Opportunities in public policy to support infant and early childhood mental health: The role of psychologists and policymakers.

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a “voice” to advocate for their support and care. This article (a) highlights several important policy areas that support the social–emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

N-terminal sequence polymorphism in the coagulase gene of Staphylococcus aureus and its potential use as an epidemiological marker

OBJECTIVE: There were two main objectives of the study: (1) To assess the effectiveness of a model of family reunification which united the role of parent aide and foster parent; and (2) to determine which characteristics of the families with children in care were associated with reunification. METHOD: A multisite project known as the Shared Parenting Project recruited families from five child protection agencies to participate in a program in which foster parents became extended rather than substitute families. Families were tested before the program began on a number of sociodemographic, psychological, and family measures. The success of the program was determined by whether the child was able to return home of if the program facilitated permanency planning. The success of the project was also examined by considering the relationship between returning home and a number of risk factors measured in the families with children in care. RESULTS: Very few families who met the criteria for the project could be recruited and only 31% of the participants completed the program and returned home. The process of permanency planning was facilitated in another 50% of the cases. The more stable families with less risk factors were more likely to complete the program successfully and to have their children return home. CONCLUSIONS: The results indicate that although the treatment model has excellent potential with less at-risk families it could not meet the treatment needs of the majority of families with children in foster care in the five child protection agencies. It is recommended that this model could be most helpful offered through parent aides attached to community support agencies that could provide respite care, support, and resources to families as needed thus avoiding the child having to be placed in care.     

Starting young: improving the health and developmental outcomes of infants and toddlers in the child welfare system

The number of infants and toddlers entering out-of-home care has increased dramatically in the past few years, yet few published reports examine their needs. This article describes a collaborative, multidisciplinary developmental follow-up program for infants and toddlers that builds on the community-based family support model described in the Family to Family Foster Care Reform Initiative. The children's health and developmental status, as well as the program's effectiveness, are highlighted.     

Evaluation of a training program for foster parents of infants with prenatal substance effects

The lack of prepared and available foster parents for children with prenatal substance effects is of increasing concern to the child welfare field. The research study reported here evaluated a multimodal inservice training program designed to enhance the competency of foster parents caring for infants with prenatal substance effects, and to promote an intent to foster such infants. Findings suggest that future foster parent training efforts in this area should focus on knowledge and skill attainment.     

Forensic psychiatry in Britain

This report provides an overview of the criminal forensic mental health system in Great Britain, that is England and Wales. The report is based on the author's participant observation as a visiting consultant psychiatrist at a regional forensic facility in Manchester, England during early 1994. British law casts a net over a wider population of forensic patients than does U.S. law. There is a forensic care system in the British National Health Service that is parallel to and independent of the general psychiatric care system. The forensic system provides continuity of care from prison through maximum security hospitals to regional medium secure facilities, and finally, into the community. Community care is provided by psychiatrists and social workers and, if necessary, by psychiatric nurses. This system appears to provide effective treatment for persons with major mental disorders and histories of violence. Differences between Britain and the United States in philosophy of government, in law, and in forensic training and practice are discussed. The fundamental difference is a greater British belief in the capacity of government to act in the best interests of the individual. Current problems in the British health care system and plans to privatize some services are also discussed.     

Developmentally sensitive diagnostic criteria for mental health disorders in early childhood: The diagnostic and statistical manual of mental disorders—IV, the research diagnostic criteria—preschool age, and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood—Revised.

As the infant mental health field has turned its focus to the presentation, course, and treatment of clinically significant mental health disorders, the need for reliable and valid criteria for identifying and assessing mental health symptoms and disorders in early childhood has become urgent. In this article we offer a critical perspective on diagnostic classification of mental health disorders in young children. We place the issue of early childhood diagnosis within the context of classification of psychopathology at other ages and describe, in some detail, diagnostic classifications that have been developed specifically for young children, including the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–3R; ZERO TO THREE, 2005), a diagnostic classification for mental health symptoms and disorders in infants, toddlers, and preschoolers. We briefly outline the role of diagnostic classification in clinical assessment and treatment planning. Last, we review the limitations of current approaches to the diagnostic classification of mental health disorders in young children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A college suicide prevention model for American Indian students.

College student suicide prevention efforts are important to campus administrators and mental health professionals due to increasing concerns about managing suicidal students. This article describes the development and preliminary effectiveness of a campus suicide prevention program designed for American Indian (AI) students who are at higher risk for suicide compared with the general population. Using the medicine wheel as a guiding framework, the current prevention model integrates communication links between AI tribes and prevention program staff, educational and cultural programming, and spiritual ceremonies with the larger campus mental health resources available to students. A discussion of the barriers faced and solutions generated for implementing the program is offered, along with suggestions for disseminating this AI-specific prevention program to other universities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A continuum of care: More is not always better.

This article describes an $80-million project designed to test whether a continuum of mental health and substance abuse services for children and adolescents is more cost-effective than services delivered in the more typical fragmented system. The study showed that an integrated continuum was successfully implemented that had better access, greater continuity of care, more client satisfaction, and treated children in less restrictive environments. However, the cost was higher, and clinical outcomes were no better than those at the comparison site. The article concludes that reform of mental health systems alone is unlikely to affect clinical outcomes. Cooperation is needed between mental health providers and researchers to better understand how to improve services delivered in the community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating mental health services within primary care. A Canadian program

The increasingly prominent role of the family physician in delivering mental health care can be enhanced if productive and collaborative relationships can be established with local mental health services. This paper describes a Canadian program that has achieved this by bringing mental health counselors and psychiatrists into the offices of 87 family physicians in 35 practices in a community in Southern Ontario. The paper describes the program, the activities of counselors and psychiatrists within the practices, and the administrative structures set up to coordinate these activities. Data is presented from the evaluation of the first year of the program's operation (13 practices and 45 family physicians) during which time 3085 referrals were received. The program made mental health care more available and accessible, increased continuity of care, provided additional support for the family physician, offered new opportunities for continuing education, and led to a reduced and more efficient use of other mental health services. The components of the program can be adapted to most communities.     

The case management model of patient care delivery

Case management is a model of care delivery that integrates patient and provider satisfaction and consideration of cost factors and provides a method of managing individuals' holistic health concerns. Using the case management approach, nurses can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance clients' quality of life, decrease length of hospitalization, increase client and staff satisfaction, and promote cost-effective use of scarce resources. Case management offers nurses an opportunity to demonstrate their roles in multidisciplinary health care teams. Case management is relevant in ambulatory surgery settings and in the perioperative care of complex surgical patients.     

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.     

Nurse managed occupational health services: a primary care model in practice

1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.     

Tennessee's failed managed care program for mental health and substance abuse services

In July 1996, Tennessee initiated a managed mental health and substance abuse program called TennCare Partners. This publicly funded "carve-out" experiment started chaotically and soon deteriorated into a crisis. Many patients did not receive care or lost continuity of care, and the traditional "safety net" mental health system nearly disintegrated. This qualitative case study sought to ascertain the impact of the TennCare Partners program. It points out that the program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population. States contemplating similar reforms should strive to protect vulnerable patients by risk-adjusting capitation payments and by focusing resources on care for severely mentally ill persons. States should also minimize program complexity and ensure the accountability of managed care networks for their patients' behavioral health care needs.     

University-based continuing education and mental health system change.

Describes how a continuing education program successfully effected a change in the organized mental health services in a large metropolitan area. The principles, goals, and outcomes of a program oriented toward mental health system change and using community organization interventions are reported and discussed. Comparisons are made with traditional individually oriented continuing education programs. Mental health professionals were trained in program consultation to community care facilities serving chronic mental patients, and attempts were made to have such consultations incorporated into the organized service delivery systems. It is concluded that university-based continuing education can be a major stimulus and have a major impact on organized mental health delivery systems. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who has the "relationship" in managed care?

Comments on R. E. Patricelli and F. C. Lee's article (see record 83-35320) describing innovations in managed behavioral health care. The author calls attention to a possible overapplication of the term "continuity of care" in the Patricelli and Lee article, when describing what is more certainly a 'continuum of care". Even the best managed care techniques do not come close to providing continuous, personal contact. It is argued that the difference between a managed continuum of care and continuity of care lies at the crux of the care delivery problems faced by many mental health care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

A summary of the Colorado Clinical Psychology/Expanded Mental Health Benefits Experiment.

Conducted an experiment to test 2 alterations in the Medicare program: (1) increasing the proportion of allowable charges for outpatient mental health services that Medicare will reimburse and raising the annual limit of reimbursement, and (2) reimbursing psychologists directly, rather than through a supervising physician, for providing mental health services. The experiment was conducted by Blue Cross/Blue Shield of Colorado from October 1976 to December 1978. All Medicare beneficiaries in that state were randomly assigned to 4 groups, each having a different combination of the 2 variables: coverage and practitioner status. The evaluation consisted of 2 primary components: assessing how successfully the operational aspects of the experiment functioned and determining the impact of the experimental changes on the use, cost, and delivery of mental health and medical services reimbursed by Medicare. There appeared to be no administrative barriers to implementing the changes necessary to select eligible psychologists to participate, select the services to be covered, or implement reimbursement procedures for clinical psychologists. However, the case-by-case peer review system developed for the experiment experienced administrative problems and was costly. There were no significant effects on the utilization of Medicare services, overall program costs, or the delivery of care. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delivering health and mental health care services to children in family foster care after welfare and health care reform

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.     

Primary care within the VA: the firm model

Many of the VA medical centers are reorganizing total care across a continuum that includes outpatient, inpatient, long-term, and home based care, into interdisciplinary firms. The goals of reorganization are to improve patient access to care and continuity of care, to improve housestaff education by assigning a specific panel of patients for the residents to follow longitudinally in a variety of situations supervised by the same mentors, and to enhance research in primary care issues. Preliminary results show increased patient satisfaction and improvements in both quality of care and increased efficiency in its delivery. Many large health care organizations might be expected to reorganize care delivery around a similar interdisciplinary team concept.