Abstract
Enrollment in the Home-Based Mental Health Evaluation (HOME) Program is associated with higher rates of treatment engagement following psychiatric hospitalization discharge, as compared to enhanced care as usual. We aim to describe feasibility and acceptability data related to implementation of the HOME Program at two Department of Veterans Affairs Medical Centers (VAMCs) to inform future program refinement and implementation. Process evaluation data regarding feasibility and acceptability were collected in the context of an interventional multi-site trial. Data regarding enrollment in the study and the intervention were collected by study staff. Additional acceptability and feasibility data were obtained via the Client Satisfaction Questionnaire-8 (CSQ-8) and Narrative Evaluation of Intervention Interview (NEII). Between 82 and 91% of enrolled Veterans participated in at least one post-discharge telephone contact. Site differences existed with respect to completion of home visits. CSQ-8 results suggested high levels of satisfaction with the HOME Program. Themes identified via the NEII reflect that as a result of participation in the HOME Program, Veterans felt hopeful and cared for and learned how to keep themselves safe following hospital discharge. Process evaluation data from a clinical trial of the HOME Program demonstrated that the intervention was feasible to implement at two VAMCs and was acceptable to participants. These data inform considerations for future research and implementation efforts.
Trial Registration ClinicalTrials.gov Identifier: NCT03347552.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Attkisson, C. (2012) Administering and scoring the CSQ scales. CSQ Scales. Retrieved from http://www.csqscales.com/pdfs/CSQ%20AdministeringScoring.pdf.
Attkisson, C. C., & Greenfield, T. K. (1996). The client satisfaction questionnaire (CSQ) scales. In L. L. Sederer & B. Dickey (Eds.), Outcome assessment in clinical practice (pp. 120–127). Wilkins & Wilkins: Baltimore, MD.
Attkisson, C. C., & Zwick, R. (1982). The client satisfaction questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5(3), 233–237. https://doi.org/10.1016/0149-7189(82)90074-X.
Berg, S. H., Rortveit, K., & Aase, K. (2017). Suicidal patients’ experiences regarding their safety during psychiatric in-patient care: A systematic review of qualitative studies. BMC Health Services Research, 17(1), 73. https://doi.org/10.1186/s12913-017-2023-8.
Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: A systematic review and meta-analysis. JAMA Psychiatry, 74(7), 694–702. https://doi.org/10.1001/jamapyschiatry.2017.1044.
Cutcliffe, J. R., Links, P. S., Harder, H. G., Balderson, K., Bergmans, Y., Eynan, R., et al. (2012). Understanding the risks os recent discharge: the phenomenological lived experiences—“existential angst at the prospect of discharge.” Crisis, 33(1), 21–29. https://doi.org/10.1027/0227-5910/a000096.
Department of Veterans Affairs, Veterans Health Administration, Office of Mental Health and Suicide Prevention. Veteran suicide data report, 2005–2016. September 2018. Retrieved from https://www.mentalhealth.va.gov/docs/data-sheets/OMHSP_National_Suicide_Data_Report_2005–2016_508-compliant.pdf.
Gaston, L., & Sabourin, S. (1992). Client satisfaction and social desirability in psychotherapy. Evaluation and Program Planning, 15(3), 227–231. https://doi.org/10.1016/0149-7189(92)90085-9.
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82. https://doi.org/10.1177/1525822X05279903.
Hasson-Ohayon, I., Roe, D., & Kravetz, S. (2006). A qualitative approach to the evaluation of psychosocial intervention for persons with severe mental illness. Psychological Services, 3(4), 262–273. https://doi.org/10.1037/1541-1559.3.4.262.
Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington: National Academies Press.
Kahn, K., Schneider, E. C., Malin, J. L., Adams, J. L., & Epstein, A. M. (2007). Patient centered experiences in breast cancer: Predicting long-term adherence to tamoxifen use. Medical Care, 45(5), 431–439. https://doi.org/10.1097/01.mlr.0000257193.10760.7f.
Kapur, N., Steeg, S., Webb, R., Haigh, M., Bergen, H., Hawton, K., et al. (2013). Does clinical management improve outcomes following self-harm? Results from the multicenter study of self-harm in England. PLoS ONE, 8(8), e70434. https://doi.org/10.1371/journal.pone.0070434.
Katz, I. (2012). Lessons learned from mental health enhancement and suicide prevention activities in the Veterans Health Administration. American Journal of Public Health, 102(Suppl 1), S14–S16. https://doi.org/10.2105/AJPH.2011.300582.
Katz, I. R., Peltzman, T., Jedele, J. M., & McCarthy, J. F. (2019). Critical periods for increased mortality after discharge from inpatient mental health units: Opportunities for prevention. Psychiatric services, 70(6), 450–456. https://doi.org/10.1176/appi.ps.201800352.
Linnan, L., & Steckler, A. (2002). Process evaluation for public health interventions and research. San Francisco: Josey-Bass.
Luxton, D. D., Trofimovich, L., & Clark, L. L. (2013). Suicide risk among US service members after psychiatric hospitalization, 2001–2011. Psychiatric Services, 64(7), 626–629. https://doi.org/10.1176/appi.ps.201200413.
Matarazzo, B. B., Farro, S. A., Billera, B., Forster, J. E., Kemp, J. E., & Brenner, L. A. (2017). Connecting veterans at risk for suicide to care through the HOME Program. Suicide and Life-Threatening Behavior, 47(6), 709–717. https://doi.org/10.1111/sltb.12334.
Matarazzo, B. B., Forster, J. E., Hostetter, T. A., Billera, M., Adler, G., Ganzini, L. K., et al. (2019). Efficacy of the Home-Based Mental Health Evaluation (HOME) Program for engaging patients in care after hospitalization. Psychiatric Services, 70(12), 1094–1100. https://doi.org/10.1176/appi.ps.201900002.
Meehan, J., Kapur, N., Hunt, I. M., Turnbull, P., Robinson, J., Bickley, H., et al. (2006). Suicide in mental health in-patients and within 3 months of discharge. National clinical survey. British Journal of Psychiatry, 188, 129–134. https://doi.org/10.1192/bjp.188.2.129.
Montross Thomas, L. P., Painkas, L. A., Meier, E. A., Iglewicz, A., Kirkland, T., & Zisook, S. (2014). Yearning to be heard: What veterans teach us about suicide risk and effective interventions. Crisis, 35(3), 161–167. https://doi.org/10.1027/0227-5910/a000247.
Morshed, A., Tabak, R., Taranhike, I., Baumann, A., & Proctor, E. Intro to D&I. St. Louis, MO: Washington University; 2016 October. Retrieved from https://cpb-us-w2.wpmucdn.com/sites.wustl.edu/dist/6/786/files/2017/08/DIRC-intro-toolkit-2016.12.9-edits-1l2x1m8.pdf.
Nguyen, T. D., Attkisson, C. C., & Stegner, B. L. (1983). Assessment of patient satisfaction: Development and refinement of service evaluation questionnaire. Evaluation and Program Planning, 6(3–4), 299–313. https://doi.org/10.1016/0149-7189(83)90010-1.
Olfson, M., Wall, M., Wang, S., Crystal, S., Liu, S. M., Gerhard, T., et al. (2016). Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiatry, 73(11), 1119–1126. https://doi.org/10.1001/jamapsychiatry.2016.2035.
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7.
Rathert, C., Wyrwich, M. D., & Boren, S. A. (2012). Patient-centered care and outcomes: A systematic review of the literature. Medical Care Research and Review, 70(4), 251–379. https://doi.org/10.1177/1077558712465774.
Riblet, N., Shiner, B., Watts, B. V., Mills, P., Rusch, B., & Hemphill, R. R. (2017). Death by suicide within 1 week of hospital discharge: A retrospective study of root cause analysis reports. The Journal of Nervous and Mental Disease, 205(6), 436–442. https://doi.org/10.1097/NMD.0000000000000687.
Riblet, N., Shiner, B., Scott, R., Bruce, M. L., Wasserman, D., & Watts, B. V. (2019). Exploring psychiatric inpatients’ beliefs about the role of post-discharge follow-up care in suicide prevention. Military Medicine, 184(1–2), e91–e100. https://doi.org/10.1093/milmed/usy129.
Roumie, C. L., Greevy, R., Wallston, K. A., Elasy, T. A., Kaltenbach, L., Kotter, K., et al. (2011). Patient centered primary care is associated with patient hypertension medication adherence. The Journal of Behavioral Medicine, 34(4), 244–253. https://doi.org/10.1007/s10865-010-9304-6.
Rubin, H., & Rubin, I. (1995). Qualitative interviewing: The art of hearing data. Thousand Oaks: Sage Publications Inc.
Smith, T. E., Abraham, M. A., Bolotnikova, N. V., Donahue, S. A., Essock, S. M., Olfson, M., et al. (2017). Psychiatric inpatient discharge planning practices and attendance at aftercare appointments. Psychiatric Services, 68(1), 92–95. https://doi.org/10.1176/appi.ps.201500552.
Stanley, B., Brown, G. K., Karlin, B., Kemp, J., & VonBergen, H. A. (2008). Safety plan treatment manual to reduce suicide risk: Veteran version. Washington, DC: U.S Department of Veterans Affairs.
Stanley, B., & Mann, J. M. (2020). The need for innovation in health care systems to improve suicide prevention. JAMA Psychiatry, 77(1), 96–98. https://doi.org/10.1001/jamapsychiatry.2019.2769.
Trafton, J. A., Greenberg, G., Harris, A. H., Tavakoli, S., Kearney, L., McCarthy, J., et al. (2013). VHA mental health information system: applying health information technology to monitor and facilitate implementation of VHA Uniform Mental Health Services Handbook requirements. Medical Care, 51(suppl 1), S29–S36. https://doi.org/10.1097/MLR.0b013e31827da836.
Valenstein, M., Hyungjin, M. K., Ganoczy, D., McCarthy, J. F., Zivin, K., Austin, K. L., et al. (2009). Higher risk periods for suicide among VA patients receiving depression treatment. Journal of Affective Disorders, 112(1–3), 50–58. https://doi.org/10.1016/j.jad.2008.08.020.
Wandersman, A., Imm, P., Chinman, M., & Kaftarian, S. (2000). Getting to outcomes: A results-based approach to accountability. Evaluation and Program Planning, 23(3), 389–395. https://doi.org/10.1016/S0149-7189(00)00028-8.
Disclaimer
This article is based on work supported, in part, by the Department of Veterans Affairs and Department of Defense but does not necessarily represent the views of the Department of Veterans Affairs, Department of Defense or the United States Government.
Funding
This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH-10-2-0178, Proposal No. 09162006). Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the MSRC or the Department of Defense.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by BM, GG and MJ. The first draft of the manuscript was written by BM, GG and MJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
Institutional review board (IRB) approval was obtained from local site IRBs and the Department of Defense (Study Sponsor).
Informed Consent
All participants provided written informed consent for participation and publication after receiving a complete description of the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Matarazzo, B.B., Gerard, G.R., Jankovsky, M.C. et al. Feasibility and Acceptability of the HOME Program for Veterans Recently Discharged from a Psychiatric Hospitalization. Adm Policy Ment Health 48, 974–982 (2021). https://doi.org/10.1007/s10488-021-01109-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-021-01109-7