Background: Measurement-Based Care (MBC) is an evidence-based practice that has demonstrated challenges integrating into care settings even under ideal circumstances. This study uses the PRISM framework to critically examine a systematic integration of MBC as standard behavioral healthcare in an adult ambulatory psychiatric clinic. Since the initial implementation in 2018, 33 distinct implementation strategies were used to enhance the uptake of this practice. To prepare for sustainment, our team developed a digital Measurement-based care Training for Resilient Implementation in a Clinical setting (METRIC) to improve implementation. The present study evaluates the reach, implementation, and contextual domains impacting METRIC. Methods: METRIC was IRB-approved and distributed to 56 multidisciplinary clinicians through the institutional learning hub. Providers completed surveys about implementation and clinician attitudes of METRIC before, 1 month, and 3 months after training. Patient attitudes were assessed before ( n = 98) and after ( n = 80) implementation. Clinician and patient attitudes were analyzed using the Friedman and Wilcoxon tests, respectively. Results: Forty-seven out of 56 (83.9%) clinicians completed METRIC. Implementation measures suggest there were promising acceptability, appropriateness, and feasibility. Clinicians positively rated METRIC. Clinicians answered 84% of module questions correctly, though their attitudes about MBC did not significantly change after METRIC. Patient attitudes did not significantly change. Conclusions: This study evaluated the implementation of METRIC in an ambulatory mental health clinic for its feasibility, acceptability, and appropriateness. After implementing strategies to enhance provider uptake, METRIC was piloted to standardize MBC training and prepare for sustainment. METRIC was well-received and provides an opportunity for less provider reliance on system champions and academic partnerships to sustain MBC utilization in mental health settings. Our findings define positive aspects of digital MBC training and areas for additional research, which include exploring the benefits of MBC training, examining need and frequency, and whether specialized training is beneficial.

Abstract Background This study examines the impact of SARS-CoV-2 (i.e., coronavirus, COVID, COVID-19) using data from a measurement-based care (MBC) system utilized in an outpatient psychiatric clinic providing telemedicine care. A novel Patient Rated Outcome Measure (PROM), the COVID-19 Events Checklist (CEC) was administered in a hospital system based ambulatory clinic beginning April 2020 to track COVID-19-19’s impact on patients’ mental, emotional, and health-related behaviors during the pandemic. The study (1) provides descriptive CEC data, and (2) compares CEC results with PROMs evaluating anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire; PHQ-9), and psychological distress (Brief Adjustment Scale-6; BASE-6). Methods This retrospective observational study included patient intake data collected from April 2020 to March 2021. Patient (N = 842) reports on the CEC’s five domain questions were aggregated to calculate average reports of COVID-19 related impacts at intake over the initial 12 months of the pandemic. Trends in COVID-19 related impacts were examined, and non-aggregated scores on the PHQ-9, GAD-7, and BASE-6 were compared to primary dichotomous (yes/no) CEC survey questions via Wilcoxon rand sum testing. Results Results capture the relationship between COVID-19 exposure, COVID-19- related sequelae and behaviors, and psychological symptom severity. Specifically, Wilcoxon rank-sum tests indicate that social determinants of health (SDOH), negative mental health impacts, and positive coping skill use were significantly associated with psychological symptomatology including overall psychological functioning via the BASE-6, anxiety via the GAD-7, and depressive symptoms via the PHQ-9. Results regarding SDOH were as follows: BASE-6 (w = 44,005, p < 0.001), GAD-7 (w = 44,116, p < 0.001), and PHQ-9 (w = 43,299, p < 0.001). Regarding negative mental health outcomes, the results were: BASE-6 (w = 38,374, p < 0.001), GAD-7 (w = 39,511, p < 0.001), and PHQ-9 (w = 40,154, p < 0.001). As the initial year of the pandemic elapsed, incoming patients demonstrated increased rates of suspected or confirmed exposure to COVID-19, (+2.29%, t = 3.19, p = 0.01), reported fewer negative impacts of COVID-19 on SDOH (−3.53%, t= −2.45, p = 0.034), and less engagement in positive coping strategies (−1.47%, t = −3.14, p = 0.010). Conclusions Psychosocial factors related to COVID-19 are discussed, as well as opportunities for further research on the relationship between psychological symptomatology and the impact of COVID-19 on health-related behaviors.

Objective: Little empirical evidence exists to support the effectiveness of hybrid psychiatric care, defined as care delivered through a combination of telephone, videoconferencing, and in-person visits. The authors aimed to investigate the effectiveness of hybrid psychiatric care compared with outpatient waitlist groups, assessed with patient-reported outcome measures (PROMs). Method: Participants were recruited from an adult psychiatry clinic waitlist on which the most common primary diagnoses were unipolar depression, generalized anxiety disorder, and bipolar disorder. Patients (N=148) were randomly assigned to one of two waitlist groups that completed PROMs once or monthly before treatment initiation. PROMs were used to assess symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and daily psychological functioning (Brief Adjustment Scale-6 [BASE-6]). Patient measures were summarized descriptively with means, medians, and SDs and then compared by using the KruskalWallis test; associated effect sizes were calculated. PROM scores for patients who received hybrid psychiatric treatment during a different period (N=272) were compared with scores of the waitlist groups. Results: PROM assessments of patients who engaged in hybrid care indicated significant improvements in symptom severity compared with the waitlist groups, regardless of the number of PROMs completed while patients were on the waitlist. Between the hybrid care and waitlist groups, the effect size for the PHQ-9 score was moderate (d=0.66); effect sizes were small for the GAD-7 (d=0.46) and BASE-6 (d=0.45) scores. Conclusions: The findings indicate the clinical effectiveness of hybrid care and that PROMs can be used to assess this effectiveness.

Abstract Problem Unlike other aspects of Obstetrics and Gynecology (OBGYN) residency training, the research education curriculum and requirements are not standardized. It is unclear what constitutes core curricula in educational research programs, which components are most useful and efficacious, and how to use these findings to adapt existing programs. Approach A multi-phase approach to (1) garner cross-sectional data from United States OBGYN Residency Program Directors and review previously published literature, (2) use Phase I and input from clinical, research and education faculty to develop a comprehensive program, and (3) evaluate the program for resident research productivity, knowledge and satisfaction. Outcomes Phase I: Sixty-one (31%) Program Directors completed the survey. Most reported ≤ 4 research didactics per year and no dedicated research rotation. Programs with post graduate year (PGY) level specific didactics, a research rotation, or allocated time for the Research Director role noted higher odds of resident research resulting in peer-reviewed publication. Phase II: A Resident Research Program was adapted to include a clinical and research faculty co-directorship and seven additional didactics (all of which were PGY-specific). A departmentally funded resident research grant and a repository to monitor completion of milestones and program requirements have been developed. Surveys were used to track residents’ research competence and satisfaction with the research program. While resident involvement in research activities and satisfaction with opportunities for scholarly activity have improved, resident self-evaluations and mentor evaluations have not. In addition, we have not seen an increase in publications or presentations. Conclusion Implementation of components of a research program associated with increased productivity did not result in increased productivity in our program, however, resident satisfaction with scholarly activity did improve.

Background Measurement-Based Care (MBC) is an evidence-based practice shown to enhance patient care. Despite being efficacious, MBC is not commonly used in practice. While barriers and facilitators of MBC implementation have been described in the literature, the type of clinicians and populations studied vary widely, even within the same practice setting. The current study aims to improve MBC implementation in adult ambulatory psychiatry by conducting focus group interviews while utilizing a novel virtual brainwriting premortem method. Methods Semi-structured focus group interviews were conducted with clinicians ( n = 18) and staff ( n = 7) to identify their current attitudes, facilitators, and barriers of MBC implementation in their healthcare setting. Virtual video-conferencing software was used to conduct focus groups, and based on transcribed verbatin, emergent barriers/facilitators and four themes were identified. Mixed methods approach was utilized for this study. Specifically, qualitative data was aggregated and re-coded separately by three doctoral-level coders. Quantitative analyses were conducted from a follow-up questionnaire surveying clinician attitudes and satisfaction with MBC. Results The clinician and staff focus groups resulted in 291 and 91 unique codes, respectively. While clinicians identified a similar number of barriers (40.9%) and facilitators (44.3%), staff identified more barriers (67%) than facilitators (24.7%) for MBC. Four themes emerged from the analysis; (1) a description of current status/neutral opinion on MBC; (2) positive themes that include benefits of MBC, facilitators, enablers, or reasons on why they conduct MBC in their practice, (3) negative themes that include barriers or issues that hinder them from incorporating MBC into their practice, and (4) requests and suggestions for future MBC implementation. Both participant groups raised more negative themes highlighting critical challenges to MBC implementation than positive themes. The follow-up questionnaire regarding MBC attitudes showed the areas that clinicians emphasized the most and the least in their clinical practice. Conclusion The virtual brainwriting premortem focus groups provided critical information on the shortcomings and strengths of MBC in adult ambulatory psychiatry. Our findings underscore implementation challenges in healthcare settings and provide insight for both research and clinical practice in mental health fields. The barriers and facilitators identified in this study can inform future training to increase sustainability and better integrate MBC with positive downstream outcomes in patient care.

Adolescents with type 1 diabetes mellitus (T1DM) are at increased risk for diabetes distress. This cross-sectional study used the Diabetes Distress Scale (DDS) to determine diabetes distress among adolescents with T1DM in a pediatric endocrinology clinic. Sixty-one percent of respondents reported moderate to sig-nificant diabetes distress levels, with overall diabetes distress of M = 2.409 (SD = 0.853). Emotional burden subcategory had the highest distress (M = 3.214, SD = 1.449). Minimal distress levels were reported in the physician burden subcategory (M =1.133, SD = 0.276). Results support the need for routine diabetes distress screening.& COPY; 2022 Elsevier Inc. All rights reserved.

Recent data by the NIMH suggest that an estimated 13.3% of the US population ages 12 to 17 years have had at least 1 episode of MDD. It is well-established that one of the core symptoms in adolescent MDD is sleep disturbance, including daytime sleepiness and insomnia. In addition, studies of adolescent sleep patterns have reported that the prevalence of insomnia in adolescents is as high as 23.8%, and a meta-analysis of longitudinal studies demonstrated that sleep disturbance is one of the primary risk factors for depression. Despite this, many of the studies looking at the relationship between insomnia and depression have been completed in the outpatient setting. Our study plans to contribute information to the literature by examining the relationship between insomnia and depression in adolescents on an inpatient psychiatric unit. Forty-nine voluntary adolescents in the age range of 13 to 17 years who were admitted to inpatient psychiatry were enrolled in this ongoing study. Children’s Report of Sleep Patterns (CRSP) Adolescent version and Patient Health Questionnaire (PHQ-9) Adolescent were used to assess sleep and depression symptoms. Adolescents who were intellectually delayed or psychotic were excluded from the study. All analyses were performed using SAS v. 9.4. Depression score (using PHQ-9) and insomnia symptom score (using CRSP) demonstrated a moderate positive relationship (r = 0.54). Using the insomnia symptom score as a predictor of depression, a linear regression analysis resulted in the insomnia symptom score being a significant predictor (p < .0001), and explaining 28.0% of the variation in depression score. Our ongoing study shows positive correlation between insomnia and depression in adolescents admitted to an inpatient psychiatry unit. Very few psychiatry inpatient adolescent studies are available in the literature exploring the relation between sleep and depression. Future studies would be helpful in understanding and addressing the role of sleep in mental health.

Introduction: To examine the effects of coronavirus disease 2019 (COVID-19) on patients in an academic psychiatric ambulatory clinic, data from a measurement-based care (MBC) system were analyzed to evaluate impacts on psychiatric functioning in patients using telemedicine. Psychiatric functioning was evaluated for psychological distress (brief adjustment scale [BASE]-6), depression (patient health questionnaire [PHQ]-9), and anxiety (generalized anxiety disorder [GAD]-7), including initial alcohol (U.S. alcohol use disorders identification test) and substance use (drug abuse screening test-10) screening. Methods: This observational study included MBC data collected from November 2019 to March 2021. Patient-Reported Outcome Measures (PROMs) were examined to determine changes in symptomatology over the course of treatment, as well as symptom changes resulting from the pandemic. Patients were included in analyses if they completed at least one PROM in the MBC system. Results: A total of 2,145 patients actively participated in the MBC system completing at least one PROM, with engagement ranging from 35.07% to 83.50% depending on demographic factors, where completion rates were significantly different for age, payor status, and diagnostic group. Average baseline scores for new patients varied for the GAD-7, PHQ-9, and BASE-6. Within-person improvements in mental health before and after the pandemic were statistically significant for anxiety, depression, and psychological adjustment. Discussion: MBC is a helpful tool in determining treatment progress for patients engaging in telemedicine. This study showed that patients who engaged in psychiatric services incorporating PROMs had improvements in mental health during the COVID-19 pandemic. Additional research is needed exploring whether PROMs might serve as a protective or facilitative factor for those with mental illness during a crisis when in-person visits are not possible.