Translation of the diabetes prevention program into a community mental health organization for individuals with severe mental illness: a case study

Abstract

Individuals with severe mental illness (SMI) have significant health disparities. Wellness services embedded in community mental health organizations could lessen these disparities. This case study illustrates the integration of the Diabetes Prevention Program (DPP) lifestyle intervention into a community mental health organization. The Diffusion of Innovations Theory was used as a model for integration, which included a collaboration between researchers and the organization and qualitative work, culminating in a small pilot of the DPP led by peer specialists to test the feasibility of the DPP in this setting. Fourteen individuals with SMI participated in the 19-week intervention. Three dropped out, but the remaining 11 demonstrated 92% attendance. Weight loss was minimal, but the participants reported benefit and showed continued interest in the intervention. The use of a peer-led DPP in a community mental health organization is feasible and warrants further investigation to demonstrate efficacy.

The current state of lifestyle intervention implementation research: where do we go next?

“…Barriers cited by both low-intensity single session programs (e.g., [14]) and high-intensity multi-session programs (e.g., [17,21,26]) include staff turnover, loss of academic and/or community "champion" of the program, program reliance on grant funding, no plan or commitment to turn funding over to the site, lack of commitment from staff who are trained to deliver the intervention, and reliance on research staff for integral functions of the program. An implementation research project does not necessarily guarantee sustainability even with the best community-academic partnership and a high initial level of institutional commitment because this can all change over time.…”

“…In two studies, some staff members expressed concern during training about absorbing the role of a lifestyle counselor given their feeling taxed in their current role [15,21]. Some expressed skepticism about the program's efficacy in the target population, as was the case for direct care workers trained to be lifestyle counselors for consumers with severe mental illness [15].…”

“…A disconnection between institutional and staff commitment underscores the importance of securing commitment at all levels, never assuming a trickle-down effect. As a way of insuring commitment among interventionists, one study trained the entire direct care work force of a community mental health clinic and through that process identified and selected the most committed and interested staff members to lead the lifestyle intervention groups [15]. They selected staff members who expressed a high level of enthusiasm during training, actively participated, and reported weight loss during training even though that was not a stated goal of training.…”

“…Each of these studies is published in the Implementation Research in Obesity and Diabetes Special Section of Translational Behavioral Medicine. The special section includes case studies demonstrating implementation of lifestyle interventions in various settings including community organizations serving low-income minorities [13], primary care settings serving low-income minorities [14], community mental health clinics serving adults with severe mental illness [15], and outpatient clinic settings targeting couples [16]. Authors were specifically asked to discuss challenges, facilitators, and barriers to implementation and to report whether the program was adopted by the target site and if so, what facilitated the adoption, or if not, what prevented it from happening.…”

“…It also describes how professionals as individuals can become more involved in affecting public policy at the city, state, and federal levels. The Evidence-Based Behavioral Medicine column includes a synopsis of the Cochrane Review on community-wide interventions for physical activity [26]. Finally, the issue includes columns reporting news from the National Institutes of Health (NIH) [27] and the Centers for Disease Control (CDC) [28], with a special emphasis on funding priorities and opportunities relevant to translational research in obesity and type 2 diabetes.…”