Feasibility and Acceptability of the HOME Program for Veterans Recently Discharged from a Psychiatric Hospitalization

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.

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References

  1. Attkisson, C. (2012) Administering and scoring the CSQ scales. CSQ Scales. Retrieved from http://www.csqscales.com/pdfs/CSQ%20AdministeringScoring.pdf.

  2. 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.

    Google Scholar 

  3. 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.

    CAS  Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

  8. 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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Linnan, L., & Steckler, A. (2002). Process evaluation for public health interventions and research. San Francisco: Josey-Bass.

    Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

  23. 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.

    CAS  Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. Rubin, H., & Rubin, I. (1995). Qualitative interviewing: The art of hearing data. Thousand Oaks: Sage Publications Inc.

    Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. 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.

    Article  Google Scholar 

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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.

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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.

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Correspondence to Bridget B. Matarazzo.

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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 (2021). https://doi.org/10.1007/s10488-021-01109-7

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Keywords

  • Suicide prevention
  • Treatment engagement
  • Veterans
  • Hospitalization