Providing mental health care services to Americans.

Summarizes legislation introduced or cosponsored by the author, a US Senator from Minnesota, to respond to Americans' need for mental health services. This legislation included the Medicare Ambulatory Mental Health Services Access Amendments of 1987; S.123, a bill that would amend Part B of the Medicare program to recognize and reimburse psychologists as independent mental health providers; S.763, the Services for Homeless Mentally Ill Individuals Act of 1987; S.809, the Urgent Relief for the Homeless Act; and S.1663, the Child Abuse Prevention Act of 1987. The author encourages mental health professionals to promote public policies that expand Americans' access to public health services through research, effective communication of this research, and preventive mental health efforts (such as programs aimed at preventing teen suicide). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Costs and use of mental health services before and after managed care

This paper tracks access, utilization, and costs of mental health care for a private employer over nine years during which mental health benefits were carved out of the medical plan and managed care was introduced. Prior to the carve-out, mental health costs increased by around 30 percent annually; in the first year after the change, costs dropped by more than 40 percent; in the six follow-up years, costs continued to decline slowly. This cost reduction was not attributable to decreased initial access, as the number of persons using any mental health care increased following the change. Instead, the cost reduction was the result of (1) fewer outpatient sessions per user, (2) reduced probability of an inpatient admission, (3) reduced length-of-stay for an inpatient episode, and (4) substantially lower costs per unit of service.     

When children cannot remain home: foster family care and kinship care

Despite the best efforts of child welfare agencies, community agencies, and individuals, some children are not safe in their homes and must be placed in substitute care settings by child welfare authorities. Increasingly, as this article points out, child welfare agencies are placing children in the homes of their relatives rather than in traditional foster family homes (31% of all children in out-of-home care in the early 1990s were living with kin). This article discusses how such factors as the availability of foster homes, the demand for foster care, attitudes toward the extended families of troubled parents, and policies regarding payment for the costs of care have contributed to the rapid growth in kinship foster care. It discusses differences in the personal characteristics of kin and traditional foster parents and in the supports provided to the caregivers by child welfare agencies. Research findings suggest that kinship homes can promote the child welfare goals of protecting children and supporting families, but they are less likely to facilitate the prompt achievement of legal permanence for children. To forge a coherent policy toward kinship caregivers, officials must balance the natural strengths of informal, private exchanges among family members with the power of government agencies to provide both resources and oversight.     

Managed care strategy for mental health services

In the UK, managed care is beginning to be recognized as a cost effective, quality-driven system which can be used to structure patient care. This article examines the potential use of managed care pathways in mental health services, focusing on clients with schizophrenia. The strengths of managed care include the effective coordination of healthcare resources, the clear accountable audit of mental health practice and the re-engineering of mental health practice to improve patient outcomes. Problems in designing representative care pathways and encouraging healthcare providers to implement care pathways are some of the disadvantages of this system.     

Issues in mental health services for children and adolescents

Existing system of psychiatric care for children and adolescents is in need of basic reorganization. The authors propose: 1) reestablishment of the speciality of children's and adolescent psychiatrist, a specialist in children's and adolescent narcology, a psychiatrist of early child's age and a pediatric medical psychologist; 2) carrying out the reform of child mental care equal in rights with general psychiatry; 3) preservation and widening of both specialized inpatient and outpatient clinics in general system of child's mental care; 4) legislative and public rehabilitation of children's psychiatry, which suffered considerably from antipsychiatric campaign; 5) professionally organized systematic elevation of psychohygienic, psychiatric and psychotherapeutic knowledges of allied medical and other specialists as well as of parents and of all population too; 6) integration and interaction of govermental services concerning mental health of children and adolescent; 7) organization of regional psychoprophylaxic interdisciplinary centers for children and adolescent.     

Integrating mental health services into primary medical care

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.     

Patterns of care in community mental health services in Lombardy

Diagnosis of lesions of the gastrointestinal tract and adjacent structures is possible using an imaging modality, endoscopic ultrasonography (EUS). Fine-needle aspiration (FNA) is a suitable and cost-effective technique for obtaining cytohistologic material to confirm the diagnosis. EUS is capable of both characterizing the lesion and then guiding the FNA under real-time (RT) ultrasound guidance using a through-the-scope needle aspiration system. The goal of this study was to determine the diagnostic accuracy of this technique and to describe the clinicopathologic features. Sixty patients underwent EUS-guided RTFNA of 64 lesions, including pancreas (n = 45), periluminal lymph nodes (n = 12), mediastinal and retroperitoneal masses (n = 4), and hepatobiliary masses (n = 3). Follow-up data were obtained by surgery, histopathology, or clinical course. Thirty-one lesions were malignant, eight were atypical/suspicious, 16 were non-neoplastic, and nine were non-diagnostic. Of the 55 lesions with sufficient material for interpretation, 54 had follow-up confirmation of the RTFNA diagnosis. The calculated sensitivity and specificity for malignancy was 90% and 100%, respectively. Diagnostic accuracy for malignancy was excellent for gastrointestinal associated lymph nodes (100%), mediastinal and retroperitoneal masses (100%), somewhat less so for pancreatic tumors (94%), and poor for hepatobiliary lesions (33%). EUS-guided RTFNA is accurate for sampling small gastrointestinal tract-associated lesions. EUS-guided RTFNA should be considered as a procedure of choice in selected patients when the results will influence management decisions.     

Delivery of mental health services in the changing health care system.

Comments on the anonymous article, "Hidden benefits of managed care" (see record 1995-33982-001), in which the author expresses concern that managed care organizations are making decisions on the basis of economics and not the well-being of the patient. B. Miller and L. Farber empathize with the author's concerns, but contend that, if structured properly, HMOs can become the vehicle for the reengineering of mental health services that will produce the best patient outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rural models for integrating primary care and mental health services

This paper presents findings from a study designed to identify and describe models for integrating primary care and mental health services in rural communities. Data were obtained from telephone interviews with staff at rural primary care sites around the country. Findings are based on the responses of 53 primary care organizations in 22 states. The authors identify four integration models--diversification, linkage, referral and enhancement--which appear to exist in combination, rather than as pure types. The proposed analytic framework outlines aspects of integration that are readily amenable to study.     

Community-based systems of care for children's mental health services

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.     

Caring for children in foster care

Twenty-six patients have had cranio-peritoneal shunts placed using a new introducer allowing the combination of frameless stereotaxy and neuroendoscopy and placement of a one-piece shunt. Operating times have been acceptable, complication rates have been low, and shunt placement has been accurate in this series.     

Social welfare and health services in the Fraylesca Region in Chiapas: the use of prenatal care services

OBJECTIVE: To analyze the use of antenatal care services (ACS) in the Fraylesca Region of Chiapas, Mexico, and to identify groups with lower probability of receiving ACS. MATERIAL AND METHODS: In 1994, a health survey was performed on a random sample of 1,100 households, which compiled sociodemographic information and on the use of ACS during the last pregnancy within the two years previous to the study (n = 297 women from 15 to 49 years of age). The groups with lower probability of receiving adequate ACS (5 or more visits) were identified with a log-linear model. RESULTS: Forty-two percent of women received inadequate ACS (0 to 4 visits). Women with better socioeconomic status had higher probability of using ACS adequately than women with lower socioeconomic status: OR 2.47 (Cl 95% 1.12-5.44). CONCLUSIONS: Results provide evidence of the need to improve the quality of ACS, to support the traditional midwives and to improve living conditions of the population.     

A general family practitioner approach for Asian-American mental health services.

A psychologist in general family practice functions as a primary care provider, who is similar to the traditional family doctor who provides treatment for clients and their families. The psychologist has an ongoing interaction with the family and serves as a resource for the family to consult when in difficulty; he or she uses knowledge of the client, as well as knowledge of the client's family, community, and social environment. This approach seems particularly suitable for Asian Americans whose culture emphasizes the role of the family. It helps to minimize the client's inhibition against seeking mental health services and provides the psychologist with certain clinical advantages. Two cases are presented to illustrate the application of this approach to Asian American clients. Situations in which family members should not be seen by the same psychologist and the issues of transference, countertransference, and confidentiality are also considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing the barriers to mental health services for inner city children and their caretakers

This paper will outline a series of three research studies meant to identify factors related to child mental health service usage and barriers to help seeking for urban minority children and their caretakers. In addition, this paper will describe the systematic development and evaluation of a telephone intervention strategy aimed towards increasing overall attendance at initial intake appointments at an urban child serving agency. The first study explores differences in demographic variables, for two groups of children (n = 450), those that came to an initial intake interview and those that requested child mental health services, but failed to come to any scheduled appointments. The second study evaluates a telephone engagement intervention meant to increase initial attendance (n = 54). Finally, the third study, more rigorously evaluates the impact of an intensive telephone intervention on initial attendance rates by randomly assigning families to the more focused telephone intervention or a "business as usual" telephone screening (n = 108).     

Cultural barriers to health care reform

The rate of proliferation of health care reform proposals makes it impossible to consider them all adequately; whatever plan is finally legislated, there will be many who are not satisfied with it, and clamor for change is likely to be a prominent feature of health care politics for a long time. This article takes a brief look at the health care reform process in the United States, including some of the impediments to development of a plan that would address both contemporary and future issues. Some traditional ethical viewpoints and cultural values, having to do with concepts of justice, are seen as inimical to long-range program development. The need for alteration of traditional views is regarded as urgent, to facilitate cultural movement in directions that will not only permit development of workable health care programs, but will extend broadly to address other compelling societal issues. The impetus for advantageous cultural movement originates among perceptive individuals who are regarded by society as legitimately influential. Many physicians still are accorded this sort of recognition, and the considered input of medical professionals is essential.     

Organizational correlates of access to primary care and mental health services in drug abuse treatment units

The mechanism by which cells in the ampullae of the rat oviducts undergo rapid deciliation during each estrous cycle and the effects of estrogen on the ciliated cells were examined. Untreated rats were killed on each day of the 5-day estrous cycle, and the ampullae of their oviducts were removed. Other rats were injected subcutaneously each day for 5 days with 0.3 microgram or 3.0 micrograms of estradiol benzoate or with 0.3 mg of tamoxifen, an estrogen antagonist, per kilogram of body weight. The ampullae of the oviducts of the treated rats were excised on the day following the last injection. The tissues from all the rats were fixed in glutaraldehyde, stained with uranyl acetate and lead citrate, and examined with a transmission electron microscope. Deciliation of cells was seen to occur by membrane-bound cilia packets (CPs) forming at the apices of cells and pinching off. Although CPs were more numerous at proestrus, they were also observed at estrus, diestrus-1, and diestrus-2, suggesting that the process of deciliation is an ongoing one that merely changes in rate. No evidence of resorption of cilia was seen. Estradiol treatment did not prevent CPs from forming, nor was tamoxifen treatment associated with any apparent enhancement of deciliation. Ciliated cells with CPs stained more darkly than ciliated cells that were without CPs, and the former appeared similar in their staining characteristics to secretory cells, most of which stain darkly. It was concluded that the cells of the ampulla deciliate rapidly by shedding their cilia into the lumen of the oviduct, that estrogen does not halt the process, and that ciliated cells may be transformed to secretory cells following loss of their cilia.     

Continuity of care and delivery of ambulatory services to children in community health clinics

This study assesses how continuity of care influences receipt of preventive care and overall levels of ambulatory care among children and adolescents in community health clinics (CHCs). It is a secondary data analysis of the 1988 Child Health Supplement to the National Health Interview Survey. Of 17,110 children in the sample population, the 1465 who identified CHCs as their routine source of care formed the study population. Continuity of site was defined as identification of a CHC as a source of both routine and sick care, and continuity with a clinician was defined as identification of a specific clinician for sick visits. In bivariate analyses both continuity with the CHC and with a specific clinician were associated with increased levels of preventive care and overall ambulatory care. In logistic regression models, continuity of care was associated with nearly a two-fold increase in the odds of receiving age-appropriate preventive care. Alternatively, insurance status was a better predictor of receipt of overall levels of ambulatory care. We conclude that expanding financial access alone is unlikely to sufficiently improve low-income children's access to Community Health Clinics. Additional emphasis on localizing the delivery of both routine and sick care services in a single site or with a specific clinician may be needed to achieve higher levels of both preventive care and overall ambulatory care.