Report From Third Annual ALACRITY Center's Mental Health Care Retreat
Photos: Hoag Levins
Launched at Penn in 2017, ALACRITY is a National Institute of Mental Health-funded center exploring how behavioral economics and implementation science research can be combined to improve mental health treatments. The acronym stands for "Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness." A collaboration between the Penn Center for Mental Health (CMH) and the Center for Health Incentives and Behavioral Economics (CHIBE), ALACRITY is co-directed by Penn Medicine faculty members and LDI Senior Fellows Rinad Beidas, PhD, David Mandell, ScD, Kevin Volpp, MD, PhD, and Alison Buttenheim, PhD.
Opening the event was Rinad Beidas, an Associate Professor of Psychiatry at Penn's Perelman School of Medicine and Director of the Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI). Beidas briefly discussed the three major research projects now underway at ALACRITY. The first is studying how to increase antidepressant adherence among adults with newly-diagnosed depression. The second is testing methods to increase data collection by therapeutic support personnel who work with children with autism. The third is assessing how to substantially increase the use of evidence-based treatment methods in community mental health centers.
Like past ALACRITY events, this one was attended by members of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). Above left, DBHIDS Deputy Commissioner Roland Lamb talks with Samantha Crabbe, MSEd, and Darby Marx (center) of the Penn Center for Mental Health (CMH), where Crabbe is Senior Clinical Research Coordinator and Marx is a Clinical Research Coordinator. DBHIDS and CMH have a long history of collaboration; earlier this year, both received a national award from the Society for Implementation Research Collaboration (SIRC) for their joint research efforts to improve care throughout Philadelphia's mental health provider networks.
Above, right, deep in discussion, is Scott Halpern, MD, PhD, a Perelman School Professor, Director of Penn's Palliative and Advanced Illness Research (PAIR) Center, and an LDI Senior Fellow.
Reporting on ALACRITY Project 1 — aimed at increasing antidepressant adherence among adults with newly diagnosed depression — is Project Co-Director Steven Marcus, PhD (above, left). He said the good news is that researchers are ahead of schedule in recruiting participants in a study testing financial incentives for adherence behavior. "The EPIC medical records system alerts us when there's a patient who is potentially eligible. We reach out to them, ask if they're interested; those who are interested get enrolled, and we follow them for six to twelve weeks," Marcus said.
Above, right, is Co-Director of ALACRITY Project 2, David Mandell, ScD, Director of CMH, Associate Director of the Center for Autism Research at Children's Hospital of Philadelphia, and an LDI Senior Fellow. "We originally planned to partner in this work with three community agencies, but seven expressed enthusiastic interest in being part of it," Mandell said. Children with autism often have a "one-to-one" therapeutic staffer who trails them throughout the day to address issues related to behavior, emotion regulation, and the planning or adjustment of an appropriate treatment strategy. But many one-to-ones don't record daily data in any manner. The current research is exploring various systems that would systematically facilitate such data documentation.
Providing an update on ALACRITY's third major project — increasing the use of evidence-based treatments (EBT) in community mental health centers — was Rebecca Stewart, PhD (above, left), Assistant Professor at the Penn Center for Mental Health in the Perelman School, and LDI Senior Fellow. Her team crowdsourced ideas for that goal from actual clinicians working throughout Philadelphia's network of community mental health centers. Their ideas were used to generate hypotheses about the barriers preventing EBT use. Stewart indicated one of those barriers involved clinician cognitive load or "the very real demand of executing multi-faceted, multi-set procedures while dealing with very complex data, i.e., real patients." The insights gained across all barriers were used to reverse engineer potential interventions. In the cognitive load case, the plan is to adopt a design strategy for more support tools, such as decision and memory aids, that could simplify and remind clinicians of the most important steps in delivering evidence-based treatments.
In a related part of the third project work, Nathaniel Williams, PhD, LCSW (above, right), an Assistant Professor at Boise State University School of Social Work, conducted a survey of 230 Philadelphia mental health clinicians, 96 agency leaders and 18 policymakers. He asked them which of Project 3's 14 implementation strategies would best improve EBT use. Very preliminary findings suggested the top choice involved increased pay. The least-liked choice was a public leaderboard reporting whether or not clinicians were meeting various EBT benchmarks.
A large part of the ALACRITY project involves engaging scientists from other disciplines in the use of the behavioral insights principles — or "nudges" — from the behavioral economics field. Alison Buttenheim, PhD, MBA (above, left), Co-Director of the ALACRITY project's Methods Core, talked through the thinking and analytical process involved in devising a "nudge" for use with clinicians or patients. "Nudging is a methodological product coming out of ALACRITY for a number of reasons," Buttenheim said. "Among them are the frequency with which we are asked by colleagues and trainees, 'where do you get these intervention ideas?; how do you actually create a financial incentive likely to work for addressing a behavioral-change problem?'"
Another part of ALACRITY is its trainee programs and projects that were spotlighted during the event's poster session detailing a dozen studies. Above, right, explaining one of those, is Briana Last, MA, a trainee from the Penn School of Arts & Sciences Department of Psychology, whose project is "Using Participatory Methods & Behavioral Economics to Increase Depression Screening in Primary Care." Others on this research study's team include LDI Senior Fellows Courtney Benjamin Wolk, PhD, Rebecca Stewart, PhD, Matthew Press, MD, MSc, Alison Buttenheim, PhD, MBA, and Rinad Beidas, PhD.
Austin Kilaru, MD (above, left), a Fellow in the Penn National Clinician Scholars Program and an LDI Associate Fellow, explains his poster to Molly Candon, PhD, a Research Assistant Professor of Psychiatry and LDI Senior Fellow. The work is entitled "Hospital Incentives to Promote Linkage to Care for Opioid Use Disorder"; the study's research team also includes LDI Senior Fellows Jeanmarie Perrone, MD, and Zachary Meisel, MD.
Brittany Rudd, PhD (above, right), Postdoctoral Fellow in Psychiatry at the Perelman School and LDI Associate Fellow, discusses her project, "Development and Pilot of an Implementation Toolkit to Increase Frontline Staff's Ability to Screen for Suicide and Triage (FASST) Among Detained Youth." It is designed to address the fact that only half of juvenile detention centers repeatedly screen for suicidality during a young person's detainment, even though detained youth are at higher risk for suicide.
Asking if nurse practitioners find financial incentives acceptable and are willing to implement them in practice (above, left) is a study by Katelin Hoskins, MSN, MBE, CRNP, and an LDI Associate Fellow. The title is "Nurse Practitioners' Views on the Acceptability of Financial Incentives for Health-Related Behavior Change."
Above, right, pointing out that community mental health clinicians are rarely trained and not confident in their ability to treat adults with autism, is Brenna Maddox, PhD, a Postdoctoral Fellow of Psychiatry and LDI Associate Fellow. For her study, "Shortage of Community Mental Health Clinicians Trained to Treat Autistic Adults," Maddox collaborated with Samantha Crabbe, MSEd, Senior Clinical Research Coordinator at CMH, and David Mandell, ScD.
The two guest speakers at the Retreat were LDI Senior Fellows Katherine Milkman, PhD (above, left), Professor of Operations, Information and Decisions at the Wharton School, and Mitesh Patel, MD, MBA (above, right), Director of the Penn Medicine Nudge Unit, the world's first behavioral insights unit set up within a health system. Their presentations were focused on nudge techniques in clinician and patient settings. Milkman talked through the six principles of choice architecture; Patel discussed lessons learned during the first three years of the Nudge Unit's operations.