Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy.

Objective: A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. Method: A 2 × 2 design encompassing 14 rural Appalachian counties included 2 factors: (a) the random assignment of delinquent youth within each county to a multisystemic therapy (MST) program or usual services and (b) the random assignment of counties to the ARC (for availability, responsiveness, and continuity) organizational intervention for implementing effective community-based mental health services. The design created 4 treatment conditions (MST plus ARC, MST only, ARC only, control). Outcome measures for 615 youth who were 69% male, 91% Caucasian, and aged 9–17 years included the Child Behavior Checklist and out-of-home placements. Results: A multilevel, mixed-effects, regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). Conclusions: Two-level strategies that combine an organizational intervention such as ARC and an evidence-based treatment such as MST are promising approaches to implementing effective community-based mental health services. More research is needed to understand how such strategies can be used effectively in a variety of organizational contexts and with other types of evidence-based treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Shifting the paradigm in community mental health: Towards empowerment and community.

Reviews the book, Shifting the paradigm in community mental health: Towards empowerment and community by Geoffrey Nelson, John Lord, and Joanna Ochocka (2001). This book, as it combines theory, practice, and research (a case study) about the processes of empowerment and integration of consumers of mental health care in a Canadian setting, delineates strategies and approaches that can be factors in fulfilling this important aim. Shifting the Paradigm in Community Mental Health is a welcome contribution to the literature on the implementation of consumer empowerment and involvement in mental health treatment and care. The authors offer an approach enabling the reader to see the dimensions for empowerment and community integration termed the empowerment-community integration paradigm. The book will be useful for a wide audience, including consumers, professionals, stakeholders, researchers, and policy makers, and should be in the libraries of all institutions, formal and informal, that deliver mental health care. The overall clarity of the writing and all the approaches will be very much appreciated by all those who work or receive services in mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pursuing an evidence-based culture through contextualized feedback: Aligning youth outcomes and practices.

How can contextualized feedback on therapy practices and youth outcomes promote an evidence-based culture for adolescent mental health? Relative to other quality improvement tools, feedback and progress monitoring systems are generally underutilized. This article describes a feedback system collaboratively developed by the Hawai'i Department of Health Child and Adolescent Mental Health Division and private agency staff contracted to provide mental health services to youth. Feedback reports allow providers to monitor progress of their youth clients, compare their progress with youth receiving similar services, examine the extent they are using practices derived from evidence-based protocols, and compare these practice profiles to what other youth are receiving. Providers gather to discuss reports, share success stories, and offer suggestions to improve practices and outcomes based on data from the reports. The provider feedback system in Hawai'i has emphasized youth outcomes and has promoted an “evidence-based culture.” This article encourages direct providers and supervisors to consider how such a system might fit in their current practice and whether contextualized feedback might be one way to enhance services and outcomes for youth with mental health needs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Canadian mental health law and policy.

Reviews the book, Canadian Mental Health Law and Policy by John E. Gray, Margaret A. Shone, and Peter F. Liddle (2000). The authors of this book have produced a multidisciplinary text that succinctly summarizes the main points of Canadian mental health laws and the variability across provinces and territories in these laws and in their typical interpretation and application. This book offers a concise guide to the laws dealing with key issues such as involuntary hospital admission, authorization of psychiatric treatment, and treatment refusal. Although not always an easy read for those unfamiliar with legal terms and writing, the book is geared to a wide audience that includes legal and policy specialists, mental health professionals, and advocates for the mentally ill. These authors are to be congratulated for their efforts to disseminate and explain information on Canadian mental health law and to promote a more humane and scientifically grounded set of legal standards and interpretations that are pertinent to the disposition and treatment of Canadian citizens with severe mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ecological constraints on mental health services.

Proposes 4 principles for community mental health programing that are consistent with an ecological thesis: (1) Assessment methods are focused on the total population rather than on those persons who presently receive a mental health service. (2) Mental health services are designed to reduce a high risk for community service. (3) Professional and research services are created as local community resources. "By initiating the informal coordination of current services, the community mental health program helps to create specific new community services as needed." (4) The program plans for change; this involves mobilizing anticipatory problem-solving resources not only for clients but for professionals as well. A "conception of community mental health work based upon the ecological thesis that adaptive programs change" is presented. (39 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis in training pediatric psychologists.

Examines the shortage in the US of personnel who are trained in child mental health care that results in underservice to children, youth, and families. Doctoral programs offering specialty training are in short supply, as are pediatric psychology training programs. In addition, many clinical psychology programs are ill-equipped to offer curriculae for the development of skills and knowledge bases required by child psychologists. It is concluded that a training conference is needed to communicate the issues involved in this mental health provider crisis if children are to have access to psychological services. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health symptoms in youth affected by Hurricane Katrina.

Natural disasters, such as hurricanes, may cause severe psychological impairment in children and adolescents, which may persist in youth who have survived hurricanes, their effects, or both. To better understand the needs of youth in the community after Hurricane Katrina, officials in St. Bernard Parish, LA, commissioned a youth needs assessment survey. The survey assessed how youth were coping approximately 2 years after Hurricane Katrina. The goal was to explore the prevalence and severity of depressive, anxious, and posttraumatic symptoms reported by youth. Based on retrospective reports from 43 youth, the prevalence of children’s mental health symptoms was 44–104% higher in the 2 years after Hurricane Katrina compared to pre-Katrina. The majority of mental health symptoms reported by youth had an onset after the hurricane, for example, 79% reported new onset of mental heath symptoms in the year after Katrina. The vast majority of these children (56%) continued to experience mental health difficulties 2 years after the disaster. Implications regarding post-Katrina mental health needs, service delivery, public response, and collaboration efforts are summarized and directions for future research are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children in the criminal justice and secure care systems: how their mental health needs are met

A study was made of the perceptions among relevant service providers of the mental health needs of young people considered for secure placement. Information was obtained in 1996 from 75% of departments of child and adolescent psychiatry, forensic psychiatry, social services children's services, youth justice, probation, secure units and young offender institutions in England and Wales. The findings confirm that highly disturbed young people, who may be a danger to themselves and others, may present to a wide range of services, and that their mental health needs are neither well recognized, widely understood, nor adequately met. Availability of appropriate levels and types of expertise and resource is patchy and strictly limited, within secure settings and in local community services across all agencies.     

Emerging issues in research on lesbians' and gay men's mental health: Does sexual orientation really matter?

Theoretical writings and research suggest that the onset, course, treatment, and prevention of mental disorders among lesbians and gay men differ in important ways from those of other individuals. Recent improvements in studies of sexual orientation and mental health morbidity have enabled researchers to find some elevated risk for stress-sensitive disorders that is generally attributed to the harmful effects of antihomosexual bias. Lesbians and gay men who seek mental health services must find culturally competent care within systems that may not fully address their concerns. The affirmative therapies offer a model for intervention, but their efficacy and effectiveness need to be empirically documented. Although methodological obstacles are substantial, failure to consider research questions in this domain overlooks the welfare of individuals who may represent a sizable minority of those accessing mental health services annually. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Trauma exposure, mental health, and service utilization rates among immigrant and United States-born Hispanic youth: Results from the Hispanic family study.

Although the largest immigrant group in the United States is Hispanic, little is known about their rates of traumatic experiences and psychiatric disorders, particularly for youth. Findings with adults suggest that recent immigrants have lower rates of mental illness than long-time residents or U.S.-born Hispanics, but use health-related services less often. The present study examined this relationship in a convenience sample of 131 foreign-born (64.5%) and 72 U.S.-born (35.5%) Hispanic youth, ages 8–17 years and a subset of their caregivers (n = 110). Findings from youth interview data suggest that immigrant and U.S.-born youth did not differ significantly in experiences of potentially traumatizing events or psychiatric disorders. However, findings from caregiver interview data suggest that there were significant disparities between the two groups in health service utilization for doctors and other medical professionals, with caregivers reporting that foreign-born youth utilize these health services at lower rates than U.S.-born youth. Results are discussed in the context of prior findings and recommendations offered for increasing service utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of general health care and STD services use among high-risk youth in Denver participating in community-based urine chlamydia screening

BACKGROUND: In the United States, youth are at highest risk for STDs, and innovative programs have been called for to increase their access to essential STD-related services. To guide the development of such programs, locally relevant information is needed on current use of general health care and STD services in this population. GOAL: To study access to and use of general health care and STD services in a purposive sample of high-risk youth in inner-city Denver. STUDY DESIGN: An interview-based survey conducted as part of a community program for urine chlamydia screening targeting black and Hispanic youth 13 years to 25 years. RESULTS: Of 221 sexually experienced youth in the survey, 72% had accessed general health services in the past year and 39% reported an STD evaluation at any time in the past. Community and school clinics were reported by 50% as a source for general health care and by 62% as a source for STD services. STD clinics were reported by only 14% as a source for STD services. Routine checkups were the most important reasons to seek general health care, yet of those who went for a routine checkup, only 34% reported an STD evaluation. Although few barriers appeared to exist in accessing general health care, anticipated anxiety about procedures and results formed the major barrier to accessing STD services. CONCLUSIONS: Use of general health services was common in this population of high-risk adolescents; however, the provision of STD services as part of general health care visits appeared to be low. On the basis of these findings, a comprehensive STD prevention strategy may be envisioned, which would include provider interventions to increase the provision of STD prevention services in general health care settings; community interventions to enhance access to general health care and STD services; and community-based screening programs for those not able or willing to seek clinic-based services.     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Leading Psychology Forward: Staying the Course in Uncertain Times.

Like everyone in the country, those in organized psychology have functioned recently in a climate marked by threats of terrorism, uncertainty, and a declining economy. In such challenging times, it might seem logical for the profession to wonder how it needs to change to respond to current circumstances. Yet at such times, staying the course already charted is likely a far more effective strategy. For psychology, this means continuing to press for mental health parity, educating decision makers about the important role of psychological services in preventive care, helping to integrate psychological and physical health services, continuing to hold managed care companies accountable, and increasing the profession's political giving. Psychologists must also be prepared to ensure that psychological services are treated as an integral part of any health reform plan that emerges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in health and illness.

The literature on sex differences in illness and disease was examined. Although some biologic sex differences are thought to exist, the overlap between the sexes precluded separation of the sexes for treatment or control of problem conditions. Statistics Canada data on mental illness among males and females in Canada were also examined, and deficiencies in available information were discussed. Most notably lacking were statistics on the use of outpatient mental health services. A number of recommendations were made regarding the collection of Canadian mental health statistics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Editorial: What will the 21st century bring? An emphasis on quality care.

Day-to-day concerns frequently take precedence over abstract concepts for psychologists practicing in the United States. However, traditional mental health services are a subset of the more generic health care environment, and changes in this environment will eventually affect the daily practice of mental health practitioners. For a profession to continue to mature and thrive, leadership must be aware of and capitalize on relevant national and international changes. In the 21st century, advances in technology and communication will affect the quality of services and will likely result in increased stress for practitioners and patients. This article reviews developments within the American Psychological Association and explores both current and potential roles that will shape the future of professional mental health practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting First Time Involvement in the Juvenile Justice System Among Emotionally Disturbed Youth Receiving Mental Health Services.

Rates of mental illness among youth in the juvenile justice system are exceptionally high, yet the understanding of the process by which some mentally ill youth end up in juvenile justice, whereas others stay in the mental health system is relatively undeveloped. The goal of the present study is to extend previous research findings by focusing prospectively on 659 youth between the ages of 8 and 17 years who were enrolled in Medicaid with a psychiatric diagnosis. Of those with no prior involvement with the juvenile justice system at baseline, 12% had contact with the juvenile justice system within 1 year. Those who were older, exhibited more externalizing behaviors, and came from minority backgrounds were more likely to come into contact with the juvenile justice system. Dual-system involvement was common, suggesting that a more integrated approach between these systems needs to be developed with a special emphasis on minority youth who exhibit externalizing disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The mental hospital in the 21st century.

Reviews the book, The mental hospital in the 21st century by Emmanuel Persad, Shane S. Kazarian, and Llewellyn W. Joseph (1992). The authors not only review past endeavors in the delivery of mental health services but speculate as to the role the mental hospital may take in the years to come. The starting point for this book is a conference entitled "The Role of the Mental Hospital in the 21st Century" sponsored by the London Psychiatric Hospital in October 1990. The book features 20 brief chapters regrouped in three sections. In all, 29 contributors mainly from Canada, bring forth varying perspectives on the role of the mental hospital. The real contribution of this book is that it puts into perspective the magnitude of the challenge that confronts the major stakeholders in developing a comprehensive and balanced system of mental health services. The present book could serve as a starting point for some serious debate among the stakeholders about the way the mentally ill are treated and to determine how the role of the mental hospital should change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)