Access to mental health care and treatment engagement are major problems for vulnerable populations living in low-income communities. In addition, efficacious treatments developed and tested in academic settings are rarely adopted by clinicians who work in the community settings available to serve these individuals. While attempts have been made to disseminate proven interventions to community mental health services, the university-community collaborations designed to do so often fail. Based on the theoretical perspective provided by the literature on culture, we posit that prospective clients, mental health treatment professionals, and academic mental health treatment researchers comprise three disparate cultures, each with different perceptions of the meaning and etiology of distress. A failure to address this disconnect, can serve as a barrier to both patient care and collaboration, preventing those most in need of effective mental health services from receiving them. This revised application, in response to the NIMH IP-RISP announcement, proposes to address these barriers by developing, implementing, and evaluating a community agency research infrastructure to promote a capacity to collect data on issues of patient access and retention, develop innovative engagement strategies tailored to both client and clinician needs, conduct effective staff training programs, and evaluate the effectiveness of interventions, training and efforts to collaborate. Specifically, the University of Pittsburgh's Department of Psychiatry, School of Social Work, and Family Services of Western Pennsylvania (FSWP), a progressive mental health/social service agency, will: (1) establish a community agency-university collaborative partnership; (2) conduct an ethnographic study of this partnership; (3) conduct 2 pilot studies documenting the differences between client and clinician perspectives, and develop, implement, and test engagement strategies based on these findings, and (4) create a training program to disseminate evidence-based interventions to clinical staff. The work will be further guided by a participatory action research perspective, which requires that research be done with people, not to them, and will be closely woven into the current structure of the agency to insure its survival beyond the term of this application. The ethnographic study of the cultures involved in the collaborative process (Aim 2) will involve periodic feedback to all parts of the system to increase the effectiveness and longevity of the academic-community collaboration, facilitate patient access, and improve clinician morale. The pilot studies (Aim 3) will address the ways in which divergent cultural beliefs, values, and expectations of clinicians and low-income patients act as deterrents to the use of services. Data from two pilot studies, one from a semi-rural community, the other from an urban minority community, will be used to develop innovative engagement strategies and adapt interventions to be appropriate to low income clients (Aim 4). In so doing, we believe we can improve client engagement rates, prevent treatment drop-out, enhance treatment outcomes, and increase satisfaction with services.
| Weaver, Addie; Greeno, Catherine G; Goughler, Donald H et al. (2013) The impact of system level factors on treatment timeliness: utilizing the Toyota Production System to implement direct intake scheduling in a semi-rural community mental health clinic. J Behav Health Serv Res 40:294-305 |
| Eack, Shaun M; Greeno, Catherine G; Christian-Michaels, Stephen et al. (2009) Case managers' perspectives on what they need to do their job. Psychiatr Rehabil J 32:309-12 |
