Prior News Flashes
African Americans Less Likely to Receive Follow-Up Care After Psychiatric Admission
Poor integration of follow-up treatment into the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment, according to a report, "Quality of Follow-Up After Hospitalization for Mental Illness Among Patients From Racial-Ethnic Minority Groups," published online today in Psychiatric Services in Advance.
Researchers at the Center for Multicultural Mental Health Research, Cambridge Health Alliance, and Department of Psychiatry at Harvard Medical School used the Medical Expenditure Panel Survey (2004–2010) to identify adults with any inpatient psychiatric treatment (N=339). They then estimated predictors of outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical-need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference.
Rates of follow-up were generally low, particularly rates of adequate treatment, which were on average less than 26%. Outpatient treatment prior to inpatient care was a strong predictor of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge.
“Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment,” the researchers stated.
For more information on health disparities in mental illness and its treatment, see the Psychiatric News article, "Overcoming Health Disparities is Goal of Baltimore Experiment."
Smoking and Mental Health
CMMHR Researchers Benjamin Cook, Nilay Kafali and Michael Flores recently published a paper in JAMA warning that tobacco control and prevention policies have largely failed to help individuals with mental illness, who smoke at a rate almost double that of adults without mental illness and are generally more severely addicted than other smokers. The study, entitled “Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation” was published as part of a theme issue marking the 50-year anniversary of the landmark 1964 Surgeon General report on the dangers of tobacco use.
The gap in smoking rates has enormous, measurable consequences: “Individuals with severe mental illness have a life expectancy 25 years less than the rest of the population and their high rates of smoking explain a significant amount of this difference,” Dr. Cook said in an interview with Boston magazine. A large part of the problem, the authors report, is that cigarettes have long been used as a reward for good behavior in psychiatric settings, and many mental health professionals still believe that tobacco cessation can add to a patient’s stress and hinder recovery from mental illness. Still, they note, recent studies suggest that individuals with mental illness do want to stop using tobacco, and this study found that those who receive mental health treatment are more likely to successfully quit.
The lesson? Treatment for mental illness and tobacco addiction should be combined more often, with the potential for significant increases in quality and length of life for the mentally ill.
The Center is very pleased to report new funding for domestic and international projects, testing research interventions to help improve behavioral heatlh care for patients and providers.
- The The International Research Partnership funded by the National Institute of Drug Abuse, brings together research institutions and their partnering community clinics in Boston and in Madrid and Barcelona, Spain to enhance a collaborative international partnership and to develop the research evidence necessary to respond to Latino migrants’ behavioral health service needs.
- Effectiveness of DECIDE in Patient-Provider Communication, Therapeutic Alliance, and Care Continuation was approved for funding by the Patient Centered Outcomes Research Institute (PCORI) to address the importance of patient-provider communication, shared decision making, and therapeutic alliance with Latino, African American and Asian patients.
We congratulate Director Margarita Alegria for being named on El Planeta's Powermeter 100 list as one of the 100 most influential people for the state’s current Hispanic community.
Several new publications and presentations highlight the research of Center staff and colleagues.
Drs. Brendan Saloner and Benjamin Cook's new publication in Health Affairs finds that Blacks and hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors. Their work was recently covered in daily Rx and Bioscience Technology. Another recent publication by Dr. Cook addresses Racial/Ethnic Disparity Trends in Children's Mental Health Care Access and Expenditures from 2002 to 2007.
Dr. Nicholas Carson reports on Racial/Ethnic Differences in Video Game and Internet use among U.S. Adolescents with Mental Health and Educational Difficulties. This paper was recently presented at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry.
Center Collaborator Peter Guarnaccia talks about "Assessing Diversity Among Latinos" based on analysis of NLAAS data. The talk is part of the newly launched Latino Information Network (LIN@R) at Rutgers.
A Special Issue in the journal of Drug and Alcohol Dependence features new publications by Center staff and collaborators.
- Dr. Molina looks at Neighborhood Context and Substance Use Disorders: A comparative analysis of racial and ethnic groups in the United States.
- Dr. Mulvaney-Day addresses Unmet Need for Treatment for Substance Use Disorders across Race and Ethnicity.
- Dr. Darghouth reports on Assessment of Co-occurring Depression and Substance Use in an Ethnically Diverse Patient Sample during Behavioral Health Intake Interviews.
New publication on Role of Referrals for ethnic/racial minority youth
Dr. Margarita Alegría and collaborators' new publication in JAACAP, Role of Referrals in Mental Health Service Disparities for Racial and Ethnic Minority Youth is now available online. This work was supported by the National Institutes of Health/National Institute on Minority Health and Health Disparities (NIH/NIMHD).
Special Issue on Measuring and Analyzing Health Care Disparities
The Center for Multicultural Mental Health Research and the Harvard Catalyst Health Disparities Research Program have collaborated on a new special issue in the Journal Health Services Research, focused on Measuring and Analyzing Health Care Disparities. The special issue is now available online and was published in June 2012 in print. Funding was provided by the NIH Office of Behavioral and Social Sciences Research.
Using Your Own Panel Data To Conduct Comparative Effectiveness Research: Three Case Studies - Continued
Forty-five participants, presenters, staff and trainees came together from Cambridge Health Alliance on March 29th to discuss the potential use of the electronic medical record (EMR) as a vehicle to conduct comparative effectiveness research, and for clinicians to monitor their patient panels. The conference convened a group of experts in EMR use, comparative effectiveness research, and quality improvement to discuss the infrastructure for using the EMR at CHA. Three pilot projects conceived by CHA clinicians were presented, and participants discussed the importance of the Institutional Review Board clearance and steps to ensure patient safety and confidentiality of data. The meeting was part of the Comparative Effectiveness Research (CER) for Eliminating Disparities study at the Center for Multicultural Mental Health Research, supported by NIMHD Research Grant # P60 MDO 02261, funded by the National Institute on Minority Health and Health Disparities. One primary aim of the project relevant to the conference is the development of infrastructure at CHA to implement CER.
Highlights of speaker presentations included:
- Margarita Alegría, PhD (Director, CMMHR) provided an overview of the importance of the EMR in pursuing comparative effectiveness research, especially for racial/ethnic minorities. She described the CERED grant, which aims to provide an evidence base to support clinicians and patients in making informed decisions about which depression care option best aligns with their needs and preferences.
- Abbot Cooper, MBA (Information Technology) discussed current and future uses of electronic medical records in research to improve patient care.
- Nicholas Carson, MD (CMMHR) summarized in-depth interviews conducted with clinicians, researchers, and administrators on this topic, citing the importance of training in the use of the EMR both in terms of entering valid data (as a user) and in knowing how to construct an accurate data request (as a researcher).
- Benjamin Cook, PhD (CMMHR) highlighted some of the lessons learned from three pilot research projects, describing the process of moving from a clinician research idea, through data extraction and analysis in collaboration with a statistician and IT analyst.
- Karen Hacker, MD, MPH (Institute for Community Health) provided commentary, describing the importance of a preliminary look at the data to see if there are sufficient numbers of cases to analyze; considering cost and ongoing funding once a grant is completed, documenting definitions that aren’t in the literature; and using research to understand and facilitate the work of an Accountable Care Organization.
- Cindy Reilly, RN, BSN (Quality Management) provided commentary, suggested incorporating work done already through quality improvement initiatives, such as analysis through chart abstraction, EMR and third party vendors; ensuring that data sets can talk to each other; and working with nationally recognized definitions which might be available from the Center for Medicare and Medicaid, the Joint Commission and the National Quality Forum (NQF), along with questionnaires validated and endorsed by this foundation.
- Sanjay Gulati, MD (Child and Adolescent Psychiatry) and Chrysa Prestia, PhD presented data on the Deaf and Hard of Hearing Service at CHA. They examined data related to language deprivation syndrome, a clinically relevant syndrome that they have observed to affect their patient population.
- David Osler, MD, MPH (Pediatrics) presented on the utility of EMR to evaluate splenectomized patients, to ensure that they have receive appropriate, related immunizations.
- Jamie Barrett, PhD (Child and Adolescent Psychiatry) looked at the service use and diagnostic patterns for patients in the Safety Net Collaborative diversion program, which aims to provide appropriate supports and services to at-risk youth and families.
- Dan Ollendorf, MPH (Institute of Clinical and Economic Review) discussed the three pilot projects and provided input for establishing them as comparative effectiveness research investigations.
Q&A and Discussion:
The question and answer section covered important themes, including how best to standardize data and outcomes and how to code clinical information from the medical record. Participants noted that with streamlining of medical records, some of the important information that is often in the form of narrative notes could be disappearing. Participants noted the importance - when doing longitudinal analysis - to remember that fields and questions have changed greatly over time across paper and electronic data. Participants stressed the importance of always safeguarding patient data, ensuring Institutional Review Board Clearance is obtained for this research and including patients and communities in defining the research agenda and process.
Center investigators have offered two webinars on grant development and quantitative analysis, as part of our Robert Wood Johnson Foundation (RWJF) Mentoring and Training Grant and RWJF’s New Connections webinar series, now available online.
- Dr. Alegria delivered a webinar on Tips for Successful Grant Development and Submission on Friday, February 18, 2011. The webinar covered cover common mistakes made in grant applications, the new process of grant review and recommendations on how to align research to the agenda of NIH Institutes.
- Dr. Benjamin Cook presented a webinar entitled, A Primer on Using Regression Analysis for Understanding Health and Health Care Disparities, on Tuesday May 17, 2011. The session provided an overview of regression analyses and other statistical methods with a focus on measuring racial disparities in health and health care.
- Dr. Norah Mulvaney-Day presented a webinar on Strategies for Successful Application of Qualitative Research Methods in Health Services Research on September 27th. The webinar provided an overview of qualitative research methods with a focus on tools and strategies for applying these methods in health services and disparities research.
The Center has been recently awarded two new grants, addressing research and mentoring to improve mental health care for ethnic/racial minorities.
- The study, funded by the NCMHD, is a two year project aimed at filling the knowledge gap of Comparative Effectiveness Research (CER) for mental health care for Latinos. The research team, with Dr. Alegria as a Co-Principal Investigator, will be comparing a brief evidence-based depression treatment offered by telephone with the same intervention face-to-face, and in usual care. By working in collaboration with the University of Puerto Rico and principal investigator Glorisa Canino, the project will expand the UPR/CHA Research Center of Excellence, provide training for junior investigators and clinicians, and help build on the data infrastructure and research base for CER for Latinos.
- The mentoring training grant, funded by the Robert Wood Johnson Foundation, supports a program for New Connections grantees, alumni and network. The RWJ Mentoring and Training program is designed to expand the diversity of perspectives that inform RWJF program strategy and introduce new researchers and scholars to the Foundation that represent historically underrepresented research communities. We have developed a three tiered program to share with New Connections and the larger network.
Read more about Dr. Benjamin Cook’s new study, Understanding Mechanisms of Mental Health Care Disparities. This RO1 looks to understand these mechanisms among adults by measuring disparities in episodes of mental health care, and emphasizes the identification of effective tools for policymakers to reduce mental health care disparities.
Read Dr. Norah Mulvaney-Day’s recent commentary on recommendations for mental health clinicians working in safety net settings during health reform in the Spring 2010 National Council for Community Behavioral Healthcare Magazine starting on page 50.
Dr. Norah Mulvaney-Day's article titled Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time has recently been published online in Quality of Life Research.
Read Dr. Bauer's and Dr. Alegria's latest publication titled Impact of Patient Language Proficiency and Interpreter Service Use on the Quality of Psychiatric Care: A Systematic Review in the August issue of Psychiatric Services.
Read the abstract of Drs. Chavez, Shrout, and Alegría's Ethnic Differences in Perceived Impairment and Need for Care, the first article released from the Advanced Center Pilot 1 study.
Read the abstracts for Dr. Benjamin Cook's Assessing Racial/Ethnic Differences in the Social Consequences of Early-Onset Psychiatric Disorder paper and Dr. Nicolas Carson's Social Determinants of Mental Health Treatment among Haitian, African American, and White Youth in Community Health Centers paper in the May 2010 Supplement of the Journal of Health Care for the Poor and Underserved.
Read Dr. Margarita Alegría's and Dr. Daniel Jiménez's comments on the prevalence of depression in ethnic minority seniors in a News Feature of New America Media.
Linda Marc's article titled HIV among Haitian-born persons in the United States, 1985-2007 in the journal AIDS reports new findings on AIDS cases among Haitian-born individuals living in the US. Dr. Marc's findings have been picked up widely in the Boston Globe, the Wall Street Journal, and other US and Caribbean news sources, as they challenge previous assumptions about higher prevalance compared to other populations.
Advisory Board Meeting of the Advanced Latino Disparities Center
The Center for Multicultural Mental Health Research recently hosted the third and final Advisory Board meeting of the Advanced Latino Disparities Center on April 15th & 16th, 2010. The Advanced Latino Disparities Center, funded in 2005 through the National Institute of Mental Health, focuses on understanding numerous factors affecting mental health service disparities among Latino and other multicultural populations and generating research knowledge to eliminate them. Advanced Center investigators were grateful for the important contributions of the Advisory Board members in attendance, including Ms. Majose Carrasco (NAMI), Drs. Junius Gonzales (University of South Florida), Kim Hopper (Columbia), Ken Wells (UCLA) and Samuel Zuvekas (AHRQ). The goals of the meeting were twofold: to garner feedback on the work and accomplishments of the Advanced Center and to solicit input about the direction of CMMHR and several proposed initiatives of Center investigators. The Advisory Board was universally positive in their response to the academic contributions and accomplishments of the Advanced Center and provided timely and meaningful feedback on how CMMHR can best continue its mission of promoting and generating research to improve the mental health of ethnic and racial minority populations.
Dr. Benjamin Cook's latest article titled Comparing Methods of Racial and Ethnic Disparities Measurement across Different Settings of Mental Health Care is now published in the Early View online section of Health Services Research. You can also read about the article on the Kaiser Family Foundation's April Update on Health Disparities
RQP Site Investigator Meeting
On March 29, 2010 the Center for Multicultural Mental Health Research hosted a meeting for the Right Question Project Mental Health (RQP-MH). This project is part of the University of Puerto Rico-Cambridge Health Alliance Research Center of Excellence, funded through the National Center on Minority Health and Health Disparities. The meeting brought together researchers from the seven RQP-MH participating sites from around the country, for an all day event. The site investigators present included Drs. Alex Interian (New Jersey), Michele Allen (Minnesota), Mary Fierro (Massachusetts), Roberto Lewis-Fernandez (New York), Gabriela Livas-Stein (North Carolina), Catherine Lee (North Carolina), Martin La Roche (Massachusetts), and Catherine Schuman (Massachusetts). The objective of the meeting was to assess the project's current status and discuss ways to continually improve this multi-site intervention. Key topics included participant recruitment, retention, and research protocol implementation. The meeting afforded site researchers an avenue to voice concerns, relate new ideas, and discuss site-specific performance. At the meetings conclusion, researchers took home detailed accounts of their respective sites' progress, learned new ways to deal with recruitment/retention, developed site specific goals, began to strategize for analysis of the data that has been collected, and continued to build on our knowledge base for implementing major multi-site projects. The meeting was a success and we are planning another RQP Site Investigator meeting for Fall 2010.
Disparities Measurement Conference
February 25 & 26, 2010
Nearly 60 people from around the Harvard community came together on February 25 to discuss methodological and conceptual issues in the measurement of healthcare disparities
The Harvard Catalyst Health Disparities Research Program hosted a transdisciplinary disparities measurement symposium, co-sponsored by the Center for Multicultural Mental Health Research, Cambridge Health Alliance on February 25, 2010. The event provided an opportunity for dialogue about disparities research from multiple perspectives including sociology, health services research, economics, statistics, and public health.
The meeting discussed ways to improve the measurement of healthcare disparities, identified debates and synergies across disciplines to incorporate in future disparities research, and disseminated state-of-the-art methods and concepts of disparities measurement to the Harvard Catalyst community. The symposium’s speakers addressed topics related to concepts and definitions of healthcare disparities; innovations in the measurement of disparities from clinical, social science, and community perspectives; innovations from the fields of statistics and economics; and comparison of methods used to implement the Institute of Medicine definition of healthcare disparities. Below are links to the conference Powerpoint presentations:
- Margarita Alegría, Professor of Psychiatry, CHA;
- John Ayanian, Professor of Medicine and Health Care Policy, HMS;
- Jason Beckfield, Assistant Professor of Sociology, HU;
- Benjamin Cook, Instructor in Psychiatry, CHA;
- Alexander Green, Assistant Professor of Medicine, MGH;
- Jennifer Haas, Associate Professor of Medicine, BWH;
- LeRoi Hicks, Assistant Professor of Medicine, BWH;
- Willard Manning, Professor of Public Policy, U. Chicago;
- Thomas McGuire, Professor of Health Care Economics, HMS;
- Xiao-Li Meng, Whipple V. N. Jones Professor of Statistics, HU;
- David Williams, Florence and Laura Norman Professor of Public Health; and
- Alan Zaslavsky, Professor of Health Care Policy, HMS
In all, the event brought together nearly 60 attendees from the Harvard Catalyst community, Boston Medical Center, Brandeis University, Dartmouth College, Fenway Community Health, Northeastern University, Tufts University, and the University of Chicago.
Dr. Linda Marc received a New Investigator Award in January 2010 from the Center for Public Health Preparedness at Harvard School of Public Health. The project is entitled "Communication Behaviors Amongst Persons of Haitian Ancestry and Public Health Preparedness." Read the description and aims of planned research efforts.
Dr. Carson was recently interviewed for an article on Psychiatric News about how clinicians should be more assertive when soliciting a patient's medical history.
Read Dr. Carson's thoughts about online social networks and their use in therapy on Clinical Psychiatry News
Listen to Dr. Alegria discuss facts concerning Depression Among Latinos in the National Alliance for Mental Health's first Down and Up Show' recorded in Spanish.
Read Dr. Nick Carson's newest publication, examining how mental health clinicians assess and respond to physical illness in intake evaluations.
CMMHR was awarded a 2-year NIH Challenge grant for the project titled "Reducing Ethnic and Racial Bias in Screening for Psychiatric Disorders in Adolescents". Read the description and aims of planned research efforts.
Listen to Dr. Alegria's podcast on El Blog, addressing the 'Latino health issue no one is talking about'
Dr. Linda Marc, vice-chair of the Race & Ethnicity Advisory Committee of the U.S. Census Bureau, is quoted in Census Advisory Board Member Urges Caribbean Nationals To Learn From Hispanics
Dr. Alegria receives the Simon Bolivar award. Read the local coverage.
Dr. Benjamin Cook's latest article titled Pathways and Correlates Connecting Latinos’ Mental Health With Exposure to the United States is now published in the Early View online section of The American Journal of Public Health.
Dr. Benjamin Cook's latest article on Measuring Racial/Ethnic Disparities is now published in the Early View online section of Health Services Research. The article is published in the October 2009 edition of the journal.
New NLAAS II Publications
Several new NLAAS publications look at important issues of mental health of U.S. Latinos:
Dr. H. Gonzalez and co-authors look at Antidepressant Use in Community-Dwelling U.S. Latinos with and without Depressive and Anxiety Disorders in Depression and Anxiety
Dr. W. Vega and co-authors examine Prevalence and Correlates Of Dual Diagnosis in Drug Abuse and Dependence
Dr. L. Suarez and co-authors address Prevalence, Course and Correlates of Child-Onset Anxiety Disorders in Psicologia Conductal
Other New Publications:
Read the first paper released using data from the Center's Patient-Provider Encounter Study (PPES). Dr. Alegria and co-authors report on How Missing Information in Diagnosis Can Lead to Disparities in the Clinical Encounter.
The CMMHR and our investigators were featured in the latest version of the National Alliance on Mental Illness (NAMI) newsletter titled 'Avanzamos'. This edition features exclusive articles written by researchers from the Center who share the results of their latest findings. This is the first fully bilingual issue of Avanzamos. Take a look at the articles below in English and Spanish from our investigators in the full version of the newsletter that you can download here.
Benjamin Cook, Ph.D., M.P.H. - 'The Center for Multicultural Mental Health Research'/'El centro de investigación de salud mental multicultural'
Daniel Jimenez, Ph.D. - 'My Story'/'Mi historia'
Margarita Alegria, Ph.D. - 'What Can We Learn from Research to Achieve Wellness and Avoid Disparities in Mental Health and Substance Use Services?'/'¿Qué podemos aprender de la investigación para lograr el bienestar y evitar desigualdades en servicios de salud mental y uso de sustancias?'
Nicholas Carson, M.D., F.R.C.P.C - 'Children's Mental Health'/'Salud mental infantil'
Norah Mulvaney-Day, Ph.D. - 'Health Care Reform in Massachusetts: How is it Affecting Individuals with Mental Health Disorders?'/'Reforma de salud en Massachusetts: ¿Cómo está afectando a individuos con trastornos de salud mental?'
If you are interested in signing up for the newsletter please visit NAMI's website at www.nami.org/avanzamos.
Dr. Benjamin Cook's latest article on Health Care Disparities published in the February 2009 edition of Medical Care Research and Review
Dr. Alegria will be giving a talk at the Institute for Health at
Dr. Alegria is the recipient of the 2006 Greenwood Award for Research Excellence, awarded by the Research Centers in Minority Institutions (RCMI) Program Directors Association.
Dr. Alegria will be working with governor-elect Deval Patrick as part of his health care advisory committee.
Dr. Antonio Polo recently published an article on school-research collaborations. See our publications page for more information.
At the 134th Annual American Public Health Association Meeting several of the Center´s investigators will present new work related to translating interventions into mental health practice. "Moving a Consumer Empowerment Intervention into Practice" will be presented on Tuesday November 7, 2006 in Boston, MA (2:30-4:00 PM).
In July, Drs. Alegria, Mulvaney-Day, and Polo, along with community partners, attended the "Community Engagement and Partnership: New Directions in Mental Health Services Research Conference".
Dr. Margarita Alegria delivered the keynote speech at the Worcester County Conference on Cultural Competency on May 31, 2006. The presentation is available here.
Dr. Pinka Chatterji and Dr. Zhun Cao will present papers at the inaugural conference of the American Society of Health Economists, to be held June 4-7, 2006.