Evaluation of indicated preventive intervention (secondary prevention) mental health programs for children and adolescents

Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.     

Culturally sensitive psychotherapy for Puerto Rican children and adolescents: A program of treatment outcome research.

Recognition of cultural distance between Hispanic clients and non-Hispanic therapists has prompted efforts to introduce culture into therapy, but there is little evidence that such efforts influence treatment outcomes. This article evaluates treatment outcomes from a program of research on modeling therapy with Puerto Ricans, targeting anxiety symptoms, acting-out behavior, and self-concept problems. Evaluation of outcomes confirmed the impact of culturally sensitive modeling therapy on anxiety symptoms and other selected target behaviors, but negative treatment effects also were evident. Results suggest that new approaches to psychotherapy for special populations, such as Hispanic children and adolescents, should be buttressed by programmatic research oriented toward the comparative evaluation of treatment outcomes and should be attuned to therapeutic processes mediating between culture and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents.

This study evaluated the efficacy of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) with depressed adolescents in Puerto Rico. Seventy-one adolescents meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for a diagnosis of depression were randomly assigned to 1 of 3 conditions: CBT, IFT, or wait list (WL). Pretreatment, posttreatment, and 3-month follow-up measures of depression symptoms, self-esteem, social adjustment, family emotional involvement and criticism, and behavioral problems were completed. Results suggest that IPT and CBT significantly reduced depressive symptoms when compared with the WL condition. IPT was superior to the WL condition in increasing self-esteem and social adaptation. Clinical significance tests suggested that 82% of adolescents in IPT and 59% of those in CBT were functional after treatment. The results suggest that both IPT and CBT are efficacious treatments for depressed Puerto Rican adolescents. IPT's impact in other levels of outcome is discussed in terms of its consonance with Puerto Rican cultural values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cuento therapy: A culturally sensitive modality for Puerto Rican children.

Epidemiological studies indicate that Hispanics underutilize community mental health facilities in proportion to their needs and often fail to benefit from traditional psychotherapeutic services. The present study investigated the effectiveness of a modeling therapy designed to be sensitive to Hispanic culture. In one version of the modality, cuentos (folktales) from Puerto Rican culture were used to present models of adaptive behavior and in another version folktales were tailored to bridge Puerto Ricans' bicultural conflict. 210 high-risk children from kindergarten through the 3rd grade and their mothers were randomly assigned to receive either cuento therapy, traditional art/play therapy, or no therapy. Results indicate that cuento therapy significantly reduced children's trait anxiety, as measured by the State-Trait Anxiety Inventory for Children, relative to traditional therapy and to no intervention and that this trend was stable over 1 yr. The cuento modalities also increased Wechsler Intelligence Scale For Children—Revised (WISC—R) Comprehension subtest scores and decreased observer-rated aggression. The need to develop and evaluate culturally sensitive therapeutic modalities for Hispanics is discussed. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immediate family crisis intervention as preventive mental health: The family consultant service.

The service employs mental health personnel who work closely with the police in order to respond immediately to family-related crises. This paper reports a preliminary evaluation of the program with respect to 5 issues: (a) whether the program is redundant with existing community services, (b) the advantages of early intervention approaches, (c) whether the program is a preventative service to any degree, (d) the evaluation of the program by the police and social agencies, and (e) whether cooperation between mental health and law enforcement professionals is enhanced. Available data collected over a 2-yr period concerning these 5 issues indicated the success of the program. It is concluded that it can serve as a model for community prevention approaches to family crises and mental health problems. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A critical analysis of Puerto Rican machismo: Implications for clinical practice.

Reviews the 2 prevalent theories of the Puerto Rican machismo concept found in the Puerto Rican and mental health literature, including the traditional and the culturalist perspectives. A new paradigm that integrates historical and sociopolitical interpretations of the male role configuration is proposed. This model examines machismo more as a result of the socioeconomic status (SES) of Puerto Rican males rather than an intrapsychic, ethnic cultural, or national characteristic issue and aims to educate the client as to how machismo functions for society and for his ethnic group. Recommendations for the use of this dialectical perspective in counseling approaches to Puerto Rican males are offered. It is suggested that a recognition of the class-related nature of machismo provides the possibility of approaching therapy or service delivery goals from a similarly based socioclinical model, with a focus on engagement and education. A group therapy case example is presented to illustrate the application of this approach to clinical practice, and its general applicability to individual, couple, and family work is noted. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally adapted mental health intervention: A meta-analytic review.

There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A strategic supportive model for health prevention in the elderly: profile of a Puerto Rican geriatric population in a public health sector

OBJECTIVE: To introduce the ASSUME study with the presentation of a clinical, socio-demographic, preventive and psychological profile of a geriatric population of patients who receive their health care in the General Internal Medicine Ambulatory Sector of our institution. METHODS: The Assume study is a prospective, randomized trial which is directed at increasing the participation of patients in preventive health care strategies at a primary, secondary and tertiary level. In this paper we focus on the initial stage of the process which aims to define and synthesize predisposing risk factors in the geriatric patient which would be amenable to primary, secondary and tertiary preventive strategies. Through a process of patient interview profiles of a physical, social and psychological nature are have been constructed. With the availability of this profile a clearer definition of the potential benefit of preventive strategies could be established. In this paper we present the initial profile of patients of all patients randomized to the study as of Sept. 01, 1997. RESULTS: A total of 123 patients have been enrolled with 48(39%) males and 75(61%) females. The mean age of patients is 70 years with a median of 68 years. Cardiovascular disorders establish the leading disease events in our population of patients with Hypertension in 85%, Ischemic heart disease in 50%, Myocardial Infarction in 19% and 40% with a history of Congestive Heart failure. Diabetes and Heart Failure were seen in 40%. An average of 4.4 prescribed drugs per patient was documented. A minority of patients took more than 7 drugs and none took more than 9 medications. Most patients (67 or 55%) had not required hospitalizations in the preceding 12 months and none of the patients required more than 4 hospitalizations. The average LOS was 8.60 days. The Preventive Medicine profile reveals a large number of un-vaccinated adults. Regular cigarette smoking was seen in 12%. We have used the body mass index as a measure of adequacy of weight. We highlight the number of patients who have a BMI equivalent to an obese, severely obese or morbidly obese category (41%). The number of patients who follow a prescribed diet was found to be 54 patients for 44% of the study group. With regards to the interventions primarily designed for early cancer detecting, approximately half of the patients undergo the recommended annual screening interventions. The screening of visual accuracy was reported in 54%, dental screen (24%) and auditory screening (15%). Nearly a quarter of patients have severe depression. The CAPE testing reveal that in the information and orientation section most patients presented none or light dysfunction(87%). In the conductual phase marked or severe impairment was detected in 12% of patients. In the mental ability section 22% of patients presented marked or severe impairment. CONCLUSION: The geriatric population studied would benefit from modalities which would increment the modern modalities for primary and secondary prevention of disease. Follow-up studies will allow the evaluation of the effectiveness of the conceptual model proposed, which would increment the patient participation in these preventive modalities.     

A preventive health paradigm for health care psychologists.

Developed a preventive health paradigm for health care psychologists by building on public health and preventive mental health models of primary, secondary, and tertiary prevention. Adoption of a "biopsychosocial" perspective on health and illness is basic to the preventive health paradigm. Examples of preventive health programs are considered along with a wide range of preventive health activities by psychologists in health care settings. (31 ref) (PsycINFO Database Record (c) 2010 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)     

Validity generalization of a school-based preventive mental health program.

Summarizes results of 6 independent evaluations of school district implementations of the Primary Mental Health Project (PMHP), a program for early detection and prevention of school adjustment problems. Data indicate that each district program was effective beyond chance expectation. The pooled change profile, based on 370 primary-grade children seen through the 6 district programs, was positive. Findings support the soundness and utility of PMHP's underlying program model and suggest that it can be implemented flexibly and effectively in a variety of settings. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Career counseling as a mental health intervention.

Discusses career counseling aimed at work adjustment or job change as a potential intervention for many individuals suffering from job stress and argues that, in certain instances, career counseling should be used instead of traditional psychotherapy and/or as an alternative to stress management. Assessment strategies for determining the appropriate intervention for individuals suffering from job stress are generated from work adjustment theory. The implications of utilizing career counseling as a mental health intervention are also presented. (34 ref) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Puerto Rican intellectuals in New York: Some intragroup and intergroup contrasts.

A factor analysis of coded interview data on 20 Puerto Rican intellectuals in the New York City area yielded 5 item-factors (R) and 2 person-factors (Q). The R factors dealt with Spanish language dominance, ideological language maintenance, Puerto Rican cultural emphases, American awareness, and sociolinguistic sophistication. The Q groups differed meaningfully and consistently on these 5 factors and on demographic background variables, particularly with respect to ideological vs. behavioral Puerto Rican culture and language maintenance. Intellectuals as a group were found to differ greatly and systematically from ordinary Puerto Rican males in having more ideological positions with respect to Puerto Rican culture and Spanish language maintenance in New York. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of a brief mental health intervention for primary care patients.

This randomized trial is a first evaluation of a brief psychotherapeutic intervention for primary care patients. Sixty-two participants were randomly assigned to the intervention or to treatment as usual. As compared with treatment as usual, the intervention led to significant reductions in symptoms of anxiety and depression. The reduction was maintained for 3 months after the end of treatment, but some return of symptoms occurred by 6 months after treatment. The treatment was well accepted by patients. This study provides good preliminary evidence for the effectiveness of this intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A brief image-based prevention intervention for adolescents.

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior–image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16–0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32–0.43, ps     

A cognitive stress-reduction intervention program for adolescents.

We examined the effectiveness of a cognitive intervention to help adolescents cope with stress and other forms of negative emotional arousal. Through this intervention procedure, youths learned how to identify and monitor stress-promoting cognitions, restructure these cognitions into more adaptive thoughts, use self-instructions to control stress-engendering self-statements, and practice and apply these acquired skills. The youths who received training were compared to a waiting list control group on measures of anxiety, anger, self-esteem, depression, and self-reports of cognitions in hypothetical stress situations. The training group showed significant reductions in levels of anxiety and anger, improvement in self-esteem, and an increase in the number of reported positive cognitions in response to a hypothetical situation. These treatment gains were maintained at a 10-week follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of two types of counselor intervention on Black American, Puerto Rican, and Anglo-American analogue clients.

Tested the hypothesis that types of counseling intervention may be differentially effective depending on the client's cultural background using 28 Black American (BAM), 27 Puerto Rican, and 28 Anglo American (AA) female community college students. Ss received either affective responses or closed questions from a 23-yr-old female BAM clinical psychology graduate student in an analog counseling situation that permitted S-generated responses. Content analyses and ratings of the counselor revealed that affective responses were superior to closed questions on all dependent measures for AA Ss. For BAM Ss, all content variables and 2 of 3 ratings of the counselor suggested superiority of affective responses. It is concluded that affective responses are superior to closed questions in initial counseling interviews with community college students, but inconsistencies in results suggest that further research is necessary. (67 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of two approaches to enhancing career maturity in Puerto Rican college women.

Our study compares two career interventions designed to enhance the career maturity of a group of Puerto Rican women in a special admissions program in a large urban college. These treatments were compared with each other and with a control group in terms of outcomes on two measures of career maturity and on locus of control. No significant differences were found between the two experimental treatments in terms of the dependent variables. However, the results of the study indicate that positive changes in career maturity and locus of control of academically and economically disadvantaged groups can be facilitated by the use of carefully designed career interventions. (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.     

Review of Epilepsy: A handbook for the mental health professional.

Reviews the book, Epilepsy: A handbook for the mental health professional edited by Harry Sands (1982). The editor has gathered 10 contributors, each with a wealth of experience in the area of psychological issues in epilepsy. The book is designed to provide necessary information about epilepsy to "the core mental health discipline: psychology, psychiatry, social work, and psychiatric nursing, and to other collaborating disciplines such as rehabilitation and counseling." It certainly achieves this goal and has the potential of becoming a major reference source as well as textbook in the field. The book could be used as a handbook and reference book for specific problems with epileptics. However, its real strength is its potential use as a unified and comprehensive textbook on a broad range of rehabilitation psychology issues with the epileptic. As a text, it would be appropriate for a senior undergraduate-level or graduate-level course within the broad area of medical psychology. Many of the psychological principles and intervention strategies are applicable to other disabilities. Thus, if educators wish, they can use these chapters as a core model to be augmented by other references to other disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)