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Active Projects:

Improving Collaborative Decision Making Among Veterans with Serious Mental Illness


Collaborative decision-making (CDM) is a recovery-oriented approach to treatment decision-making that assigns equal participation and obligation to patients and providers across all aspects of decision-making, empowering patients and facilitating better decision-making based on patient values and preferences. CDM is associated with several important outcomes including improved treatment engagement, treatment satisfaction, and social functioning. However, current levels of CDM among Veterans with SMI are low, and there is not yet an evidence-based method to improve CDM. Improving Veteran skill sets associated with engaging in CDM is a potential intervention strategy. Collaborative Decision Skills Training (CDST) [PDF] is a promising new intervention that was developed for adult civilians with SMI and found to improve relevant skills and improve sense of personal recovery. This study has two stages: 1) initial adaptation of CDST for Veterans and the VA context; and 2) evaluation of CDST’s feasibility in an open trial of 12 Veterans with SMI currently receiving services at a VA Psychosocial Rehabilitation and Recovery Center (PRRC). Stakeholder feedback from Veterans, VA clinicians, and VA administrators will be collected to assess Veteran needs and service context to identify any needed adaptations to the CDST manual or the delivery of CDST to maximize its impact and feasibility. A mixed methods assessment battery will evaluate initial evidence of effectiveness. The primary outcome is number of collaborative decision-making behaviors used during appointments.


Trial registration:

Adapting Collaborative Decision Skills Training (CDST) for Underserved Minority Veterans with Serious Mental Illness

Collaborative decision-making [PDF] aims to cultivate an environment that supports equal participation and power between patients and clinicians during treatment decision-making. In this study, we aim to understand current and preferred treatment decision-making among Veterans with serious mental illness who identify as ethnic and/or racial minorities, and the factors that lead to better and worse treatment decision-making experiences, including discrimination and culture. We also aim to tailor Collaborative Decision Skills Training (CDST) to these Veterans to improve how helpful it is for their needs, values, and preferences. We will use participatory methods hiring two people who represent the group we are studying, incorporating the feedback and opinions from participants to improve CSDT, and giving community members access to improved CDST at the San Diego VA.

Veterans with lived experience of serious mental illness: [PDF]

Psychiatric Advance Directive

A psychiatric or mental health advance directive is a document that allows people with mental health concerns to express preferences for future treatment should they ever lack decisional capacity. It is a way for people with serious mental illness (SMI) to have their voice heard and to have a sense of autonomy over their own care. Psychiatric advance directives have been found to reduce compulsory admissions for people with mental health concerns. Despite the potential benefits of psychiatric advance directives, there are well-documented barriers to implementation of PADs both inside and outside of the VA. While there is existing research about barriers to implementation at the VA, our team was unable to identify any VA-specific data identifying the prevalence of psychiatric advance directives or chart-based evidence of their use during crises within the VA. This project has two primary aims. The first aim of this project is to gather data about the rates of Veterans with SMI in VISN-22 that have psychiatric advance directives. Secondarily, we will examine evidence that psychiatric advance directives were referenced during mental health crises (e.g., emergency room visits) for a subset of Veterans with SMI in VISN-22 that have them. The overarching goal of this project is to examine psychiatric advance directive prevalence and evidence of implementation within a VA setting.

Lived Experience and Preferences in Language Models

Person-first language (PFL; e.g. person with schizophrenia) has been regarded as the best way to refer to individuals who have a serious mental illness or other disabilities. Others however, regard identity-first language (IFL; e.g. epileptic person) as more favorable as it does not minimize the disability. Our ongoing scoping study [PDF] aimed to examine the current literature on person-first language and identity-first language to understand more about the topic. We want to learn about the usage of PFL versus IFL and how the usage of either affects the well being of those with serious mental illness. Once we have completed the scoping study, we will use the information from the literature to begin an empirical study that will fill in the gaps in the literature. 

Determinants of High Quality Public Mental Health Care

The primary aim of the study was to investigate the potential barriers and facilitators in public mental health care settings that are associated with evidence-based practices and person-centered care. The purpose of this survey was to collect data concerning the perspective of care in public mental health care settings of behavioral health staff. The survey design intended to capture how factors such as training, collaboration, and telehealth impact aspects of mental health care including client involvement, group-based therapy, and client care. Additionally, the survey investigated what aspects of mental health care contribute to cultural tailoring to properly address racial disparities in public mental health settings. The survey was informed by PRISM (Practical Robust Implementation and Sustainability Model) to evaluate factors that impact healthcare intervention reach, effectiveness, adoption, implementation, and maintenance (RE-AIM).

Self-Assessment and Tailored Feedback to Improve Diversity and Social Justice Training for Psychology Postdoctoral Fellows


Our recent scoping study [PDF] found that only one peer-reviewed paper had previously been published about diversity and social justice training for psychology postdoctoral fellows. Overall, a set of best practices for training in this area, and particularly at this stage in professional development, is not yet established. We previously developed and piloted a self-assessment, the San Diego Diversity and Social Justice Self-Assessment, to increase understanding of incoming fellows’ existing knowledge and competences, their remaining needs, their perceptions of the helpfulness of previous training approaches, and their comfort about engaging in diversity and social justice topics in professional spaces at the group and the individual level to inform training. In this study, we extend use of the self-assessment and pilot a feedback session to provide group-level feedback of the results of the self-assessment to provide immediate opportunities to impact fellows’ individual training plans and the cohort’s diversity seminar topics and format. Using iterative mixed methods feedback from pilot participants, we will scale up the San Diego Diversity Social Justice Self-Assessment to an easily accessible and user-friendly online administration, disseminate the online tool for evaluation by interns and fellows, and finalize the tool for broad dissemination.

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