Psychiatric Services From Pages to Practice Psychiatric Services

Elizabeth Bromley, M.D., Ph.D. (University of California, Los Angeles) joins Dr. Dixon and Dr. Berezin to discuss the use of outpatient conservatorship in the effort to address mental health disability among unsheltered homeless persons in Los Angeles County, California.
00:00    Introduction 03:04     Homelessness in Los Angeles County, California 09:04     The paper and services 11:39     Lanterman-Petris-Short (LPS) conservatorship 13:44     Outpatient conservatorship (OPC) pilot program 15:54     Skepticism 18:48     Beyond conservatorship: other aspects of the program 22:34     Initial evaluation 25:21     Quantitative measures 28:33     Coordination Transcript
 
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Gregory E. Simon, M.D., M.P.H. (Kaiser Permanente Washington Health Research Institute, Seattle) join Dr. Dixon and Dr. Berezin to discuss the use of machine learning models to analyze electronic health records to predict antidepressant treatment response.
00:00     Introduction
02:31    Focus on practical research
04:55    Population studied
05:57    Predicting outcomes
07:20    Using diagnostic codes, not personalized notes
08:04    What three data items might be more helpful?
08:49    What key indicators are we missing in clinical care?
11:35    A billing tool, not a clinical tool
12:57    Is suicide a predictable event based on electronic health record data?
14:48    “Machine learning and artificial intelligence” 
16:15    Methods
18:59     Can we do a better job clarifying what we mean by depression?
22:32    How can we use a predictive model in clinical practice?
28:20    Predictive models, probability, the weather, and communicating 

Transcript
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Misty C. Richards, M.D., M.S. (University of California, Los Angeles), and Nicole Kozloff, M.D. (University of Toronto), join Dr. Dixon and Dr. Berezin to discuss the need to remodel our systems and provision of mental health services for children and adolescents.
00:00     Introduction 01:18     Impetus 05:45     What constitutes a mental health crisis? 11:14     “Remodeling” 16:21     Differences by location 18:28     Remodeling primary care 21:25     Virtual care 27:19     New service models 32:19     Are we moving in the right direction?  
Transcript
 
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Andrew D. Carlo, M.D., M.P.H. (Northwestern University Feinberg School of Medicine, Chicago) joins Dr. Dixon and Dr. Berezin to discuss the insurance acceptance rates of psychiatric practitioners compared with other medical disciplines.
00:00     Introduction 01:04     Background and Motivation 02:46     Data Set and Methodology 05:12     Restricted Data Set and Privacy Concerns 06:08     Research Questions and Goals 10:04     Findings: Insurance Acceptance Rates 11:29     Factors Influencing Insurance Acceptance 14:23     Magnitude of the Gap in Insurance Acceptance 15:44     Factors Affecting Insurance Acceptance for Psychiatrists 18:08     Challenges in Enforcing Mental Health Parity 19:27     Market Power of Psychiatrists 22:48     Impact on Other Mental Health Professionals 24:16     Importance and Implications 25:11     Potential Solutions and Policy Changes 29:31     Conclusion  
Transcript
 
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Eliza Hallett, M.S., (Oregon Health & Science University, Portland, Oregon) joins Dr. Dixon and Dr. Berezin to discuss the challenges faced by staff and behavioral health service providers, including low wages, traumatic work environments, low wages, and physical and administrative infrastructure.
Workforce crisis in behavioral health care [01:33] How representative of the country is Oregon? [03:45] Who were you talking to? [05:32] A figure on radio [06:30] Generating a theoretical framework from the responses [08:01] Qualitative methods [09:30] The five factors [10:33] Wages [14:05] Infrastructure [14:40] Are these issues unique to behavioral health services? [19:11] Legislative changes in Oregon [21:25] Feeling supported matters [23:39] Did the pandemic exacerbate the problem? [27:04] Take home [29:08] Access the complete Behavioral Health Workforce Report to the Oregon Health Authority and State Legislature here.
Transcript
 
Figure 1.  Factors influencing turnover and attrition in the public behavioral health system workforce in Oregona
a Interviewees identified factors across three levels—system, organizational, and individual—that contribute to the direct drivers of workforce turnover and attrition.
 
https://ps.psychiatryonline.org/pb-assets/podcasts/transcripts/PS/PS_Chung_August_2023_transcript.pdf
 
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Henry Chung, M.D., (Albert Einstein College of Medicine, Bronx, New York City) joins Dr. Dixon and Dr. Berezin to discuss the differences between the collaborative care model and the colocation model, and the impact on Medicaid costs and utilization, for the treatment of patients with depression.
Chung interview [00:58] A bridge between clinical and research work [02:32] The colocation model and the collaborative care model [03:44] What populations are you working with? [07:21] Differences in service utilization and cost [10:25] Methodology [10:47] Concentration on depression instead of other psychiatric disorders [13:59] Findings [15:11] Choosing between models [20:21] Impact of COVID [24:06] Final thoughts [28:21] Transcript
 
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