Department of Health Policy and Management Works

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    ‘Clustering of exemptions’ as a collective action threat to herd immunity
    (2003-03) May, Thomas; Silverman, Ross D.
    In this paper, we examine the phenomenon of ‘clustering of exemptions’ to childhood vaccination, and the dangers this poses both to those exempted as well as the general population. We examine how clusters of exemptions might form through collective action as described by Thomas Schelling, and how religious groups who live in close proximity to one another can “self-select” in a way that exacerbates this phenomenon. Given the growing number of exemptions and the increasing visibility of the anti-vaccine movement, policy makers must be vigilant for dangerous clustering in order to avoid loss of herd immunity.
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    Patient Safety and Patients' Rights
    (2004-06) Silverman, Ross D.
    Patient safety can be improved through the implementation of a physician reporting system, in which medical errors can be reported confidentially. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
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    From Structural Chaos to a Model of Consumer Support: Understanding the Roles of Structure and Agency in Mental Health Recovery for the Formerly Homeless
    (2012-07) Watson, Dennis P.
    Deinstitutionalization shifted the focus in mental health care from provider-guided treatment to consumer-centered recovery. In this article, I seek to develop a deeper understanding of the effect that the organization of mental health services offered in community settings has on the recovery process. I do this by presenting findings from the analysis of focus group and interview data collected from consumers and staff at four housing programs serving formerly homeless individuals with dual diagnosis. My findings highlight the importance of understanding the connection that exists between social structure and personal agency and the recovery process.
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    The Evolving Understanding of Recovery: What the Sociology of Mental Health has to Offer
    (2012-11) Watson, Dennis P.
    The meaning of recovery from serious mental illness (SMI) has evolved over time. Whereas it was not even considered to be a primary goal of treatment 30 years ago, it is the main focus of mental health policy today. These changes are partially the result of sociological research conducted during the age of institutional treatment and the early stages of community-based care. Despite these early influences, the sociology of mental health has largely overlooked the explicit study of recovery. This is because sociologists began shifting their focus from the study of SMI to the study of less severe mental health problems beginning in 1970s. In this article, I (a) discuss the evolving history of mental health recovery; (b) discuss how recovery is defined today in policy, practice, and research; and (c) present an argument for why sociological perspectives and methods can help shed light on the tensions between the definitions while assisting to develop better understandings of the recovery process. In this argument, I place particular attention on qualitative social psychological perspectives and methods because they hold the most potential for addressing some of the central concerns in the area of recovery research.
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    Perceived mental illness stigma, intimate relationships and sexual risk behavior in youth with mental illness
    (Sage, 2013) Elkington, Katherine S.; Hackler, Dusty; Walsh, Tracy A.; Latack, Jessica A.; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    The current study examines the role of mental illness-related stigma on romantic or sexual relationships and sexual behavior among youth with mental illness (MI), including youths' experiences of stigma, the internalization of these experiences, and the behavior associated with managing stigma within romantic and sexual relationships. We conducted in-depth interviews with N=20 youth with mental illness (MI) (55% male, 16-24 years, 75% Latino) from 4 psychiatric outpatient clinics in New York City. We conducted a thematic analysis to investigate shared experiences of MI stigma and its impact on youth's sexual or romantic relationships and associated behaviors. Our analysis revealed four main themes: 1) societal perceptions of those with MI as partners (societal stigma); 2) individual experiences of stigma within relationships (individual level); 3) internalized stigma of self as a partner (social-psychological processes); and 4) managing a stigmatized identity, of which some of the behaviors directly placed them at increased risk for HIV. We found that just under half of the sample (n=9/20) endorsed all themes, including engaging in HIV/STI sexual risk behaviors as a method to manage a stigmatize identity, which suggests that MI stigma and sexual risk may be linked. We discuss differences by gender and diagnosis. Findings provide new information for providers and researchers to address on the role of stigma experiences in the romantic and sexual behavior of youth in psychiatric treatment. Implications for stigma and HIV/STI prevention interventions are discussed.
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    Understanding the Critical Ingredients for Facilitating Consumer Change in Housing First Programming: A Case Study Approach
    (2013-04) Watson, Dennis P.; Wagner, Dana E.; Rivers, Michael
    Housing First is a form of permanent supportive housing for chronically homeless consumers with mental health and substance abuse issues. In light of the model’s growing popularity and wide diffusion, researchers and policy makers have identified a need to better understand its critical ingredients and the processes through which they affect consumer outcomes. Researchers used a bottom-up approach to understand the critical ingredients of Housing First within community-based programs. Interviews and focus groups were conducted with 60 informants (staff and consumers) across 4 “successful” Housing First programs. Qualitative analysis demonstrated six program ingredients to be essential: (1) a low-threshold admissions policy, (2) harm reduction, (3) eviction prevention, (4) reduced service requirements, (5) separation of housing and services, and (6) consumer education.
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    Towards Interoperability for Public Health Surveillance: Experiences from Two States
    (JMIR, 2013-04-04) Dixon, Brian E.; Siegel, Jason A.; Oemig, Tanya V.; Grannis, Shaun J.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: To characterize the use of standardized vocabularies in real-world electronic laboratory reporting (ELR) messages sent to public health agencies for surveillance. Introduction: The use of health information systems to electronically deliver clinical data necessary for notifiable disease surveillance is growing. For health information systems to be effective at improving population surveillance functions, semantic interoperability is necessary. Semantic interoperability is “the ability to import utterances from another computer without prior negotiation” (1). Semantic interoperability is achieved through the use of standardized vocabularies which define orthogonal concepts to represent the utterances emitted by information systems. There are standard, mature, and internationally recognized vocabularies for describing tests and results for notifiable disease reporting through ELR (2). Logical Observation Identifiers Names and Codes (LOINC) identify the specific lab test performed. Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) identify the diseases and organisms tested for in a lab test. Many commercial laboratory and hospital information systems claim to support LOINC and SNOMED CT on their company websites and in marketing materials, and systems certified for Meaningful Use are required to support LOINC and SNOMED CT. There is little empirical evidence on the use of semantic interoperability standards in practice. Methods: To characterize the use of standardized vocabularies in electronic laboratory reporting (ELR) messages sent to public health agencies for notifiable disease surveillance, we analyzed ELR messages from two states: Indiana and Wisconsin. We examined the data in the ELR messages where tests and results are reported (3). For each field, the proportion of field values that used either LOINC or SNOMED CT codes were calculated by dividing the number of fields with coded values by the total number of non-null values in fields. Results: Results are summarized in Table-1. In Indiana, less than 17% of incoming ELR messages contained a standardized code for identifying the test performed by the laboratory, and none of the test result fields contained a standardized vocabulary concept. For Wisconsin, none of the incoming ELR messages contained a standardized code for identifying the test performed, and less than 13% of the test result fields contained a SNOMED CT concept. Conclusions: Although Wisconsin and Indiana both have high adoption of advanced health information systems with many hospitals and laboratories using commercial systems which claim to support interoperability, very few ELR messages emanate from real-world systems with interoperable codes to identify tests and clinical results. To effectively use the arriving ELR messages, Indiana and Wisconsin health departments employ software and people workarounds to translate the incoming data into standardized concepts that can be utilized by the states’ surveillance systems. These workarounds present challenges for budget constrained public health departments seeking to leverage Meaningful Use Certified technologies to improve notifiable disease surveillance.
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    The housing first model (HFM) fidelity index: designing and testing a tool for measuring integrity of housing programs that serve active substance users
    (2013-05) Watson, Dennis P.; Orwat, John; Wagner, Dana E.; Shuman, Valery; Tolliver, Randi
    Background The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. The model has been widely diffused across the United States since 2000 as a result of positive findings related to consumer outcomes. However, a lack of clear fidelity guidelines has resulted in inconsistent implementation. The research team and their community partner collaborated to develop a HFM Fidelity Index. We describe the instrument development process and present results from its initial testing. Methods The HFM Fidelity Index was developed in two stages: (1) a qualitative case study of four HFM organizations and (2) interviews with 14 HFM "users". Reliability and validity of the index were then tested through phone interviews with staff members of permanent housing programs. The final sample consisted of 51 programs (39 Housing First and 12 abstinence-based) across 35 states. Results The results provided evidence for the overall reliability and validity of the index. Conclusions The results demonstrate the index’s ability to discriminate between housing programs that employ different service approaches. Regarding practice, the index offers a guide for organizations seeking to implement the HFM.