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Two NIH grants support IU psychologist's effort to improve community mental health care

Indiana University


IMAGE: This is Cara Lewis. view more

Credit: Indiana University

BLOOMINGTON, Ind.--With a pair of new National Institutes of Health grants totaling nearly $3 million, Indiana University clinical psychologist Cara Lewis will tackle two major issues in the effort to bring evidence-based mental health treatment into community mental health centers.

Together, they take on a common challenge: How to move scientific findings off the shelf and into the communities they are designed to serve.

Currently, it takes 17 years for only 14 percent of clinical research to reach health care consumers. An assistant professor in the IU Bloomington College of Arts and Sciences' Department of Psychological and Brain Sciences, Lewis seeks to reverse this trend by increasing the accessibility and usefulness of mental health research.

$1.79 million to explore implementation of measurement-based treatment

The award will enable Lewis to compare two methods for integrating measurement-based care for depression -- using symptom data collection to identify client progress and guide treatment -- into the routines of community mental health clinics. Measurement-based care has already been shown to improve treatment by highlighting ongoing treatment goals, reducing symptom deterioration and engaging clients who might not otherwise respond to treatment.

Front and center in the research is a nine-question survey administered at the beginning of each therapy session, which asks clients to identify on a zero-to-three scale the severity of nine specific symptoms of depression. The survey allows therapists to systematically collect data on these symptoms over the course of treatment and compare client progress to national norms.

Multiple studies have repeatedly affirmed this process as an effective tool for managing depression treatment, but the survey, Lewis pointed out, has gained little traction in the day-to-day practices of clinicians.

"Depression remains among the nation's top 10 chronic illnesses, with costs of over $80 billion annually in the U.S.," said Lewis. "We now have evidence-based practices for the treatment of depression, but unfortunately those practices remain largely unavailable to clients receiving services in community mental health centers."

It's common practice in other areas of health care to collect data and track an individual's progress over time, she said.

"A doctor will check your blood pressure and ask you pointed questions about symptoms before making changes in medication," she said. "So here we have reliable and valid ways to measure psychological conditions, but it is not happening in the community mental health setting.

"It is not common practice to think about measuring depression to see if your treatment is having an effect. The idea hasn't transferred," Lewis said.

The new funding will allow Lewis to test two methods for implementation of the nine-item survey: a tailored vs. standardized method, with six clinics across two states randomly assigned to each method. A tailored approach, which takes into account the specific circumstances of a clinic, has been touted as more effective, but the two approaches have never been systematically compared.

$1.16 million grant to measure readiness for change

The second study takes a broader view of the implementation process by asking community stakeholders like agency administrators what measurement features are necessary to determine what a clinic needs to put evidence-based practices in place. The aim, Lewis says, "is to come up with a set of pragmatic measures for a clinic to assess its readiness for change."

For example if in the first project they conclude that a tailored approach to implementing the questionnaire is most effective, the next step would be to determine what conditions are needed to adopt the new practice and whether those conditions are in place to make the transition.

To answer these questions, Lewis and her team will conduct a series of interviews with the administrative and managerial stakeholders at a range of agencies providing mental health treatment around the U.S. The goal is to jointly create a set of criteria and pragmatic measures that serve to promote the use of measurement and ensure successful implementation.

Creating measures for real-world settings

Lewis wants to take the resulting surveys and measures to guide what providers do.

"As scientists we use these tools to evaluate our studies, but because of their length, cost and the specialized ways of scoring, these tools haven't made their way into common practice," she said.

Tools for measuring the symptoms of depression or the readiness of a clinic to adopt a new practice are not unlike an ordinary, sometimes indispensable kitchen tool: "If you're cooking at home, you might use a measuring cup to measure your ingredients. But for some reason the measures we have for clinical care and for informing organizational change aren't used, even if they have the same utility," Lewis added.

The clinics participating in the trial are located in Indiana and Tennessee and are members of Centerstone, one of the nation's largest not-for-profit behavioral health service providers.


Editor's Note: An op-ed from Cara Lewis on the effectiveness of simple screening techniques for the treatment of depression at community clinics and elsewhere is available for publication.

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