Research

Emergency Risk Protection Orders (ERPOS) recently proliferated in the wake of the Parkland, Florida shootings, after only existing in one state (Connecticut) for many years (starting in 1999). From March 2018 to December 2019 there were 5,074 petitions for ERPOs in Florida. USF is participating in the six-state study of ERPOS (CA, CO, CT, FL, MD, and WA) via a subcontract with Michigan State University. The focus of this study is to describe the implementation of ERPOs in states with ERPO laws that are different from each other, as well as to look at certain outcomes (such as suicide) pre and post ERPO implementation. This study will include obtaining and coding ERPO court documents, coding these documents, linking the identifiers from these ERPO documents to involuntary (Baker Act) examination data, and analyzing the ERPO coding and Baker Act data for people with ERPOs.

Principal Investigator:  Annette Christy, PhD
Funding Agency:  The National Collaborative on Gun Violence Research / Michigan State University

Examine public payer healthcare treatment patterns for Medicaid recipients. Determine the factors associated with the use of duloxetine versus comparator medications in the treatment of depressive disorders and the treatment of pain associated with DPN.

Principal Investigator: Marion Becker, RN, PhD
Funding Agency: Eli Lilly and Company
Award Amount: $274,623
Dates: 07/01/2005 - 12/31/2007

The purpose of this project is to evaluate a federally funded (SAMHSA) program developed to end homelessness among those with people that have been labeled public inebriates who may also have co-occurring mental illnesses. Working with two community partners ACTS and MHC, the evidence -based intervention is called Critical Time Intervention (CTI). CTI is short term intensive case management that serves to move people quickly from the streets into stable housing and connect them with existing community services.

Principal Investigator: Colleen Clark, PhD
Affiliated Research Faculty / Staff: Kathleen Moore, PhD, M. Scott Young, PhD
Funding Agency: SAMHSA (flow through), ACTS
Award Amount: $350,000
Dates: 09/01/2010 - 08/31/2015

This project assessed stakeholder needs and local service delivery patterns for adolescents with co-occurring mental health and substance use disorders.

Principal Investigator: M. Scott Young, PhD
Funding Agency: District 14 Substance Abuse Program Office, Florida Department of Children and Families
Award Amount: $22,500
Dates: 03/01/2003 - 12/31/2003

The purpose of this study is to develop additional data elements to add as a side to the Cover Sheet submitted with Baker Act examination BA-52 forms and ex-parte orders. 

Funding Agency: Agency for Health Care Administration (AHCA)
Award Amount: $42,834
Dates: 07/01/2008 - 06/30/2009

Principal Investigator: Robert Constantine, PhD
Funding Agency: Agency for Health Care Administration (AHCA)
Dates: 07/01/2006 - 06/30/2007

Principal Investigator: Roger Boothroyd, PhD
Funding Agency: Agency for Health Care Administration (AHCA)
Dates: 07/01/2006 - 06/30/2007

Principal Investigator: Marion Becker, RN, PhD
Funding Agency: Agency for Health Care Administration (AHCA)
Dates: 07/01/2006 - 06/30/2007

With funding from Florida’s Agency for Health Care Administration (AHCA), faculty Institute-wide have participated in the evaluation of an important expansion of Medicaid managed care to cover mental health services, including enrollees with disabilities. In collaboration with the Policy and Services Research Data Center (PSRDC), faculty engage in multiple studies that include qualitative implementation analysis, administrative data analysis, and a population-based mail survey of prepaid mental health plans; examination of racial and ethnic disparities in health outcomes; and examination of special targeted issues that have yielded important findings for researchers and policy makers in Florida and nationally.

STUDY                                                                                       STUDY LEAD
Overall Administration                                                           Roger Boothroyd
PSRDC Infrastructure                                                             Charles Dion
Enrollee Satisfaction                                                               Roger Boothroyd
Medicaid Methadone Maintenance Programs                   Holly Hills
Managed Care Administrative Data Analysis                      Greg Teague
Efficacy of SAPT for Positive Outcomes                                Jim Winarski
Evaluation for OOHC Alternatives                                        Mary Armstrong
Evaluation of CW Prepaid Mental Health Plan                   Amy Vargo
Evaluation of Behavioral Health Overlay Services             S. Yampolskaya
Profiles of High SIPP Users                                                    S. Yampolskaya
Alzheimer’s Waiver Evaluation                                              David Chiriboga
Prescriptions for New NH Residents                                    Victor Molinari

Principal Investigator: Roger Boothroyd, PhD
Award Amount: $1,767,399
Dates: 07/01/2009 - 06/30/2010

This project examines the use of Medicaid reimbursed services for mental illnesses and substance use disorders among individuals arrested in Florida. The analysis focuses initially on six Florida counties chosen from the 23 counties that received state grants under the Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant Program Act. While there is evidence that individuals released from jail with Medicaid benefits have longer community stays than those without, little is known about service use among these individuals. This project begins to fill that gap in Florida.

Principal Investigator: John Petrila, JD, LLM
Funding Agency: Agency for Health Care Administration (AHCA)
Award Amount: $21,351
Dates: 07/01/2008 - 06/30/2009

In October 2004 Florida’s Medicaid Authority, the Agency for Health Care Administration (AHCA), developed and implemented new Medicaid services that were intended to promote the recovery and rehabilitation of adults with severe mental illnesses.

This study analyzed administrative data to determine the rate at which recovery oriented services are provided in differing areas of the state and financing conditions.  We also collected qualitative data (consumer focus groups and staff interviews) to monitor the development of recovery-oriented programming in Florida and to identify challenges or barriers that could impede successful implementation.  The purpose of the study included the following: 

Determine the effect that changes in administrative service codes have had on delivery of recovery services.
Determine if the services delivered represent a change to a recovery/rehabilitation orientation, as based on recovery principles and emerging standards in the mental health field.
Establish a baseline of recovery-based services currently being delivered in the public mental health system, including strengths and barriers to service delivery.
Examine consumer experiences with services delivered under the new procedure codes.
Results provided information to assist in determining how providers are making the transition to delivering services described under the new administrative service codes, whether these services are recovery oriented, and how the service array can be improved to be more responsive to the needs of consumers.  The second phase of this study commenced in 2006 with the goal of providing an empirical basis for the development of recovery standards that can guide future program implementation, monitoring, and evaluation. 
  
Principal Investigator: James Winarski, MSW
Funding Agency: Agency for Health Care Administration (AHCA)
Dates: 07/01/2006 - 06/30/2007

This study will validate a set of performance measures that use administrative data to evaluate the process of care (POC) for persons receiving mental health.

Principal Investigator: Gregory Teague, PhD
Funding Agency: Agency for Health Care Administration (AHCA)
Award Amount: $4,400
Dates: 07/01/2008 - 06/30/2009

The Self-Assessment/Planning Tool for Implementing Recovery-Oriented Mental Health Services (SAPT) is designed to provide a clear definition of the principles and practices of recovery-oriented mental health services, as well as practical guidance for implementing these services in service provider agencies. The SAPT also provides a process for establishing a baseline of performance that can be measured over time. It includes two sections.

Section One: Self-Assessment

The self-assessment provides operational definitions for 14 domains organized under the categories of administration, treatment, and support.  The instrument uses a five point rating scale for each item.

Section Two: Planning and Implementation

The planning and implementation section provides a description of each domain, defines the essential characteristics for implementing the service, describes common barriers and remedies for overcoming barriers, and lists resources that support service implementation.

This evaluation will gather data on the implementation of the SAPT from service provider agencies in Florida and conduct an in-depth examination as part of a pilot study with five service provider agencies.  Information will also be gathered about the use of similar tools in states that were awarded federal mental health transformation grants.  All of the information gathered in the study will be used to revise the tool prior to disseminating it for use by mental health service provider agencies throughout Florida.

Principal Investigator:James Winarski, MSW
Funding Agency: Agency for Health Care Administration (AHCA)
Award Amount: $70,568
Dates: 07/01/2008 - 06/30/2009

Study will use Medicaid health data to access the impact of managed care arrangements on access cost and quality of health care for Medicaid population.

Principal Investigator: Robert Constantine, PhD
Funding Agency: Agency for Health Care Administration (AHCA)
Award Amount: $15,704
Dates: 07/01/2008 - 06/30/2009

Use study findings to develop policy and practice recommendations aimed at reducing the rate and length of hospital stays for nursing home residents with ACS conditions.

Principal Investigator: Marion Becker, RN, PhD
Funding Agency: Agency for Health Care Administration (AHCA)
Award Amount: $61,945
Dates: 07/01/2008 - 06/30/2009

This study is for instracture development that is maintained by the Policy and Services Resources Data Center, which is responsible for conducing data analyses for the other studies.

Principal Investigator: Roger Boothroyd, PhD
Funding Agency: Agency for Health Care Administration (AHCA)
Award Amount: $436,698
Dates: 07/01/2008 - 06/30/2009

The task of monitoring the performance of the HMOs and Pre-paid Mental Health Plans (PMHPs) in managing the mental health benefit of enrollees requires a number of different approaches. While annual reviews are important in the context of contract re-negotiations and renewals, and investigations of enrollee complaints are important for consumer satisfaction, neither provides the Agency with objective, standardized and timely information regarding plan performance during the fiscal year. This study aims to fill this gap through the development and reporting of key indicators of enrollee access to mental health services and of the outcomes of enrollees who use mental health services on a quarterly basis.  Vendor will develop such a quarterly monitoring system through meeting with key Agency staff in Tallahassee to determine feasible variables to monitor; meeting with Agency staff in AHCA areas who are responsible for managing mental health contracts with managed care organizations; developing a mock quarterly report based on these meetings that uses encounter and other administrative data sets which provide the Agency with important and timely plan performance data; using feedback from Agency staff on the contents and format of the mock report to develop a final set of performance indicators and reporting format for monitoring performance; producing two quarterly reports using the approved indicators and format; and meeting with Agency staff to receive feedback and develop a revised report format for FY 2010-2011.

Principal Investigator: Gregory Teague, PhD
Dates: 07/01/2009 - 06/30/2010
Website: AHCA - Medicaid Behavioral Health Services

This study proposes a follow-up to the fiscal year 2008-2009 study which revealed that approximately 67,000 individuals arrested in Florida used Medicaid services for mental health and/or substance abuse treatment in the two years prior to arrest. This figure represents approximately 10 percent of all arrestees in the State, yet little is known about the specific types of Medicaid services received by arrestees with mental illnesses, the costs of such services, and whether different service patterns are associated with reduced arrests. Vendor proposes to analyze these issues in the six counties (Alachua, Leon, Hillsborough, Miami-Dade, Monroe and Nassau) studied in the 2008-2009 study.  In doing so, study findings will provide policy makers for the first time with information regarding the actual costs of Medicaid services among arrestees with mental illnesses, as well as information regarding the relationship between service use and arrest patterns.

Principal Investigator: John Petrila, JD, LLM
Dates: 07/01/2009 - 06/30/2010
Website: AHCA - Medicaid Behavioral Health Services

This AHCA study will examine depression and obesity among adolescents and was developed in response to federal mandates calling for states to address chronic disease management and chart mental health trajectories. Vendor’s goal is to clarify the association between depression and obesity among Medicaid-enrolled adolescents, focusing on treatment practices, service use and costs for both conditions, and whether differences exist by race or ethnicity. Specific study aims are to (1) examine the characteristics of community-dwelling Medicaid enrolled adolescents with a depression diagnosis (major and minor depression); (2) understand the predictors of receiving evidence-based practice (EBP) treatment for depression; (3) determine predictors for the development of obesity among adolescents with depression; and (4) determine the trajectory of service use and costs among adolescents with a diagnosis of depression and/or obesity compared with adolescents with neither diagnosis. The study will utilize three and one-half years of Medicaid administrative data, including eligibility, fee-for-service and pharmacy data, and behavioral health encounter data to assess predictive factors. Current treatment practices will be compared to EBP guidelines for MDD developed by the American Psychiatric Association. Findings will inform Medicaid policies for best practice treatment of depression among adolescents, with the hope of maximizing service use effectiveness for a diverse adolescent population.

Dates: 07/01/2009 - 06/30/2010

With the expansion of mental health managed care having been completed throughout the state of Florida, ongoing evaluation and monitoring is essential for maintaining the quality of services within these programs. Consumer satisfaction has emerged nationally as an important indicator of health care quality. As such, this year’s project will focus on assisting AHCA in monitoring the quality of the mental health services provided by these managed care entities. We will use the Experience of Care and Health Outcomes Survey (ECHO?) to conduct a statewide satisfaction survey of Medicaid recipients who have recently received mental health services. We will also begin development of a mechanism for reporting survey findings in a “user friendly” format for consumers, providers, and policymakers.

Principal Investigator: Roger Boothroyd, PhD
Dates: 07/01/2009 - 06/30/2010
Website: AHCA - Medicaid Behavioral Health Services

At the request of AHCA, the general goals of this project are twofold: (1) to perform a systematic review of the literature to assess the current state of knowledge associated with Medicaid-reimbursed methadone maintenance programs, and (2) to conduct a series of descriptive analyses using existing Medicaid administrative data to determine the current state of Florida’s Medicaid-reimbursed methadone maintenance programs.

Principal Investigator: Holly Hills, PhD
Co-PI: Roger H. Peters, PhD
Dates: 07/01/2009 - 06/30/2012
Website: AHCA - Medicaid Behavioral Health Services

The purpose of the Assisted Outpatient Treatment Grant Program is to increase capacity of services and evidence-based health services to individuals who have a serious mental illness (SMI) and have been court-ordered to receive treatment services.  Serious mental illness includes those with a diagnosis of schizophrenia, major depressive disorder, bipolar disorder, psychotic disorders, delusional disorder, and/or obsessive-compulsive disorder.  Individuals with SMI have higher rates of cardiovascular disease, diabetes, and hypertension, which negatively affect their quality of life and life expectancy.  In addition, symptoms associated with SMI often impair therapeutic compliance and self-care, resulting in higher rates of morbidity and mortality.  The goals of the program are to reduce Baker Act readmission rates, reduce interactions with law enforcement due to non-compliance with court orders, improve integration with primary medical care and preventive health services, and integrate key community programs including the jail diversion program.  USF serves as the evaluator of the program to determine effectiveness of the interventions.

Principal Investigator:  Annette Christy, PhD
Funding Agency:  SAMHSA / Pinellas County

A significant body of literature shows that practitioners' practices typically lag the scientific evidence by many years. It has been argued that the resulting sub-optimal care can be associated with increased costs, demonstrably in the case of inappropriately high use of high-cost medications, and potentially where such care may be associated with poorer outcomes, and thus lead to unnecessarily high use of high-cost services.

The current project was initiated primarily as a pilot study to assess the feasibility of using Medicaid and other administrative data to assess the impact of an educational intervention designed to normalize the prescribing practices of physicians found to be operating outside of accepted practice guidelines. A secondary purpose was to examine the relationship of outlying prescribing practices to other service uses and costs and to determine whether normalization of prescribing practice is associated with reduction in use of high-cost services. The project was funded under contract with Comprehensive NeuroScience, Inc. (CNS) with funding from AstraZenica Pharmaceuticals, LP and focused on prescriptions of anti-psychotic medications for adults with schizophrenia.

Despite experimentation with a number of corrective strategies, it was ultimately necessary to conclude that the pharmacy claims data for the period under examination lacked the necessary accuracy in a crucial field (provider ID) to support a rigorous evaluation of the intervention, the CNS Behavioral Healthcare Pharmacy Management program. Consequently, outside funding was not provided beyond the amount of $49,570 for the pilot phase. However, the secondary aims are minimally affected by the specific problem with the pharmacy data, and the project continues without outside support. The principal investigator is Gregory B. Teague, Ph.D.; Timothy L. Boaz, Ph.D. and Stephen Banks, Ph.D. are co-investigators.

Principal Investigator: Gregory Teague, PhD
Co-PI: Timothy Boaz, PhD
Dates: 02/11/2005 - 02/10/2006

Principal Investigator: Brett Hagman, PhD
Dates: 11/01/2012 - 10/31/2013

The primary goal of this project is to conduct an evaluation of the three psychiatric emergency departments within Bay Care Health, Inc. This will be accomplished by revising the intake form and standardizing it across the three psychiatric departments. Data will be collected over a two-month period and then analyzed in order to assist in more effective crisis intervention services.

Principal Investigator: Kathleen Moore, PhD
Co-PI: M. Scott Young, PhD
Funding Agency: Bay Care Health
Award Amount: $12,000
Dates:09/01/2003 - 02/28/2004

Principal Investigator:  Marie McPherson, MBA
Funding Agency:  Florida Department of Health

The Charlotte County “Home 2 Recovery” Project is a collaborative effort between Coastal Behavioral Healthcare, the Charlotte County Homeless Coalition, the Florida Peer Network, and USF-Florida Mental Health Institute’s Department of Mental Health, Law and Policy. The five-year project was funded by a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to implement a comprehensive and integrated system of evidenced-based mental health and substance abuse recovery services that are tailored to the unique needs of the chronically homeless population in Charlotte County, Florida.

As the grantee, Coastal will utilize an Assertive Community Treatment (ACT) team with an emphasis on “Housing First” to help individuals achieve recovery from homelessness and co-occurring mental illness and substance use disorders. Coastal, in collaboration with the Charlotte Homeless Coalition, Charlotte Community Mental Health, Southwest Florida Addiction Services, and other community organizations will offer individualized treatment, rehabilitation, and support services to assist persons who are chronically homeless move into permanent housing, achieve recovery from mental illnesses and co-occurring substance use disorders, and increase self-reliance and self-sufficiency. The grant will include persons who are homeless with co-occurring disorders that were displaced from Hurricane Charley and exiting FEMA trailers.

MHLP will evaluate this “Housing First” approach to homelessness by tracking access to immediate housing, supportive housing over five years, co-occurring mental health and substance abuse treatment interventions, fidelity to the Assertive Community Treatment (ACT) model, peer-directed recovery services and a process evaluation that will include a community-wide approach to serving persons who are chronically homeless in Charlotte County. It is anticipated that the impact of these findings will provide evidence that a “Housing First” approach, coupled with an assertive community-wide effort, will yield better outcomes for persons who would otherwise lack available housing and intensive co-occurring supports.

Principal Investigator: Mark A. Engelhardt, MS, MSW, ACSW
Co-PI: Kathleen Moore, PhD
Co-PI: M. Scott Young, PhD
Funding Agency: SAMSHA
Award Amount: $220,000
Dates: 10/01/2006 - 09/30/2010

Pre-service training and certification for newly hired DCF and CBS staff

Principal Investigator: Laurie Cunningham, MS
Funding Agency: Community Based Care of Volusia and Flagler Counties
Award Amount: $843,134
Dates: 01/01/2006 - 06/30/2008
Website: Child Welfare Training Academy

The Child Welfare Training Academy operates under a multi-year contract with the Florida Department of Child and Families. The Training Academy is solely responsible for training and certifying child welfare trainers statewide.  These certified trainers provide pre-service training to new child welfare staff and supervisors.   The Training Academy administers the state’s Child Welfare Professional Certification Program.  This contract includes 3 trainer FTEs, 3 registrars, an office manager, a director of operations, and a 28% FTE director.

Principal Investigator: Laurie Cunningham, MS
Funding Agency: Florida Department of Children and Families
Award Amount: $4,253,878
Dates:01/01/2006 - 06/30/2010
Website: Child Welfare Training Academy

2009 - Family Engagement Training with field coaching.

Principal Investigator: Laurie Cunningham, MS
Funding Agency: Children's Board of Hillsborough County
Award Amount: $39,748
Dates: 02/17/2009 - 03/31/2010

This project was funded by SAMHSA’s Center for Mental Health Services and provides a forum for strategic planning among mental health, substance abuse, criminal justice, and consumer advocacy organizations from the Hillsborough County area to improve services for persons with co-occurring disorders. The project has resulted in a web-based training curriculum, hiring of staff within service agencies to enhance service integration, development of practice guidelines, and implementation of a practice network that has stimulated change in other service districts throughout the State.

Principal Investigator: Holly Hills, PhD
Co-PI: Mark A. Engelhardt, MS, MSW, ACSW
Funding Agency: Center for Mental Health Services (CSAT)
Award Amount: $300,000
Dates: 09/30/2002 - 12/30/2005

Between 1998 and 2005, the Substance Abuse and Mental Health Administration (SAMHSA) supported a large, multi-site study of consumer-operated services, the Consumer-Operated Services Program (COSP) Multi-Site Research Initiative. This study generated the largest extant database for examining the effectiveness of consumer-run mental health programs; papers are in preparation for publication in peer-reviewed journals. Additional analysis of the COSP data is required for the purpose of supporting a current SAMSHA initiative, development of an Implementation Resource Kit for consumer-run services. The goals of the current project are to strengthen the evidence base for consumer-operated services and to make the resource kit optimally evidence-based. FMHI faculty had research responsibility for two of the program sites in the COSP study and, in collaboration with staff from study’s original coordinating center based at the Missouri Institute of Mental Health, subsequently took on primary responsibility for the data analyses that yielded the initial multi-site findings. In the current contract, the lead research role is again based at FMHI.

Principal Investigator: Gregory Teague, PhD
Funding Agency: Center for Mental Health Services (CMHS)
Award Amount: $60,000
Dates: 09/12/2005 - 11/30/2006

Federal regulations have special concerns about the protection of vulnerable populations from harm in research studies.  One such vulnerable population that has received great attention is the prisoner population. Entire sections of federal regulations focus on defining special procedures to make sure prisoners are not coerced into participating in research. Although there is much concern about coercion of prisoners in this context, no one has ever asked prisoners themselves about what pressures they experience when being asked to participate in research.

The current NIMH funded study will be the first time the contextual influences on prisoners are examined and where prisoners are actually asked about the issues and assumptions upon which these federal regulations are based.  People in several types of custody (e.g., prison, community programs, NGRI patients in psychiatric hospitals) will be interviewed to assess their perceptions of the factors in their environments that might adversely affect their capacity to make a voluntary decision about taking part in research studies. Potential factors could include, for example: beliefs that institution staff might offer them incentives, such as a promise for early release; or beliefs that they might be threatened by staff or other patients if they did (or did not) take part in a research study.  This study will also examine personality factors that might lend themselves to various levels of perceived coercion.

Principal Investigator: Paul Stiles, JD, PhD
Co-PI: Norman Poythress, PhD
Funding Agency: National Institute of Mental Health through a subcontract with Texas A&M University
Award Amount: $234,314
Dates: 09/18/2008 - 06/30/2012