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ABSTRACT: The mental health system is inefficient and ineffective in providing behavioral health care services to the 1 in 4 Americans who have a mental illness or a substance abuse problem. Current health care reform initiatives present a significant opportunity for advanced practice psychiatric nurses-psychiatric mental health (APRN-PMH) to develop action-oriented recommendations for developing their workforce and thereby increasing access to high-quality and full-spectrum behavioral health care services. If endorsed by the professional nursing associations and the APRN-PMH workforce, the strategies presented in this paper provide a blueprint for developing the APRN-PMH workforce. Achieving these goals will significantly reform the APRN-PMH workforce, thereby contributing to the overall goal of supporting an integrated model of behavioral health care. No change has as much potential to influence the APRN-PMH workforce as the uniting of all APRN-PMHs in a "Blueprint for APRN-PMH Workforce Development."
Nursing outlook 06/2011; 60(2):91-104. · 1.54 Impact Factor
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Gail W Stuart
Journal of the American Psychiatric Nurses Association 11/2010; 16(6):360-5.
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Michael A Hoge,
John A Morris, Gail W Stuart,
Leighton Y Huey,
Sue Bergeson,
Michael T Flaherty,
Oscar Morgan,
Janice Peterson,
Allen S Daniels,
Manuel Paris,
Kappy Madenwald
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ABSTRACT: Across all sectors of the behavioral health field there has been growing concern about a workforce crisis. Difficulties encompass the recruitment and retention of staff and the delivery of accessible and effective training in both initial, preservice training and continuing education settings. Concern about the crisis led to a multiphased, cross-sector collaboration known as the Annapolis Coalition on the Behavioral Health Workforce. With support from the Substance Abuse and Mental Health Services Administration, this public-private partnership crafted An Action Plan for Behavioral Health Workforce Development. Created with input from a dozen expert panels, the action plan outlines seven core strategic goals that are relevant to all sectors of the behavioral health field: expand the role of consumers and their families in the workforce, expand the role of communities in promoting behavioral health and wellness, use systematic recruitment and retention strategies, improve training and education, foster leadership development, enhance infrastructure to support workforce development, and implement a national research and evaluation agenda. Detailed implementation tables identify the action steps for diverse groups and organizations to take in order to achieve these goals. The action plan serves as a call to action and is being used to guide workforce initiatives across the nation.
Psychiatric services (Washington, D.C.) 08/2009; 60(7):883-7. · 2.81 Impact Factor
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ABSTRACT: Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR).
Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes.
A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders.
This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement.
Implementation Science 02/2008; 3:3. · 3.10 Impact Factor
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ABSTRACT: Educational practices and strategies have changed very little over the years, and even emerging advances in technology have become the prisoners of traditional academic norms. Thus, while there is increasing emphasis on evaluating and aligning caregiving processes with the strongest evidence of effectiveness, there is little demonstration or role-modeling of this same expectation in either the formal or continuing educational processes of behavioral healthcare providers. This "disconnect" is a significant problem in the field. This paper addresses the urgent need to inform the education and training of the behavioral health workforce with current theories regarding the teaching-learning process and evidence about the effectiveness of various teaching strategies. The relevant theories and available bodies of evidence are described, and the implications for workforce education and training are identified.
Administration and Policy in Mental Health 12/2004; 32(2):107-30. · 2.09 Impact Factor
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ABSTRACT: Controversy surrounds the concept of EBP. Many individuals question whether research is capable of guiding decisions about diagnosis and treatment, or whether it simply gives oversimplified answers to highly complex questions about human behavior. These concerns aside, it is hard to envision a future in which consumers and payers do not demand that the health professions ground their interventions in an evidence base. It is sobering to recognize that training in EBP has been far from the norm in the various behavioral health disciplines. This is just one aspect of a much larger crisis in behavioral health workforce education. Graduate and residency programs have not kept pace with many of the changes in behavioral health care delivery over the past decade. The field continues to use continuing education strategies that are ineffective, and little training is offered to the paraprofessional and bachelor-prepared staff members who comprise a large segment of the workforce in public sector and inpatient settings. Broad strategies are needed to overcome the lethargy in behavioral health education and training programs to make them more relevant to contemporary clinical practice. Incorporating evidence-based approaches to treatment is one critical element of needed reforms. General medicine has laid a foundation that can be built on for teaching the process of EBP. Psychiatry and psychology have taken the lead in identifying those interventions to be taught that are evidence-based or empirically supported. Research on continuing education and adult learning illuminates the educational strategies that are likely effective in teaching evidence-based interventions and an evidence-based process of care. Additionally, the research on changing provider behavior shows the importance of ensuring practice environments that support and reinforce, rather than thwart, the practice of evidence-based treatment. There are many resources to draw on but the task facing educators is substantial.
Psychiatric Clinics of North America 01/2004; 26(4):851-65. · 2.13 Impact Factor
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ABSTRACT: Practice guidelines have proliferated in mental health and addiction services; more than 40 organizations have developed guidelines in the field. However, much confusion, controversy, and contextual issues remain, particularly regarding effective dissemination and the clinical, financial, political, and ethical issues that emerge when evidence-based behavioral health practice guidelines are implemented in systems of care. The American College of Mental Health Administration (ACMHA) focused on these problems in their 1999 and 2000 Santa Fe Summits and produced a number of specific outcomes that contribute to thinking in the field. These include the following: (a) a taxonomy of building blocks for informed decision-making in behavioral health assessment and treatment; (b) a paradigm for the development of practice guidelines; (c) characteristics of a good practice guideline; (d) strategies for disseminating and implementing practice guidelines; and (e) areas in need of future research.
Administration and Policy in Mental Health 10/2002; 30(1):21-33. · 2.09 Impact Factor
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ABSTRACT: There are few reports from the behavioral health field that focus on educational best practices. This article summarizes a panel presentation from the Annapolis Conference in which four different programs were described: (1) a provider educational initiative, (2) a tool-kit project related to evidence-based services, (3) a multidisciplinary faculty training program in addictions, and (4) an AIDS education project. While such innovative educational practices appear to be the exception rather than the norm, they do offer ideas and strategies for challenging and energizing current educational practices in behavioral health.
Administration and Policy in Mental Health 06/2002; 29(4-5):325-33. · 2.09 Impact Factor
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ABSTRACT: Much of the behavioral health care delivered to people with serious mental illnesses and chronic addictive disorders is provided by front-line or direct service mental health workers. Issues related to the qualifications, training, and ongoing evaluation of the competencies of this important provider group have received scant attention in the behavioral health field. This paper explores the educational needs and best practices of the consumers and families who carry much of the burden of caring for disabled populations, as well as the front-line staff, many of whom are employed in state psychiatric hospitals and community mental health or addiction treatment systems. Within the overall context of culturally competent behavioral health care, specific recommendations are proposed in an attempt to move the field forward.
Administration and Policy in Mental Health 06/2002; 29(4-5):377-402. · 2.09 Impact Factor
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Gail W Stuart
Journal of Professional Nursing 23(5):251-2. · 0.89 Impact Factor
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Gail W Stuart
Journal of Professional Nursing 20(1):5-6. · 0.89 Impact Factor
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Michael A Hoge,
John A Morris,
Allen S Daniels,
Leighton Y Huey, Gail W Stuart,
Neal Adams,
Manuel Paris,
Eric Goplerud,
Constance M Horgan,
Linda Kaplan,
Susan A Storti,
Joan M Dodge
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ABSTRACT: In May 2004, the Annapolis Coalition on Behavioral Health Workforce Education convened a national meeting on the identification and assessment of competencies. The Conference on Behavioral Health Workforce Competencies brought leading consumer and family advocates together with other experts on competencies from diverse disciplines and specialties in the fields of both mental health care and substance use disorders treatment. Aided by experts on competency development in business and medicine, conference participants have generated 10 consensus recommendations to guide the future development of workforce competencies in behavioral health. This article outlines those recommendations. A collaborative effort to identify a set of core or common competencies is envisioned as a key strategy for advancing behavioral health education, training, and other workforce development initiatives.
Administration and Policy in Mental Health 32(5-6):651-63. · 2.09 Impact Factor
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ABSTRACT: Advances in technology can have direct and indirect benefits to clinical practice. The challenge that clinicians face is to properly match resources and outcomes, along with patient preferences. This article explores the use of an innovative interactive voice response system to increase patient compliance with antidepressant medication prescribed in primary care settings. The development of the interactive voice response system, its implementation, and clinical outcomes are described. The findings underscore the need to carefully match intervention strategies with the needs of specific patient populations, and the importance of human dialog in the context of healing.
Topics in health information management 24(1):15-20.
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ABSTRACT: This study characterizes the early family experiences of 30 women with bulimia nervosa and 15 women with major depression, and compares them with 100 women controls, with particular emphasis placed on parental rearing practices, family conflict resolution, sexual mistreatment, problematic childhood indicators, and childhood separation experiences. There is little research on these patient populations in relation to their childhood experiences, and thus, it is difficult to identify markers for women at risk for these disorders. The findings show that there are significant differences between the experiences these women had growing up and those of the control group, and a profile of children at risk based upon the study indicators is presented.
Archives of Psychiatric Nursing.
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ABSTRACT: This study characterizes the childhood environment of adult women having panic disorder with agoraphobia, with particular emphasis placed on parental rearing practices, family conflict resolution, experiences of sexual mistreatment, problematic childhood indicators, and childhood separation experiences. The retrospective research design included attitudinal and behavioral indicators for 80 female patients diagnosed with panic disorder with agoraphobia, and a control group of 100 female volunteers with no history of psychiatric illness. Study findings did not support evidence of parental overprotection, parental death, devorce, or sexual mistreatment as risk factors. Results did suggest the significance of childhood separation anxiety, a conflicted family environment, lack of parental warmth and support, and the presence of chronic physical illness and substance abuse in the chilhood home of patients, as well as more emotional, family, alcohol, and school problems as children and adolescents.
Journal of Anxiety Disorders.
