Hyejin Jung, a doctoral student in the School of Social Work at The University of Texas at Austin, was selected to receive the 2014 Frances Fowler Wallace Memorial for Mental Health Dissertation Award by the Hogg Foundation. The award will go to support research expenses for her dissertation on mental health literacy among public housing organizations.
Frances Fowler Wallace, the award’s namesake, was married to John Forsythe Wallace, who served as a member of the Texas House of Representatives and the State Board of Control. She died July 18, 1972, in Austin at the age of 80. The Wallace Award provides partial support for doctoral students’ dissertation research on “the cause, treatment, cure, and prevention of mental disease, mental illness, and mental disorders,” as directed in her will. The award provides up to $1,500 for research-related expenses.
“One of the Hogg Foundation’s key strategic areas is broadening mental health literacy among non-mental health professionals, and supporting research to this end,” said Dr. Octavio N. Martinez, Jr., executive director of the Hogg Foundation. “We are thrilled for Ms. Jung and eagerly await the fruits of her research.”
We spoke with Hyejin Jung about her research.
- Tell us about yourself. At what point did you decide to pursue a career in mental health research, and what influenced that decision? My interest in mental health research grew out of working at a state hospital as a psychiatric social worker. In that position, I encountered multiple challenges serving people with mental health conditions, particularly with maintaining their lives in the local community. Unfortunately, some people with serious mental health conditions like schizophrenia that were released from the state hospital soon returned to the facility due to a lack of community support. Working with those who came back multiple times encouraged me to study ways in which mental health practitioners and community members can help people with mental health conditions thrive in their local communities.
- Your dissertation is titled, ““The Role of Mental Health Literacy in Mental Health Care in Public Housing Setting.” What questions are you trying to answer with this work? My dissertation particularly investigates what factors are associated with higher-levels of mental health literacy. In addition, my dissertation examines the ways in which mental health literacy is related to confidence in helping someone with mental health conditions and intention to seek mental health services among public housing staff.
- What led to your taking a professional interest in this particular topic? Mental health literacy is an important factor related to mental health care, wellness and recovery. Yet, few mental health literacy studies include public housing organizations that serve those with lower incomes, disabilities, and the elderly—all of whom are at a greater risk for mental health conditions. Current literature indicates that many public housing residents with mental health conditions do not receive mental health services. Therefore, there is a need to understand basic mental health information and learn about wellness and recovery in public housing settings and the ability of public housing staff to help their residents with accessing mental health services in a timely manner.
- How do you think your research methods and approach will help you to answer the questions that you’re posing? My dissertation uses data from a cross-sectional survey that examines the mental health literacy of a local public housing staff in Texas. I developed the survey questionnaire to include items measuring knowledge, attitudes and beliefs about mental illness, treatment, and local resources; stigma; confidence level of helping someone with mental health conditions; intention to seek mental health services; and demographics. The survey data will be analyzed using structural equation modeling (SEM) along with a series of regression analyses to identify factors associated with mental health literacy and examine relationships among mental health literacy, intention to use mental health services, and confidence in helping someone with mental health conditions.
- Are there any suggested readings you can recommend for those who might be interested in learning more about this topic? I would like to suggest two journal articles that I’ve cited below for those who are interested in learning about mental health literacy and mental health in public housing settings. The first article is written by A.F. Jorm, one of the scholars who coined the term, “mental health literacy.” This article explains the concept of mental health literacy and current status of mental health literacy research, intervention, and policy.1 The second article focuses on African Americans and it still demonstrates need for mental health care among public housing residents.2
Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231.
Simning, A., Wijngaarden, E., & Conwell, Y. (2011). Anxiety, mood, and substance use disorders in United States African-American public housing residents. Social Psychiatry and Psychiatric Epidemiology, 46(10), 983-992. doi: 10.1007/s00127-010-0267-2
by Rick Ybarra
Over the past decade, there has been significant momentum to advance integrated health care (IHC) as a standard of practice in health care delivery. Integrated health care is the systematic coordination of physical and behavioral healthcare. Studies have shown that integrated health care approaches, such as the Collaborative Care model are more effective than usual care for depression, anxiety disorders and more serious conditions such as bipolar disorder and schizophrenia.1
In 2006, the Hogg Foundation for Mental Health began funding integrated health care through a three-year, service initiative grant program to bring the “collaborative care” model of integrated health care to several clinics in Texas. The model proved so successful that most of the grantees continued using it after the grant ended. Since then, the foundation has funded a comprehensive integrated health care resource guide; statewide learning communities to bring organizations together for shared learning opportunities to advance integration; and a major statewide integrated health care conference. In addition, we partnered with the U.S. Department of Health and Human Services Office of Minority Health to explore integrated health care as a strategy to eliminate health disparities. This effort resulted in two major reports and a comprehensive literature review (http://www.hogg.utexas.edu/initiatives/integrated_health_care.html).
In 2012, the foundation awarded 11 grants to nonprofit community-based providers to either begin a planning process to adopt an integrated health care program or for providers who had completed a planning process to begin or expand on the implementation of their project. The aim was to increase the number of nonprofit behavioral health and primary care providers delivering integrated health care with the goal of making integrated care standard practice in Texas.
What We Have Learned
Through site visits, evaluation reports and hearing first-hand accounts/reports from grantees, there’s a great deal we’ve learned about integration. We have learned that true and successful integration:
- Begins with collaboration (bringing community partners together; how resources are brought together) and moves through co-location and increasing levels of integration (how services are redesigned and delivered).
- Begins with thoughtful planning processes to (1) allow organizations to conduct a readiness assessment; (2) have meaningful dialogue with staff, community stakeholders and other community health care partners; (3) inventory the human and collective assets; (4) align or realign resources; and (5) have external consultation if needed. The result is an implementation plan with a purposeful goal of outcomes designed to achieve a level of integration.
- Understands that having a common lexicon of integration is important to have shared understanding.
- Realizes that team-based care is superior to individual practitioners providing services in a fragmented manner.
- Knows that screening for mental health and/or behavioral health conditions is essential to completing a comprehensive assessment; it is only then that historically unidentified behavioral health conditions are now identified and can be treated.
- Has a point person to serve as care coordinator, which adds tremendous value to effectively monitoring and managing the overall coordination of care the person receives.
- Delivers training on IHC (definition; models; components; go-to resources) enhancing competencies and helping integration take root within organizations.
- Develops and implements workflows for practitioners to follow offers the best chance for the workflow or process to be successfully “integrated” into the practice.
- Understands that a shared record system is integral to effective coordination of care.
- Recognizes that platforms such as learning communities bring providers together to support shared learning and promotes the spread of integration throughout the state.
- Provides evaluation support to help providers think more objectively and honestly about their goals, objectives and the intended impact of their work.
- Has metrics to determine whether programs are having real impact on health outcomes. Is the health status of the people being served improving?
- Recognizes that local, state and national policy that supports programmatic and payment reforms must be established in rule and in statute to drive systemic change towards integration in health care.
Most of all, we have learned that for integration to succeed, it takes people and commitment. People who are committed, willing to embrace a new way of doing things, and stay the course despite the challenges that organizations face when implementing a new program or service. Organizational change on its own is hard. Policies and funding are important, but without people and commitment, such efforts fall by the wayside. Integrated health care works! So let’s bring it on!
1. Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. (2012). Collaborative Care for people with depression and anxiety. Cochrane Database of Systematic Reviews. http://summaries.cochrane.org/CD006525/DEPRESSN_collaborative-care-for-people-with-depression-and-anxiety
by Rick Ybarra
Every day in health care settings across the country, payers, providers and patients make decisions that impact service delivery and patient outcomes. The struggle continues as the health care system goes through, in some cases, radical transformation. The health care field seeks to improve the assessment, diagnosis and treatment of various health conditions, including mental health, that result in good quality care and positive health outcomes.
Once again the conversation circles back to “the stick or the carrot.” Which is the strategy (or set of strategies) that will effectively change provider behavior resulting in improved quality of care, improved health outcomes and decreased costs?
According to a recent blog posted Tuesday, July 15, the Commonwealth Fund’s blog authors Mark A. Zezza, Anne-Marie J. Audet, M.D. and Dominique Hall announced a new and exciting portfolio of work in the Breakthrough Health Care Opportunities program. “Incentives 2.0: A Synergistic Approach to Provider Incentives” explores the use of strategies to influence provider decision-making and promote higher-value, outcome-based health care.
The authors remind us that financial incentive strategies such as pay-for-performance programs have had limited success in improving outcomes and controlling costs. It is important to note that a wide range of factors influence providers’ choices, beyond financial rewards or penalties, including intrinsic motivation and medical professionalism, organizational influences and policy advancement.
The initiative will be seeking insights from diverse fields of study such as economics, psychology, nursing, social work, sociology, and the management sciences in order to identify influences, understand how they affect behaviors, how these influences interact with each other, and develop ways to use them to optimize health system performance. A huge undertaking indeed!
Some examples of approaches that might result from this work include:
- Redesigning financial incentives so they are more meaningful to providers. Psychological research has shown that people tend to spend more effort avoiding losses than achieving gains of comparable value. For example, Massachusetts General Physicians Organization has found it effective to give upfront financial rewards to providers, with the potential to return some of the funding if performance standards/measures are not met.
- Leveraging providers’ innate desire to do a better job. Psychological research also demonstrates that nonmonetary motivators, such as peer comparisons, may actually strengthen providers’ inherent desire to perform well. The introduction of quality report cards for cardiac surgeons across Pennsylvania had a four times larger effect on surgeons’ performance than profit incentives.
- Creating an organizational environment that promotes high performance at the provider level. The link between strong organizational culture and top performance is well demonstrated. One study found that hospitals with a clear mission, highly involved senior management teams, and non-punitive approaches to problem-solving had lower 30-day mortality rates for heart attack patients than did other hospitals.
The initiative seeks to create a “model” or “guide” for how to combine various influences in ways that can lead to a real breakthrough in performance.
Four projects are highlighted showing how innovators are working to design provider incentives that drive high-quality and achieve high-value care – and most importantly, contribute to improved health outcomes.
The program aims to identify opportunities and make changes in health care that can have large-scale impact. At the end of the day, that’s what it’s about, right?
I have always said that true health care reform cannot happen without payment reform. There are many pilots underway across the US examining value-based payment versus our current volume-based payment system, an approach that is perpetuated by the current fee-for-service reimbursement system. We must disrupt the status quo and look towards other payment models that hold providers accountable for high quality and positive health outcomes. The authors remind us that “In any industry or field, a little disruption every once in a while―and, sometimes, even a major shock―can be a good thing.”
Updates and lessons learned from these programs will be available on the CMWF website throughout the year. Stay tuned! More to follow….
by Rick Ybarra
Today, The Chronicle of Philanthropy posted a video titled, Foundations Reveal What They Look for in Grant Proposals. The video was taken during the Council on Foundation’s recent annual conference in Washington, D.C. It is a brief, inside perspective by grant makers representing the Walmart Foundation, Ford Foundation, Berks County Community Foundation, the Marie C. and Joseph C. Wilson Foundation, and the Minnesota Council on Foundations. The video captures “pearls of inside wisdom,” discussing the characteristics that make a grant proposal advance in the funding consideration process. The elements cited are what many foundations look for during the proposal review process.
For grant seekers who run at a frantic pace, this may be the best 1 minute, 36 seconds you’ll ever spend!
by Ike Evans
We are excited to announce that the Hogg Foundation has launched a new monthly podcast! Into the Fold, the brainchild of the communications team here at the foundation, is our newest attempt at creating a niche for candid conversations around mental health. We have just recently completed our pilot episode, an interview with LaQuinton Wagner, a youth consultant for Texas Network of Youth Services, a Hogg Foundation grantee. He spoke with eloquence and insight on the subject of transition-age youth, a key area of concern for the foundation.
Even with all of the other kinds of communications technology out there, the human voice continues to hold its own as an eerily effective tool for reaching, informing, and educating an audience. We’re still making up the rules as we go, but our overarching aim is to create audio content that’s easy to get and that presents conversations that are worth listening to. Episodes will be hosted and produced by Ike Evans, public affairs specialist.
We’re taking some of our inspiration from other mental health organizations, as well as other UT departments, who are showing that podcasting can be an inexpensive way to present engaging or informative content to a sizable audience. The hope is that once we get the hang of the format, it will come into its own as a primary means of capturing the human implications of our program areas, i.e. highlighting the challenges and achievements of our grantees in a way that is interesting, informative and appropriately provocative. Along the way, there will also be ample opportunity to enlighten the public about our grantmaking process, and even to delve into the past and present lives of Hogg Foundation staff.
Any and all feedback is appreciated!
For ® iTunes users, you can download podcast episodes here.
Into the Fold Pilot Episode: LaQuinton Wagner
by Rick Ybarra
On June 3, I posted on Hogg Blog, Measure Activities or Measure Outcomes? And the Answer is . . . based on Jason Saul’s May 28th piece in The Chronicle of Philanthropy highlighting the difference between activities (or outputs) and outcomes. Well, our friend Jason has upped the ante again with a follow-up blog post from June 16 titled, 4 Tips for Measuring Outcomes Instead of Activities. It sparked some interest from the field. But he noticed some uncertainty on how to go about measuring outcomes. In this follow-up blog post, Jason offers a few tips:
- Aim at the right outcomes. The “right” outcomes are those you can credibly claim to produce. It must be believable that your organization makes a substantial contribution to producing the outcomes it lays claim to. Got it!
- Use existing research. We’ve heard and often used, “No need to reinvent the wheel.” Same goes with data.Often you don’t need to start from scratch. Since most nonprofits use strategies that have been implemented or studied, there is a wealth of research available. Check!
- Consider indirect measurements. He validates that many programs are working toward achieving ambitious outcomes that take a long time to produce and thus, are impractical to measure as a whole. Community-based organizations can demonstrate their impact by utilizing indicators that may not directly measure their outcomes but that help predict how likely an intervention will produce the intended outcomes. Great point!
- Focus on measuring what matters to funders. The most useful information you can offer your supporters is the expected return on their investment. Think about how effectively you can produce the outcome that matters to them (the funder). Rather than providing the number of hours students are tutored, retention rates, and volunteer involvement (all activities or outputs), he suggests making a more compelling data-supported case that you are 80 percent likely to produce an intended outcome, like getting students in a promising program to be proficient in math. Makes sense!
Jason closes with that there is no one perfect way to calculate efficacy, but measurement that shows value (outcome/impact) will pay off more than data about activities (outputs). A word to the wise…
Eliminating Health Disparities through Culturally and Linguistically Centered Integrated Health Care: Consensus Statements, Recommendations, and Key Strategies from the Field
We are excited to share with you a manuscript just published in the Journal of Health Care for the Poor and Underserved (May, 2014) highlighting the Hogg Foundation’s work with the Office of Minority Health resulting in a seminal report titled “Eliminating Health Disparities through Culturally and Linguistically Centered Integrated Health Care: Consensus Statements, Recommendations, and Key Strategies from the Field.” This report is the outcome of an expert consensus meeting sponsored by the United States Department of Health and Human Services Office of Minority Health, which was convened to formulate consensus statements, recommendations and key strategies for implementing integrated health and behavioral health care with the aim to improve the overall health status for traditionally underserved populations.
Much has been reported in peer review and non-peer review publications about the benefits of integrated health care: treating and coordinating the health care of persons with both physical health and behavioral health conditions. However, very little has been reported to date regarding integrated health care as a strategy to reduce health disparities. We hope this article offers health care leaders, providers, researchers, payors, and policy makers practical recommendations that hold promise for improving access, treatment, and health outcomes for racial and ethnic minorities.
Journal of Health Care for the Poor and Underserved, Volume 25, Number
2, May 2014, pp. 469-477 (Article)
Published by The Johns Hopkins University Press