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Published in: Administration and Policy in Mental Health and Mental Health Services Research 6/2006

01-11-2006 | ORIGINAL PAPER

Does Systems Integration Affect Continuity of Mental Health Care?

Authors: Janet Durbin, Paula Goering, David L. Streiner, George Pink

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 6/2006

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Abstract

Continuity of care is a concern for mental health clients in the post deinstitutionalization era of community care. A proposed solution is systems integration. This paper reviewed research on systems integration, focusing on continuity of care outcomes. A positive association between systems integration and client continuity of care was consistently demonstrated. Better results were obtained in systems characterized by stronger management arrangements, fewer service sectors, and system wide implementation of intensive case management and centralized access to services. Future research should evaluate a wider range of systems integrating mechanisms, using client-based measures that more directly represent continuity of care experiences.
Literature
go back to reference Adair, C. E., McDougall, G. M., Beckie, A., Joyce, A., Mitton, C., & Wild, C. T., et al. (2003). History and measurement of continuity of care in mental health services and evidence of its role in outcomes. Psychiatric Services, 54, 1351–1356.PubMedCrossRef Adair, C. E., McDougall, G. M., Beckie, A., Joyce, A., Mitton, C., & Wild, C. T., et al. (2003). History and measurement of continuity of care in mental health services and evidence of its role in outcomes. Psychiatric Services, 54, 1351–1356.PubMedCrossRef
go back to reference Adair, C. E., Wild, T. C., Joyce, A. S., McDougall, G. M., Gordon, M. D., Costigan, N., et al. (2001). Development of a measure of perceived continuity of care for persons with severe mental illness. Paper presented at the proceedings of the 2001 Congress of Epidemiology, Toronto, Ontario. Adair, C. E., Wild, T. C., Joyce, A. S., McDougall, G. M., Gordon, M. D., Costigan, N., et al. (2001). Development of a measure of perceived continuity of care for persons with severe mental illness. Paper presented at the proceedings of the 2001 Congress of Epidemiology, Toronto, Ontario.
go back to reference Anthony, W., Rogers, E. S., & Farkas, M. (2003). Research on evidence-based practices: Future directions in an era of recovery. Community Mental Health Journal, 39, 101–114.PubMedCrossRef Anthony, W., Rogers, E. S., & Farkas, M. (2003). Research on evidence-based practices: Future directions in an era of recovery. Community Mental Health Journal, 39, 101–114.PubMedCrossRef
go back to reference Bachrach, L. L. (1981). Continuity of care for chronic mental patients: A conceptual analysis. The American Journal of Psychiatry, 138, 1449–1456.PubMed Bachrach, L. L. (1981). Continuity of care for chronic mental patients: A conceptual analysis. The American Journal of Psychiatry, 138, 1449–1456.PubMed
go back to reference Bachrach, L. L. (1993). Continuity of care and approaches to case management for long-term mentally ill patients. Hospital and Community Psychiatry, 44, 465–468.PubMed Bachrach, L. L. (1993). Continuity of care and approaches to case management for long-term mentally ill patients. Hospital and Community Psychiatry, 44, 465–468.PubMed
go back to reference Beecher, L. H. (2003). Ask patients and caregivers about continuity of care. Psychiatric Services, 54, 425.PubMedCrossRef Beecher, L. H. (2003). Ask patients and caregivers about continuity of care. Psychiatric Services, 54, 425.PubMedCrossRef
go back to reference Bickman, L. (1996). A continuum of care. More is not always better. The American Psychologist, 51, 689–701.PubMedCrossRef Bickman, L. (1996). A continuum of care. More is not always better. The American Psychologist, 51, 689–701.PubMedCrossRef
go back to reference Bickman, L., Noser, K., & Summerfelt, W. T. (1999). Long-term effects of a system of care on children and adolescents. The Journal of Behavioral Health Services and Research, 26, 185–202. Bickman, L., Noser, K., & Summerfelt, W. T. (1999). Long-term effects of a system of care on children and adolescents. The Journal of Behavioral Health Services and Research, 26, 185–202.
go back to reference Chamberlain, R., Rapp, C. A., Ridgway, P., Lee, R., & Boezio, C. (1999). Mental health reform in Kansas: Cost containment and quality of life. Psychiatric Rehabilitation Journal, 23, 137–142. Chamberlain, R., Rapp, C. A., Ridgway, P., Lee, R., & Boezio, C. (1999). Mental health reform in Kansas: Cost containment and quality of life. Psychiatric Rehabilitation Journal, 23, 137–142.
go back to reference Cocozza, J. J., Steadman, H. J., Dennis, D. L., Blaskinsky, M., Randolph, F. L., Johnsen, M., et al. (2000). Creating successful systems integration strategies: Lessons from the ACCESS Program for persons who are homeless and mentally ill. Administration and Policy in Mental Health, 27, 395–407.PubMedCrossRef Cocozza, J. J., Steadman, H. J., Dennis, D. L., Blaskinsky, M., Randolph, F. L., Johnsen, M., et al. (2000). Creating successful systems integration strategies: Lessons from the ACCESS Program for persons who are homeless and mentally ill. Administration and Policy in Mental Health, 27, 395–407.PubMedCrossRef
go back to reference Devers, K. J., Shortell, S. M., Gillies, R. R., Anderson, D. A., Mitchell, J. B., & Erickson, K. L. (1994). Implementing organized delivery systems: An integration scorecard. Health Care Management Review, 19, 7–20.PubMed Devers, K. J., Shortell, S. M., Gillies, R. R., Anderson, D. A., Mitchell, J. B., & Erickson, K. L. (1994). Implementing organized delivery systems: An integration scorecard. Health Care Management Review, 19, 7–20.PubMed
go back to reference Druss, B. G., Miller, C. L., Rosenheck, R. A., Shih, S. C., & Bost, J. E. (2002). Mental health care quality under managed care in the United States: a view from the Health Employer Data and Information Set (HEDIS). The American Journal of Psychiatry, 159, 860–862.PubMedCrossRef Druss, B. G., Miller, C. L., Rosenheck, R. A., Shih, S. C., & Bost, J. E. (2002). Mental health care quality under managed care in the United States: a view from the Health Employer Data and Information Set (HEDIS). The American Journal of Psychiatry, 159, 860–862.PubMedCrossRef
go back to reference Durbin, J., Goering, P., Streiner, D., & Pink, G. (2004). Continuity of care: Validation of a new Self-Report measure for individuals using mental health services. Journal of Behavioral Health Services and Research, 31(3), 279–296.PubMedCrossRef Durbin, J., Goering, P., Streiner, D., & Pink, G. (2004). Continuity of care: Validation of a new Self-Report measure for individuals using mental health services. Journal of Behavioral Health Services and Research, 31(3), 279–296.PubMedCrossRef
go back to reference Freeman, G., Crawford, M., Weaver, T., Low, J., & de Jonge, E. (2003). Promoting continuity of care for people with severe mental illness whose needs span primary, secondary and social care. A multi-method investigation of relevant mechanisms and contexts: Briefing paper. Retrieved on October 10, 2003, from http://www.sdo.lshtm.ac.hk/continuityofcare.htm Freeman, G., Crawford, M., Weaver, T., Low, J., & de Jonge, E. (2003). Promoting continuity of care for people with severe mental illness whose needs span primary, secondary and social care. A multi-method investigation of relevant mechanisms and contexts: Briefing paper. Retrieved on October 10, 2003, from http://​www.​sdo.​lshtm.​ac.​hk/​continuityofcare​.​htm
go back to reference Goering, P., Wasylenki, D., & Durbin, J. (2000). Canada’s mental health system. International Journal of Law and Psychiatry, 23, 345–359.PubMedCrossRef Goering, P., Wasylenki, D., & Durbin, J. (2000). Canada’s mental health system. International Journal of Law and Psychiatry, 23, 345–359.PubMedCrossRef
go back to reference Goldman, H. H., Lehman, A. F., Morrissey, J. P., Newman, S. J., Frank, R. G., & Steinwachs, D. M. (1990). Design for the national evaluation of the Robert Wood Johnson Foundation Program on Chronic Mental Illness. Hospital and Community Psychiatry, 41, 1217–1221.PubMed Goldman, H. H., Lehman, A. F., Morrissey, J. P., Newman, S. J., Frank, R. G., & Steinwachs, D. M. (1990). Design for the national evaluation of the Robert Wood Johnson Foundation Program on Chronic Mental Illness. Hospital and Community Psychiatry, 41, 1217–1221.PubMed
go back to reference Goldman, H. H., Thelander, S., & Westrin, C. G. (2000). Organizing mental health services: An evidence-based approach. The Journal of Mental Health Policy and Economics, 3, 69–75.PubMedCrossRef Goldman, H. H., Thelander, S., & Westrin, C. G. (2000). Organizing mental health services: An evidence-based approach. The Journal of Mental Health Policy and Economics, 3, 69–75.PubMedCrossRef
go back to reference Hadley, T. R. (1996). Financing changes and their impact on the organization of the public mental health system. Administration and Policy in Mental Health, 23, 393–405.CrossRef Hadley, T. R. (1996). Financing changes and their impact on the organization of the public mental health system. Administration and Policy in Mental Health, 23, 393–405.CrossRef
go back to reference Hoge, M. A., Davidson, L., Griffith, E. E., Sledge, W. H., & Howenstine, R. A. (1994). Defining managed care in public-sector psychiatry. Hospital and Community Psychiatry, 45, 1085– 1089.PubMed Hoge, M. A., Davidson, L., Griffith, E. E., Sledge, W. H., & Howenstine, R. A. (1994). Defining managed care in public-sector psychiatry. Hospital and Community Psychiatry, 45, 1085– 1089.PubMed
go back to reference Hohmann, A. A. (1999). A contextual model for clinical mental health effectiveness research. Mental Health Services Research, 1, 83–91.CrossRef Hohmann, A. A. (1999). A contextual model for clinical mental health effectiveness research. Mental Health Services Research, 1, 83–91.CrossRef
go back to reference Johnson, S., Prosser, D., Bindman, J., & Szmukler, G. (1997). Continuity of care for the severely mentally ill: Concepts and measures. Social Psychiatry and Psychiatric Epidemiology, 32, 137–142.PubMed Johnson, S., Prosser, D., Bindman, J., & Szmukler, G. (1997). Continuity of care for the severely mentally ill: Concepts and measures. Social Psychiatry and Psychiatric Epidemiology, 32, 137–142.PubMed
go back to reference Konrad, E. L. (1996). A multidimensional framework for conceptualizing human services integration initiatives. New Directions for Evaluation, 69, 5–19.CrossRef Konrad, E. L. (1996). A multidimensional framework for conceptualizing human services integration initiatives. New Directions for Evaluation, 69, 5–19.CrossRef
go back to reference Lamb, H. R., & Bachrach, L. L. (2001). Some perspectives on deinstitutionalization. Psychiatric Services, 52, 1039–1045.PubMedCrossRef Lamb, H. R., & Bachrach, L. L. (2001). Some perspectives on deinstitutionalization. Psychiatric Services, 52, 1039–1045.PubMedCrossRef
go back to reference Lefkovitz, P. M. (2001). A model of service delivery integration. In L. J. Kiser, P. M. Lefkovitz, & L. L. Kennedy (Eds.), The integrated behavioral health continuum: Theory and practice (1st ed., pp. 17–40). Washington, DC: American Psychiatric Publishing, Inc. Lefkovitz, P. M. (2001). A model of service delivery integration. In L. J. Kiser, P. M. Lefkovitz, & L. L. Kennedy (Eds.), The integrated behavioral health continuum: Theory and practice (1st ed., pp. 17–40). Washington, DC: American Psychiatric Publishing, Inc.
go back to reference Lehman, A. F., Postrado, L. T., Roth, D., McNary, S. W., & Goldman, H. H. (1994). Continuity of care and client outcomes in the Robert Wood Johnson Foundation program on chronic mental illness. The Milbank Quarterly, 72, 105–122.PubMedCrossRef Lehman, A. F., Postrado, L. T., Roth, D., McNary, S. W., & Goldman, H. H. (1994). Continuity of care and client outcomes in the Robert Wood Johnson Foundation program on chronic mental illness. The Milbank Quarterly, 72, 105–122.PubMedCrossRef
go back to reference Morrissey, J. P., Calloway, M., Bartko, W. T., Ridgely, M. S., Goldman, H. H., & Paulson, R. I. (1994). Local mental health authorities and service system change: Evidence from the Robert Wood Johnson program on chronic mental illness. The Milbank Quarterly, 72, 49– 80.PubMedCrossRef Morrissey, J. P., Calloway, M., Bartko, W. T., Ridgely, M. S., Goldman, H. H., & Paulson, R. I. (1994). Local mental health authorities and service system change: Evidence from the Robert Wood Johnson program on chronic mental illness. The Milbank Quarterly, 72, 49– 80.PubMedCrossRef
go back to reference Morrissey, J. P., Calloway, M. O., Thakur, N., Cocozza, J., Steadman, H. J., & Dennis, D. (2002). Integration of service systems for homeless persons with serious mental illness through the ACCESS program. Access to Community Care and Effective Services and Supports. Psychiatric Services, 53, 949–957.PubMedCrossRef Morrissey, J. P., Calloway, M. O., Thakur, N., Cocozza, J., Steadman, H. J., & Dennis, D. (2002). Integration of service systems for homeless persons with serious mental illness through the ACCESS program. Access to Community Care and Effective Services and Supports. Psychiatric Services, 53, 949–957.PubMedCrossRef
go back to reference Provan, K. G., & Milward, H. B. (1994). Integration of community-based services for the severely mentally ill and the structure of public funding: A comparison of four systems. Journal of Health Politics, Policy and Law, 19, 865–894.PubMed Provan, K. G., & Milward, H. B. (1994). Integration of community-based services for the severely mentally ill and the structure of public funding: A comparison of four systems. Journal of Health Politics, Policy and Law, 19, 865–894.PubMed
go back to reference Randolph, F., Blasinsky, M., Morrissey, J. P., Rosenheck, R. A., Cocozza, J., & Goldman, H. H. (2002). Overview of the ACCESS Program. Access to community care and effective services and supports. Psychiatric Services, 53, 945–948.PubMedCrossRef Randolph, F., Blasinsky, M., Morrissey, J. P., Rosenheck, R. A., Cocozza, J., & Goldman, H. H. (2002). Overview of the ACCESS Program. Access to community care and effective services and supports. Psychiatric Services, 53, 945–948.PubMedCrossRef
go back to reference Rapp, C. A., & Moore, T. D. (1995). The first 18 months of mental health reform in Kansas. Psychiatric Services, 46, 580–585.PubMed Rapp, C. A., & Moore, T. D. (1995). The first 18 months of mental health reform in Kansas. Psychiatric Services, 46, 580–585.PubMed
go back to reference Ridgely, M. S., Morrissey, J. P., Paulson, R. I., Goldman, H. H., & Calloway, M. O. (1996). Characteristics and activities of case managers in the RWJ Foundation Program on chronic mental illness. Psychiatric Services, 47, 737–743.PubMed Ridgely, M. S., Morrissey, J. P., Paulson, R. I., Goldman, H. H., & Calloway, M. O. (1996). Characteristics and activities of case managers in the RWJ Foundation Program on chronic mental illness. Psychiatric Services, 47, 737–743.PubMed
go back to reference Rivard, J. C., & Morrissey, J. P. (2003). Factors associated with interagency coordination in a child mental health service system demonstration. Administration and Policy in Mental Health, 30, 397–415.PubMedCrossRef Rivard, J. C., & Morrissey, J. P. (2003). Factors associated with interagency coordination in a child mental health service system demonstration. Administration and Policy in Mental Health, 30, 397–415.PubMedCrossRef
go back to reference Rosenheck, R., & Cicchetti, D. (1998). A mental health program report card: A multidimensional approach to performance monitoring in public sector programs. Community Mental Health Journal, 34, 85–106.PubMedCrossRef Rosenheck, R., & Cicchetti, D. (1998). A mental health program report card: A multidimensional approach to performance monitoring in public sector programs. Community Mental Health Journal, 34, 85–106.PubMedCrossRef
go back to reference Rosenheck, R., Morrissey, J., Lam, J., Calloway, M., Johnsen, M., Goldman, H., et al. (1998). Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness. American Journal of Public Health, 88, 1610–1615.PubMedCrossRef Rosenheck, R., Morrissey, J., Lam, J., Calloway, M., Johnsen, M., Goldman, H., et al. (1998). Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness. American Journal of Public Health, 88, 1610–1615.PubMedCrossRef
go back to reference Rosenheck, R., Morrissey, J., Lam, J., Calloway, M., Stolar, M., Johnsen, M., et al. (2001). Service delivery and community: Social capital, service systems integration, and outcomes among homeless persons with severe mental illness. Health Services Research, 36, 691–710.PubMed Rosenheck, R., Morrissey, J., Lam, J., Calloway, M., Stolar, M., Johnsen, M., et al. (2001). Service delivery and community: Social capital, service systems integration, and outcomes among homeless persons with severe mental illness. Health Services Research, 36, 691–710.PubMed
go back to reference Rosenheck, R. A., Lam, J., Morrissey, J. P., Calloway, M. O., Stolar, M., & Randolph, F. (2002). Service systems integration and outcomes for mentally ill homeless persons in the ACCESS program. Access to Community Care and Effective Services and Supports. Psychiatric Services, 53, 958–966.PubMedCrossRef Rosenheck, R. A., Lam, J., Morrissey, J. P., Calloway, M. O., Stolar, M., & Randolph, F. (2002). Service systems integration and outcomes for mentally ill homeless persons in the ACCESS program. Access to Community Care and Effective Services and Supports. Psychiatric Services, 53, 958–966.PubMedCrossRef
go back to reference Saarento, O., Oiesvold, T., Sytema, S., Gostas, G., Kastrup, M., Lonnerberg, O., et al. (1998). The Nordic Comparative Study on Sectorized Psychiatry: Continuity of care related to characteristics of the psychiatric services and the patients. Social Psychiatry and Psychiatric Epidemiology, 33, 521–527.PubMedCrossRef Saarento, O., Oiesvold, T., Sytema, S., Gostas, G., Kastrup, M., Lonnerberg, O., et al. (1998). The Nordic Comparative Study on Sectorized Psychiatry: Continuity of care related to characteristics of the psychiatric services and the patients. Social Psychiatry and Psychiatric Epidemiology, 33, 521–527.PubMedCrossRef
go back to reference Salzer, M. S., Kamis-Gould, E., & Hadley, T. (2001). Current research on mental health systems integration. In L. J. Kiser, P. M. Lefkovitz, & L. L. Kennedy (Eds.), The integrated behavioral health continuum: Theory and practice (First ed., pp. 235–256). Washington, DC: American Psychiatric Publishing, Inc. Salzer, M. S., Kamis-Gould, E., & Hadley, T. (2001). Current research on mental health systems integration. In L. J. Kiser, P. M. Lefkovitz, & L. L. Kennedy (Eds.), The integrated behavioral health continuum: Theory and practice (First ed., pp. 235–256). Washington, DC: American Psychiatric Publishing, Inc.
go back to reference Shern, D. L., Wilson, N. Z., Coen, A. S., Patrick, D. C., Foster, M., Bartsch, D. A., et al. (1994). Client outcomes II: Longitudinal client data from the Colorado treatment outcome study. The Milbank Quarterly, 72, 123–148.PubMedCrossRef Shern, D. L., Wilson, N. Z., Coen, A. S., Patrick, D. C., Foster, M., Bartsch, D. A., et al. (1994). Client outcomes II: Longitudinal client data from the Colorado treatment outcome study. The Milbank Quarterly, 72, 123–148.PubMedCrossRef
go back to reference Shields, C. (1999). Guide to Services Integration Projects. Ontario, Canada: sine nomine (s. n.) Shields, C. (1999). Guide to Services Integration Projects. Ontario, Canada: sine nomine (s. n.)
go back to reference Sytema, S., & Burgess, P. (1999). Continuity of care and readmission in two service systems: A comparative Victorian and Groningen case-register study. Acta Psychiatrica Scandinavica, 100, 212–219.PubMed Sytema, S., & Burgess, P. (1999). Continuity of care and readmission in two service systems: A comparative Victorian and Groningen case-register study. Acta Psychiatrica Scandinavica, 100, 212–219.PubMed
go back to reference Sytema, S., Micciolo, R., & Tansella, M. (1997). Continuity of care for patients with schizophrenia and related disorders: a comparative south-Verona and Groningen case-register study. Psychological Medicine, 27, 1355–1362.PubMedCrossRef Sytema, S., Micciolo, R., & Tansella, M. (1997). Continuity of care for patients with schizophrenia and related disorders: a comparative south-Verona and Groningen case-register study. Psychological Medicine, 27, 1355–1362.PubMedCrossRef
go back to reference Tansella, M., & Thornicroft, G. (1998). A conceptual framework for mental health services: The matrix model. Psychological Medicine, 28, 503–508.PubMedCrossRef Tansella, M., & Thornicroft, G. (1998). A conceptual framework for mental health services: The matrix model. Psychological Medicine, 28, 503–508.PubMedCrossRef
go back to reference Thornicroft, G., & Tansella, M. (1999). Translating ethical principles into outcome measures for mental health service research. Psychological Medicine, 29, 761–767.PubMedCrossRef Thornicroft, G., & Tansella, M. (1999). Translating ethical principles into outcome measures for mental health service research. Psychological Medicine, 29, 761–767.PubMedCrossRef
go back to reference Ware, N. C., Dickey, B., Tugenberg, T., & McHorney, C. A. (2003). CONNECT: A measure of continuity of care in mental health services. Mental Health Services Research, 5, 209– 221.PubMedCrossRef Ware, N. C., Dickey, B., Tugenberg, T., & McHorney, C. A. (2003). CONNECT: A measure of continuity of care in mental health services. Mental Health Services Research, 5, 209– 221.PubMedCrossRef
Metadata
Title
Does Systems Integration Affect Continuity of Mental Health Care?
Authors
Janet Durbin
Paula Goering
David L. Streiner
George Pink
Publication date
01-11-2006
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 6/2006
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-006-0087-6

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