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Background: Provisions of the Affordable Care Act (2010) require the use of validated quality measures (QMs) to evaluate the quality of health care programs, services, and outcomes. The need for such measures is crucial in serious mental illness (SMI), a long-term illness involving substantial functional impairment over multiple symptom domains that affects more than 11 million U.S. adults. Using QMs to assess the effect of programs designed to improve the mental health of SMI populations is an important task in improving the quality of these programs and services and, ultimately, health outcomes. Although stakeholders have proposed a variety of QMs, none are used consistently across all treatment sites or all forms of SMI. Key areas of uncertainty remain. Knowledge gaps for SMI include an agreed-upon list of relevant QMs; identification of the most meaningful outcomes by which to measure the success of QMs; identification of barriers to and facilitators of their implementation; and robust assessments of whether use of such measures improves medical, psychiatric, and patient-centered outcomes. -- Purpose: The goal of this Technical Brief is to identify how QMs are currently used in the SMI population and to describe the evidence supporting their use. -- Methods: We discussed with Key Informants and performed targeted searches of published and gray literature on questions of (1) a description of QMs; (2) the context for their use; (3) research linking QMs to changes in outcomes; and (4) current key issues in future uptake, use, evidence gaps, and research priorities. -- Findings: The evidence base, which was sparse, suggests that no uniformly accepted practices exist on how to define or implement QMs for SMI, nor on which QMs are the most relevant. Outcomes against which to evaluate the effectiveness of QMs are difficult to measure. Time, the additional burden of using QMs on a resource-limited health care system, and a thin evidence base on their use were key barriers to implementation of QMs. Indeed, we found no prospective research evaluating whether the use of QMs for SMI leads to changes in outcomes. Of note, evidence does not exist that indicates that certain measures often used as proxies for quality of care actually measure quality of care or improve outcomes. -- Conclusions: The literature does not indicate an agreed-upon list of preferred relevant QMs for the SMI population, and the outcomes against which to assess the effectiveness of QMs are challenging to measure. Relatedly, and possibly of greatest practical importance, no studies have assessed whether the use of QMs improves health outcomes for patients with SMI nor do stakeholders agree on preferred outcomes. Accordingly, critical issues for the field to address include (1) determining the level of evidence (or strength of evidence) necessary to support implementation of QMs, given the complexities of studying the topic and the likely limited research funding; (2) developing the evidence base that assesses the link between QM use and outcomes; (3) considering when to invest the time and resources on measuring outcomes of care to evaluate the impact of QMs, and when process measures (proxies of the outcomes) are a reasonable and more feasible alternative; (4) determining the resource needs for QM implementation; and (5) developing validated and reliable QM tools that can be implemented feasibly in real-world practice.

Mental Disorders --- Treatment Outcome --- Quality Improvement --- therapy. --- United States

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Neuropsychiatry --- Mental Disorders --- Psychology, Clinical. --- Treatment Outcome. --- Neuropsychiatry. --- therapy. --- Neuropsychiatrie

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Parenthood represents a fundamental construct that identifies the quality of early adult-infant interactions. In both short and long period, relationships, as primary interactional experiences, have an essential role in influencing individual’s adjustment and psychopathology development during in lifetime. In this scenario, the most important areas of interest and innovation are (a) parents’ representation of themselves, both in relation to the child and to their care-giving role; (b) the quality of couple relationship, in terms of both conjugal and co-parental bounds, and its influence on the quality of early mother-father-child interactions; (c) the early models of caregiver-baby interaction; (d) the recent approach to the “maternal brain”, that represents the contribution coming from neurosciences, linked to the adult’s activation and cerebral functioning processes, in association with the parental role. These data are a starting point for the individuation of functioning mechanisms and developmental trajectories of parenting in groups of adults and babies, belonging to normative populations. At the same time, those studies may provide an important introduction to the detection of critical and/or dysfunctional aspects in populations of babies and adults at risk (e.g. preterm babies, adopted children, etc.) or in adults’ clinical group (e.g. a depressed parents, addicted parents, etc.) or in children with one or more impaired characteristic (e.g. children with organic diseases, with autistic disorders, etc.).. The present Research Topic puts the attention on these themes, particularly, considering the possible aftermaths that empirical research may have on planning and realizing interventional models to support the parental functioning. We will consider papers focused on the individuation of methods of observation and assessment, which allow to plan and realize prevention programs and/or interventions, primarily focused on parental support, both in the early stadium of the child’s development and in the long-term period. Thus, the focus is both on the prevention and sustenance sphere and, also, on specific manners of taking on the therapeutic responsibility of the adult-infant relationship.

Parenting --- relationships --- Post-partum depression --- Brain Imaging Methods --- parenting measures --- Attachment --- treatment outcome --- Parenting --- relationships --- Post-partum depression --- Brain Imaging Methods --- parenting measures --- Attachment --- treatment outcome

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Human reproductive technology --- Infertility --- Reproductive Techniques, Assisted. --- Infertility --- Treatment Outcome --- Treatment --- therapy.

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Osteoarthritis, Knee --- Evidence-Based Medicine --- Treatment Outcome. --- drug therapy. --- methods. --- surgery.