Workforce Development: Mental Health Service Delivery by Non-Mental Health Professionals

Jessica Pollard, PhD, Department of Psychiatry, Yale University School of Medicine, 34 Park Street , Room 219, New Haven, CT 06519

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)


PArtners in mental health: Certified PAs addressing national crises

Tiffany Flick, nccPA Health Foundation, Johns Creek, GA and Dawn Morton-Rias, Ed.D., PA-C, NCCPA & nccPA Health Foundation, Johns Creek, GA

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

In the United States, more than 44 million Americans have a mental health condition, and more than 115 million people live in areas where it is difficult to access services. The resulting human and financial impact is incalculable. The 131,000 certified PAs with their generalist fund of core medical knowledge can help bridge this gap. As PAs adapt to address unmet workforce and patient needs, this study explores PA contributions to addressing mental health and substance use disorder.

This study collected demographic and practice analysis data regarding how certified PAs are providing mental health services. A practice analysis delineates the knowledge and skills that characterize proficient performance and may also illuminate how particular knowledge and skills are used. The practice analysis survey included diseases and disorders as well as knowledge and skill statements that PAs rated on frequency and criticality scales. Aggregated data was analyzed using descriptive statistics.

The practice analysis was distributed to 93,365 PA respondents, and 15,771 responded. The 16.9% response rate was a representative sample of the PA profession. Descriptive analysis identified the top 10 diseases and disorders seen by PAs practicing in psychiatry and compared the frequency of those diseases and disorders seen by PAs in other practice areas. Further analyses identified the percentage of all PAs (and by practice area) using various knowledge and skills at least weekly: 62% of all PAs are evaluating patients with psychiatric symptoms; 45% are conducting a risk assessment for suicidal/homicidal ideation and violence/harm to self or others; and 73% are conducting education on modifiable risk factors with an emphasis on prevention. Additional analyses looked at substance use disorder.

Certified PAs are addressing mental health across practice settings, and this analysis establishes baselines to track contributions longitudinally. Further, the data informs the PArtners in Mental Health Initiative, which strives to advance the roles of PAs and strengthen partnerships to address issues impacting mental health and substance use disorders. Additional research is needed regarding the initiative’s key focus areas: enhancing educational approaches, strengthening practice integration, and raising awareness of PA models to address these critical needs.

Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Social and behavioral sciences


Examining the Associations between Community Health Worker-Rated Health and Depressive Symptomology in Latino Adults

Kiera Coulter, MPH, MS1, Maia Ingram, MPH2, Cynthia Espinoza, BA3, Abby Lohr, MPH2 and Scott Carvajal, PhD, MPH2, (1)University of Arizona, Tucson, AZ, (2)Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, (3)Yuma County Public Health Services District, Yuma, AZ

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Background: Studies show that individuals with chronic disease, including Latinos, often experience comorbid depression. Community health workers (CHWs) are effective in improving chronic disease self-management in Latinos, and develop trusting relationships with their clients to successfully identify and address their physical and emotional needs. In addressing their health, CHWs often appraise clients’ health status, but research has not examined the association between CHW-rated health (CHWRH) and clients’ mental health. Studies demonstrate the robustness of self-rated health’s (SRH) relations to mental health, but Latinos exhibit lower rates of mental health treatment, highlighting the need for improved ways of identifying Latinos experiencing depression. CHWs are uniquely positioned to rate their clients’ health, which could help in this effort. Thus, this study’s purpose was to examine CHWRH’s association with their clients’ depressive symptoms in a sample of Latino adults with or at-risk for chronic disease.

Methods: The current study utilized baseline data from the Linking Individual Needs to Community and Clinical Services (LINKS) study, examining the efficacy of CHW-led community-clinical linkages programs in improving chronic disease risk and emotional wellbeing among Latinos in U.S./Mexico border counties. CHWRH was measured as a CHW’s rating of their clients’ health status (poor – excellent), and SRH was measured as the clients’ rating of their health status (poor – excellent). The outcome, severity of depression symptoms, was measured utilizing the 10-item Center for Epidemiologic Studies Depression Scale Revised (CESD-R). We utilized multilevel linear regression modeling to examine the relationship between CHWRH and depression symptoms, controlling for SRH and demographics.

Results: CWHRH showed a statistically significant and robust association with severity of depression symptoms (p=0.035). SRH was also highly significant with participants’ severity of depression symptoms (p<0.001).

Conclusion: This study suggests that CHWRH could be indicative of depression symptomology above and beyond SRH, particularly within Latino adults. Given the cultural stigma and lower rates of mental health treatment among Latinos, further studies investigating CHWRH as an independent indicator of mental health are important. Future research should examine how CHWs use their cultural competence to rate health in a way that may improve identification of Latinos with depression symptoms.

Assessment of individual and community needs for health education Chronic disease management and prevention Diversity and culture Public health or related research


Demographic Differences Among University Faculty and Staff Who Participate in a Mental Health First Aid Training Program

Jessica Garcia, MPH, CPH, Jessica Garcia, MPH, CPH, Amy Gatto, MPH, Concha Prieto, BS, Jennifer Bleck, Ph.D., MPH and Rita DeBate, PhD, MPH, FAED, FAAHB, University of South Florida, Tampa, FL

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Background: Mental Health First Aid (MHFA) is a training program aimed at improving participants’ mental health literacy (MHL) and ability to approach, support, and aid those in distress of a mental health crisis. This study explored differences in outcomes among varying demographic groups among university faculty and staff who participated in a MHFA program.

Methods: A longitudinal, pre-, post-, and 3-month follow-up study design was used to assess the impact of MHFA training on faculty and staff participants (data collection ongoing – anticipated completion April 2019). Using an adapted version of the Mental Health Beliefs and Literacy Scale (MBLS), grounded in the Unified Theory of Behavior Change framework, the following constructs were assessed: 1) attitudes and beliefs on difficulty, reward, and positivity of MHFA, 2) personal and perceived social beliefs on MHFA and MH problems, 3) self-efficacy in respect to confidence and control, 4) behavioral intention, 5) knowledge of MH issues, 6) cues to action, 7) behavior, and 8) perceived behavioral change. Chi-Square tests, ANOVA, and regression analysis was conducted to highlight differences in outcomes between participants of varying cultures, identities, and demographics.

Results: Results highlighted outcomes that significantly improve and are retained over time after MHFA training. Preliminary analysis (n = 100) revealed statistically significant improvements across several constructs, including increases in personal beliefs towards others with MH illness (p = .046) and performing MHFA (p = .014), perceptions of difficulty (p = .006), belief in positivity (p = .001), perceptions on reward (p = .017), self-confidence to carry out MHFA actions (p = .001), and perceived control over these actions (p = .026) after MHFA training was received. Demographic differences will be assessed upon completion of data collection.

Conclusions: While MHFA trainings are an effective intervention to train university faculty and staff on recognition of students in distress demographic differences should be considered. MHFA training can be improved to address key components of the training that yield differences between demographic groups.

Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Other professions or practice related to public health Public health or related education


From silos to integration: Collaborating with psychiatry to provide peer led mental health education for primary care trainees

Nkemka Esiobu, MD MPH, Yale School of Medicine, New Haven, CT

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Primary care providers are often the first to encounter undiagnosed and untreated mental health disorders. Inadequately addressed mental health issues account for a significant amount of morbidity, mortality, health care costs, and workplace financial losses. Internal medicine residents report low comfort levels with seeing patients with mental illnesses despite frequently encountering them in their primary care clinics. To address this a psychiatry resident led interdepartmental (Psychiatry and Internal Medicine) skills based workshop for internal medicine residents was created. The aim of the project was to assess and address attitudes towards mental illness in primary care and gaps in primary care mental health education. A survey assessing comfort with and attitudes towards primary mental healthcare was disseminated to 120 Internal Medicine residents. Results confirmed that the majority of residents exhibited minimal comfort with addressing mental health issues in their primary care rotations. Many felt that mental illness affected the majority of their patients and they desired more training to better care for their patients. Based on these results, a four hour workshop was crafted focusing on 1) mental health stigma in health care 2) the impact of trauma across the lifespan and 3) substance use disorders in primary care. Qualitative feedback was gathered from post survey data and workshop discussion sessions. Residents expressed a greater sense of confidence in entering into mental health related clinical encounters and working with “difficult patients”. Residents also connected the significant impact of mental health on the management on physical chronic ailments and expressed a desire for clinical integration of care with mental health systems and further integration of mental health education into their traditional curriculum. In future iterations of this work, it would be important to assess if changes in provider attitudes and knowledge corresponded to changes in patient care and outcomes.

Administration, management, leadership Conduct evaluation related to programs, research, and other areas of practice Ethics, professional and legal requirements