The impact of war on the mental health of children: a Salvadoran study

OBJECTIVE: This ecologically conceptualized, intensive study assesses the mental health impact of the Salvadoran Civil War on 54 12-year-olds, born into the war, exposed to different levels of war violence. METHODS: Half of the students came from a repopulated country village and half from an industrial neighborhood near the capital city. Children, their mothers or caretakers, and their teachers responded to interviews and some instruments. RESULTS: Children from the repopulated village reported higher war experience and lower mental health. The personal/social impact of the war was more important than family togetherness or war intensity in determining the mental health of the children. Children's intelligence was highly related to surviving with higher mental health. Higher socioeconomic status (SES) and education of parents was related to better mental health. Controlling for intelligence, children who experienced the highest personal-social impact of war showed the poorest mental health. Children with high war experience were most likely to have difficulty in imagining the future. CONCLUSIONS: Intelligence and the foreshortening of future vision are variables that should be controlled for and investigated in outcome studies of trauma. Treatment for survivors should include aid in planning for the future.     

Video as a medium of oral health education for children with mental handicaps

This study assessed the usefulness, appropriateness, and relevance of a video as an oral health education medium for children with mental handicaps and for preschool groups where children with mental handicaps and healthy children are taught together. The evaluated video was designed for children with mental handicaps but was also recommended for integrated groups. Forty children with mental handicaps from four special education classes and two nursery school groups, 151 normal children from 11 nursery school groups, and the teachers of these classes and groups evaluated the material. The assessment of the material's value was based on the teachers' records of their experiences with the material, their records of the children's opinions and discussions about the material, and their records of drawing interviews with the children. Based on the evaluation, it is apparent that, when used by trained teachers, professionally made videos designed for children with mental handicaps can be useful and valuable aids in educating children of different levels of mental and social development about oral health. Integrated groups need videos featuring both children with mental handicaps and normal role models and with a diversity of contents that will interest and challenge both types of audiences.E.     

Collaboration of a university and state mental health agency: Curriculum for improving services for children.

We describe the collaboration of a state university and a state mental health agency in implementing training to improve skills of community mental health center staff for working with children, adolescents, and their families. The project consisted of three phases: (a) a needs assessment survey was conducted, (b) a series of written instructional modules were developed, and (c) workshops were conducted in six locations across the state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Theoretical and statistical derivation of a screener for the behavioral assessment of executive functions in children.

The problem of valid measurement of psychological constructs remains an impediment to scientific progress, and the measurement of executive functions is not an exception. This study examined the statistical and theoretical derivation of a behavioral screener for the estimation of executive functions in children from the well-established Behavior Assessment System for Children (BASC). The original national standardization sample of the BASC–Teacher Rating Scales for children ages 6 through 11 was used (N = 2,165). Moderate-to-high internal consistency was obtained within each factor (.80–.89). A panel of experts was used for content validity examination. A confirmatory factor analysis model with 25 items loading on 4 latent factors (behavioral control, emotional control, attentional control, and problem solving) was developed, and its statistical properties were examined. The multidimensional model demonstrated adequate fit, and it was deemed invariant after configural, metric, and scalar measurement invariance tests across sex and age. Given its strong psychometric properties, with further tests of item validity, this instrument promises future clinical and research utility for the screening of executive functions in school-age children. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Migrant mental health: A model for indicators of mental health and health care consumption.

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of formal and informal sources of mental health care among older African-American public-housing residents

BACKGROUND: Elderly residents of public housing have high rates of psychiatric disorders, but most of those in need of care do not use any mental health service. This study examines the use of formal and alternative informal sources of mental health care in a sample of elderly African-American public-housing residents. METHOD: Data from an epidemiological survey of six Baltimore public-housing developments for the elderly (weighted N = 818) were analysed to examine the utilization of mental health services by older African-American residents. Logistic regression analyses were used to determine correlates of using formal and informal sources by those needing mental health care. RESULTS: Thirty-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38.5%) than informal sources (18.6%) for care. The strongest correlates of using formal providers were substance use disorder (OR = 15.62), Medicare insurance (OR = 10.31) and psychological distress (OR = 10.27). The strongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR = 21.65), cognitive disorder (OR = 19.71) and having a confidant (OR = 15.07). CONCLUSIONS: Contrary to elderly African-Americans in general, those in public housing rely more on formal than informal sources for mental health problems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treatment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.     

Reliability of proxy response on mental health indices for aged, community-dwelling women.

The correspondence between respondent and proxy response was evaluated on 4 mental health measures (Affect Balance Scale, Center for Epidemiological Studies Depression Scale, Mental Status Questionnaire, and Mini-Mental State Examination) with a sample of 538 respondent–proxy pairs. Results indicated that respondent and proxy responses were strongly associated, particularly for the cognitive measures. This association was found even for respondents classified as depressed or cognitively impaired. Although there was evidence of proxy bias, with proxies underrating affective status and overrating cognitive status, the magnitude of the bias proved small for all scales but the Mental Status Questionnaire. Examination of response comparability by proxy characteristics showed that choice of proxy affected agreement and bias. Implications of these findings for survey research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supply dynamics of the mental health workforce: implications for health policy

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.     

Geography and mental health: a review

In our current health care context, characterized by fiscal restraint and decentralization of accountability for health to regional authorities, geographic inequities in need, access to care, utilization, and health outcomes will come under increasing scrutiny. Knowledge gained from ecological studies about geographic disparities in mental health are likely to have important implications for policy, program planning, and resource allocations. In light of the growing relevance of the geography of mental health, this paper will review (1) selected contributions of geographic studies to the field of mental health, (2) common ecologic study approaches used in most geographic studies, (3) key conceptual and methodological challenges related to the application and interpretation of ecologic models in mental health, and (4) the wider potential of this technique for resource equity. Given the importance of geography for needs assessment and service planning, it is surprising that geographic study designs, which use ecological data, have not received greater attention as an important and viable method of assessing population mental health.     

The needs of prisoners' wives: a challenge for the mental health professions

This research assessed the needs of prisoners' wives in six areas (information, finances, relationships with friends, family relationships, grief, and relationships with children) and determined if stage of separation or previous experience with the correctional system affected those needs. High levels of need were found in each area. Women in the initial stage of separation had significantly greater need for information than women in the pre-reunion stage, but prior experience with the correctional system did not predict needs. Results suggest giving more information to the women at the time of their husbands' trials and the formation of self-help groups.     

Problem types of children referred to a school-based mental health program: Identification and outcome.

Describes a methodology by which primary-grade children experiencing school maladjustment problems are classified according to specific problem types. Evidence is presented that the methodology reliably differentiates among children with acting-out, shy-anxious, and learning difficulties. An intervention program using nonprofessional child aides was most effective in reducing the problems of shy-anxious children. The methodology is proposed as a paradigm for identifying problem types, an important step in individualizing helping interventions. Findings suggest that a generalized helping approach is likely to be differentially effective with different problem types. Implications for more traditional treatment approaches such as psychotherapy are considered. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health of children in an HMO program

Collaboration between pediatricians and mental health clinicians in an HMO has provided a useful method of identifying and caring for the usual spectrum of developmental and situational disturbances in children and the associated parent-child conflicts. A social worker is included in the primary-care team in pediatrics; other mental health resources are available when indicated. In 1974, 5.7% of total visits and 8.9% of all children under 19 years of age were noted to have emotional problems. A follow-up study carried out early in 1976 disclosed that most of the observed emotional problems were resolved or quiescent.     

Outcomes of mental health care for children and adolescents: II. Literature review and application of a comprehensive model

OBJECTIVE: Using a comprehensive model of outcomes, the authors review the scientific literature to determine the extent of knowledge concerning the outcomes of mental health care for children and adolescents. METHOD: Previous research is examined to determine the degree to which it addresses five salient outcome domains: symptoms/diagnoses, functioning, consumer perspectives, environments, and systems (the SFCES model). RESULTS: Despite numerous studies, only 38 met minimal scientific criteria. They generally fall into two categories, according either to their focus on the efficacy of treatment(s) for specific disorders or the effectiveness of a particular service or service system. Only two studies include outcome assessments across all five domains. CONCLUSIONS: As health care practices shift, improvements in mental health care will require credible evidence detailing the impact of clinical treatments and services on all salient outcome domains. Embedding efficacious treatments into effective service programs will likely improve care, but treatments will require modification to make them flexible, inclusive, and appropriate to multicultural populations. Furthermore, service delivery systems must be modified to meet the specific clinical needs of children with mental disorders and to embrace new efficacious treatments as they become available.     

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).     

National health insurance: Implications for mental health practitioners.

Notes that beyond health care coverage, any national health plan has broad implications for administration, financing, the nature of practice, and social conditions. Some 26 implications (e.g., defining professional standards, determining who may "doctor") for the mental health professions are delineated. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing smarter: a decision support system for mental health providers

Financing of mental health care has changed radically, especially with managed care. Shrinking revenues have forced providers to look for creative ways in which to provide quality services at less expense. Delivery of quality services depends largely on the productive use of the provider's prime resource--the clinicians. Productivity was the focus of the PC-based decision support system developed for mental health providers in New York State. It enables administrators to track key indicators of productivity such as face-to-face time and non-face-to-face time against goals. Unmet goals can be pinpointed quickly, and clinicians' caseloads can be reviewed to determine the underlying causes. A key feature of the system is the conversion of raw data into actionable information to help in problem finding and problem solving. The system has been implemented in Ulster County, the pilot site for the project. The software can be customized easily to suit the data of other providers.     

The mental health and adjustment of immigrant and refugee children

Although parents may make decisions to leave their homes, either willingly in the hope of improving their lives or involuntarily to escape danger and seek safety for themselves and their families, it is never a voluntary decision for the child. The economic, political, social, and other contextual issues associated with migration are as significant in predicting the child's adjustment to his or her new circumstances as his or her physical and psychological endowment. This article addresses these issues and suggests that particular consideration be given to children whose migration was punctuated by life-threatening danger or whose families were overwhelmed by the stresses of migratory experiences. Child and adolescent psychiatrists and other well-trained mental health professionals can further the understanding of the interactions among the child, family, and new community, which can promote or hinder the process of adaptation to the new setting.