims to equip mental health providers with the ability to coordinate guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI in the context of Psychiatric Rehabilitation Programs implementing behavioral health homes in Maryland (31)(32)(33). Guided by the Translating Evidence into Practice (TRIP) model for large-scale knowledge translation into community settings (34), the study team conducted a comprehensive review of clinical guidelines and scholarly literature to create a bundle of evidence-based care processes for hypertension, dyslipidemia, and diabetes tailored for people with SMI.…”

Section: Evidence-based Interventions To Improve Cardiovascular Healthmentioning

confidence: 99%

“…The bundle includes two overarching components: (1) clinical care processes (e.g., annual dilated eye exam for patients with diabetes), and (2) care coordination and management processes (e.g., using a brief form to facilitate communication between a primary care provider and behavioral health home team at the time of a routinely scheduled visit). These evidence-based practices will be implemented using an adapted version of the Comprehensive Unit Safety Program (CUSP) strategy, which seeks to foster a team-based quality improvement culture and reduce preventable harm (31).…”

Section: Evidence-based Interventions To Improve Cardiovascular Healthmentioning

confidence: 99%

Scaling Evidence-Based Interventions to Improve the Cardiovascular Health of People With Serious Mental Illness

Yuan

McGinty

Dalcin³

et al. 2022

Front. Psychiatry

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People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical trials; however, the uptake of these interventions into real-life clinical settings remains limited. Implementation strategies, which constitute the “how to” component of changing healthcare practice, are critical to supporting the scale-up of evidence-based interventions that can improve the cardiovascular health of people with SMI. And yet, implementation strategies are often poorly described and rarely justified theoretically in the literature, limiting the ability of researchers and practitioners to tease apart why, what, how, and when implementation strategies lead to improvement. In this Perspective, we describe the implementation strategies that the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness is using to scale-up three evidenced-based interventions related to: (1) weight loss; (2) tobacco smoking cessation treatment; and (3) hypertension, dyslipidemia, and diabetes care for people with SMI. Building on concepts from the literature on complex health interventions, we focus on considerations related to the core function of an intervention (i.e., or basic purposes of the change process that the health intervention seeks to facilitate) vs. the form (i.e., implementation strategies or specific activities taken to carry out core functions that are customized to local contexts). By clearly delineating how implementation strategies are operationalized to support the interventions' core functions across these three studies, we aim to build and improve the future evidence base of how to adapt, implement, and evaluate interventions to improve the cardiovascular health of people with SMI.

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Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

Cited by 4 publications

References 45 publications

Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness

Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness

Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies

Scaling Evidence-Based Interventions to Improve the Cardiovascular Health of People With Serious Mental Illness

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