Provoking evolution in child and youth mental health in Canada.

Approximately 14–25% of Canadian children and youth have a diagnosable mental disorder. Fewer than 25% of those with such disorders receive specialised services. Even for those receiving services, there is no guarantee that the interventions provided are effective or based on any credible evidence. It is time that child and youth mental health be recognised as the health priority that it truly is. The barriers to meaningful change in child and youth mental health are many and include historical, attitudinal, cultural, financial, and systemic considerations. True change will require creativity, innovation, collaboration, and leadership. Mindsets need to be shifted and the status quo needs to be challenged. Canadian psychologists have skillsets that should be critical in accelerating change in child and youth mental health. We should not shy away from taking on leadership roles to provoke such change. Examples of where this is occurring and opportunities for further action are profiled. (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)     

Characteristics of women working as child aides in a school-based preventive mental health program.

Investigated whether a group of 50 adult women hired to work as nonprofessional mental health workers (child aides) were higher than 40 demographically comparable controls on attributes which, on an a priori basis, could be expected to be related positively to effective functioning in their role. Ss were compared on the Personality Research Form, the SVIB, the Marlowe-Crowne Social Desirability scale, a semantic differential, the Situational Response Test, and R. Hogan's Empathy Scale. The groups were significantly differentiated from one another on a wide range of scales. The inference is drawn that the aide group possessed more desirable attributes than the control group for the role of nonprofessional mental health worker. (25 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics.

Several studies have documented low rates of agreement between clinician- and researcher-generated diagnoses. However, little is known about whether this lack of agreement has implications for the processes and outcomes of subsequent treatment. To study this possibility, the authors used diagnostic agreement to predict therapy engagement and outcomes for 197 youths treated in 5 community mental health clinics. Diagnostic agreement predicted better therapy engagement, with the agree group having fewer therapy no-shows and cancellations and a decreased likelihood of therapy dropout. Additionally, support for a link between agreement and treatment outcomes was found, as the agree group obtained larger reductions in parent-reported internalizing problems during treatment. These findings suggest that diagnostic accuracy may be an important precursor to successful treatment and highlight the importance of future research to find ways to incorporate standardized diagnostic procedures into clinical care settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology graduate school training on interventions for child maltreatment.

This current study surveyed psychology programs' use of empirically supported treatments (ESTs) for children and their families with a history of child maltreatment. In May 2009, there were 599 graduate school programs listed by the Graduate Study in Psychology Online of the American Psychological Association (APA). Psychology graduate school department heads or directors of training were asked to complete an online survey about training offered in treatments for this population. Of the 599 psychology graduate school programs contacted, 201 (34%) responded. Of the 201 programs that responded, 140 provided training in treatments for children and their families with a history of child maltreatment. Results indicated that training in at least 1 EST was provided by 89% of the programs that provided training in treatments for this population. However, training in the treatment rated as meeting the highest standard of evidence, Trauma-focused cognitive–behavioral therapy, was provided in only 45% of the programs. Training in treatments that have been rated as not yet having sufficient research evidence to be labeled as supported were more likely to occur in non-APA accredited and non-PhD programs (i.e., terminal Master's, EdS, PsyD). As an important vehicle for the dissemination of ESTs in child maltreatment, considerable progress is needed to improve the training provided by psychology graduate programs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Creating and field-testing diagnostic criteria for partner and child maltreatment.

An integrated set of diagnostic criteria for partner abuse and child abuse and neglect were developed and tested in 4 studies conducted with a branch of America's largest family maltreatment protection agency (i.e., the U.S. military's Family Advocacy Program). Maltreatment criteria then in force were found to have adequate levels of content validity, but experts' and users' feedback indicated ambiguities and poorly specified criteria that undermined reliable application. Criteria incorporating elements of the best existing civilian and military operationalizations were developed and evaluated in two field trials. The final definitions were found to support very high levels of agreement (92%) between base adjudicating committees and master reviewers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multilevel selected primary prevention of child maltreatment.

Few treatment studies and even fewer primary prevention studies have demonstrated successful reduction of child maltreatment. Successful preventive interventions have often been lengthy and expensive; shorter programs have been didactic and ineffective. The present investigation relied on a 7-level model of successful parenting to mount a time-limited, "selected" prevention effort with high-risk mothers. This program included modeling, role-playing, Socratic dialogue, home practice, and home visits. The study demonstrated effective intervention at every level of the model, including improvements in (a) parenting skills, (b) developmentally appropriate interventions, (c) developmentally appropriate beliefs, (d) negative affect, (e) acceptance of a responsible parent role, (f) acceptance of a nurturing parent role, and (g) self-efficacy. Directions for future research are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The public health approach to youth violence and child maltreatment prevention at the Centers for Disease Control and Prevention.

Millions of people in the United States suffer the consequences of violence, including physical injuries, psychological trauma, and death. Solutions to violence have traditionally been reactive. Through the lens of the public health perspective, the Centers for Disease Control and Prevention (CDC) views violence as predictable based on various contributing factors, and thus as preventable. Within CDC, the Division of Violence Prevention (DVP) leads efforts to prevent injury, death, and disability, and to reduce the suffering and medical costs caused by violence. DVP employs a multidisciplinary, public health approach to identify factors associated with violence, and to develop, evaluate, and disseminate preventive interventions. Psychology is one discipline that has contributed to our approach. The authors present a series of violence prevention initiatives funded by the CDC that are framed within a public health perspective, with attention to the contributions of psychology to youth violence and child maltreatment prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public health approaches to family maltreatment prevention: Resetting family psychology's sights from the home to the community.

The authors review recent trends within the family maltreatment research field toward a public health approach, discuss the rationale for community-level interventions for family maltreatment, and sketch the history and development of community-level prevention approaches. Next, to illustrate the both the logistic and the scientific challenges of such work, the authors discuss the development and testing of an empirically guided, research-community partnership for the prevention of family maltreatment, the United States Air Force's NORTH STAR initiative (New Orientation to Reduce Threats to Health From Secretive Problems That Affect Readiness). Finally, recommendations are made for effective and disseminable family maltreatment prevention interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use.

In this study, the authors examined the role of parental beliefs about the causes of child problems in predicting later mental health service use in a large, diverse population of at-risk youths. Study hypotheses were that parental beliefs consistent with biopsychosocial causes would be associated with later mental health service use; sociological, spiritual, or nature disharmony etiologies would be negatively associated with service use; and beliefs would partially mediate the relationship between race/ethnicity and service use. Of the 5 biopsychosocial beliefs, 2 were positively related to later mental health service use. Unexpectedly, of the 6 parental beliefs related to sociological, spiritual, or nature disharmony etiologies, only 1 was negatively associated with later service use patterns. Parental endorsement of etiologies relating to physical causes, relational issues, trauma, and prejudice was found to partially mediate the relationship between race/ethnicity and service use for Asian/Pacific Islander American and Latino youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Filial family play therapy with an adoptive family: A response to preadoptive child maltreatment.

This article describes an in-depth case study analysis of the process of working therapeutically with a family, who adopted a young male after several child maltreatment experiences, using filial family play therapy. Psychological and behavioral assessments conducted before and after the play therapy process illustrates a varying picture of results in the scores of both parent and child functioning. In-depth narratives collected from the adoptive parents a year later reflect the positive influence the play therapy process had on long-term family dynamics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving parenting in families referred for child maltreatment: A randomized controlled trial examining effects of Project Support.

Project Support is an intervention designed to decrease coercive patterns of aggressive discipline and increase positive parenting. This research evaluates Project Support in a sample of families reported to Children's Protective Services (CPS) for allegations of physical abuse or neglect; 35 families with a child between 3- and 8-years-old participated. In all families, CPS allowed the children to remain in the family home while the family received services. Families were randomly assigned to receive either Project Support or services as usual, which were provided by CPS or CPS-contracted service providers. To evaluate intervention effects, a multimethod, multi-informant assessment strategy was used that included data from mothers' reports, direct observation of parents' behavior, and review of CPS records for re-referrals for child maltreatment. Families who received Project Support services showed greater decreases than families who received services as usual in the following areas: mothers' perceived inability to manage childrearing responsibilities, mothers' reports of harsh parenting, and observations of ineffective parenting practices. Only 5.9% of families in the Project Support condition had a subsequent referral to CPS for child maltreatment, compared with 27.7% of families in the comparison condition. The results suggest that Project Support may be a promising intervention for reducing child maltreatment among families in which it has occurred. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advancing mental health in political places.

The author describes his career as a psychologist serving in elected office. He found that by his attending to individual concerns, supporting community consensus on key issues, playing the outsider role, leading an issue individually, and calling media attention to a problem, city hall could be moved to action. In the state legislature, the author serves in the minority but has made an impact by amending legislation, sponsoring less controversial bills, or generating enough public support for a bill that the majority advances its own similar bill. He identified the following mental health needs in Ohio: better understanding by legislators of the nature and impact of mental illness, adequate funding, mental health parity legislation, and more effective advocacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child maltreatment history among newlywed couples: A longitudinal study of marital outcomes and mediating pathways.

Participants included 202 newlywed couples who reported retrospectively about child maltreatment experiences (sexual abuse, physical abuse, psychological abuse, and neglect) and whose marital functioning was assessed 3 times over a 2-year period. Decreased marital satisfaction at T1 was predicted by childhood physical abuse, psychological abuse, and neglect for husbands; only neglect predicted lower satisfaction for wives. Increased maltreatment of various types was also related to T1 difficulties with marital trust and partner aggression. Dyadic growth curve analyses showed that the marital difficulties reported at T1 tended to remain over the course of the study. Further, in several instances, maltreatment exerted an increasingly detrimental influence on marital functioning over time, particularly for husbands. Examination of possible mediators between maltreatment and reductions in marital satisfaction revealed pathways through decreased sexual activity, increased psychological aggression, and increased trauma symptoms reported by husbands. These findings suggest that clinicians should consider how an adult’s history of child maltreatment may contribute to current marital dysfunction. The authors also identify possible targets for intervention when working with this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research definitions of mental health and mental illness.

The conceptual and methodological difficulties involved in each of the various categories of definitions of mental health outlined in this review are discussed. Suggestions for further research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lifestyle and mental health.

Mental health professionals have significantly underestimated the importance of lifestyle factors (a) as contributors to and treatments for multiple psychopathologies, (b) for fostering individual and social well-being, and (c) for preserving and optimizing cognitive function. Consequently, therapeutic lifestyle changes (TLCs) are underutilized despite considerable evidence of their effectiveness in both clinical and normal populations. TLCs are sometimes as effective as either psychotherapy or pharmacotherapy and can offer significant therapeutic advantages. Important TLCs include exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement, and service to others. This article reviews research on their effects and effectiveness; the principles, advantages, and challenges involved in implementing them; and the forces (economic, institutional, and professional) hindering their use. Where possible, therapeutic recommendations are distilled into easily communicable principles, because such ease of communication strongly influences whether therapists recommend and patients adopt interventions. Finally, the article explores the many implications of contemporary lifestyles and TLCs for individuals, society, and health professionals. In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical, and public health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evidence-based practices addressed in community-based children's mental health clinical supervision.

Clinical supervision is the principal method of training for psychotherapeutic practice, however there is virtually no research on supervision practice in community settings. Of particular interest is the role supervision might play in facilitating implementation of evidence-based (EB) care in routine care settings. This study examines the format and functions of clinical supervision sessions in routine care, as well as the extent to which supervision addresses psychotherapeutic practice elements common to EB care for children with disruptive behavior problems, who represent the majority of patients served in publicly funded routine care settings. Supervisors (n = 7) and supervisees (n = 12) from four publicly funded community-based child mental health clinics reported on 130 supervision sessions. Supervision sessions were primarily individual in-person meetings lasting one hour. The most common functions included case conceptualization and therapy interventions. Coverage of practice elements common to EB treatments was brief. Despite the fact that most children presenting to public mental health services are referred for disruptive behavior problems, supervision sessions are infrequently focused on practice elements consistent with EB treatments for this population. Supervision is a promising avenue through which training in EB practices could be supported to improve the quality of care for children in community-based “usual care” clinics. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

New perspectives regarding positive mental health.

Critical comments regarding the terms "mental health" are indicated. "Needed is some rubric that at once retains the good will and enthusiastic participation of members of the mental health profession and their medical, health, and welfare colleagues, and yet effectively elicits the involvement of members of other social sciences, the humanities, education, religion, and philosophy—groups already committed to the exploration of new horizons and to guiding man toward the fulfillment of his aspirations." 4 areas of injury are noted "to illustrate some of the new perspectives for psychology in research and action regarding positive mental health or creative growth.… Greatly needed at this time are new conceptualizations that have compelling significance for all psychologist." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confrontations with aggression and mental health problems in police officers: The role of organizational stressors, life-events and previous mental health problems.

The extent to which the frequency of facing aggression incidents is associated with mental health problems among police officers when organizational stressors, life-events, and previous mental health problems are taken into account is unclear. To elucidate this data from a longitudinal study of police officers was analyzed (N = 473). Mental health problems (MHPs) are here defined as severe anxiety, depression, hostility, burnout symptoms, and/or sleeping problems according the SCL-90–R and MBI. All MHPs were assessed at baseline and 27 months later. Logistic regression showed that serious threat was statistically significant associated with MHPs at follow-up among officers without MHPs at baseline, but not among those with MHPs at baseline. However, stepwise logistic regression showed that serious threat and/or physical aggression were not independently associated with MHPs at follow-up. Organizational stressors, that is, problems with colleagues were independent predictors in all analyses. Among the total study sample, previous MHPs were the strongest independent predictors. These findings suggest superiors should attend to the mental health, organizational stressors and life-events of their officers regularly and not only following critical incidents at work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality, child maltreatment, and substance use: Examining correlates of deliberate self-harm among university students.

Despite recent interest in deliberate self-harm (DSH), the majority of DSH studies have been limited to clinical samples and have identified psychological or clinical correlates and neglected general personality factors. The present study examined personality traits, child maltreatment, and substance use as correlates of DSH in a sample of 319 (65.2% women) university students. A related goal was to describe the nature of DSH in university students. Overall, 29.4% of students reported that they had engaged in at least 1 act of DSH, and rates of DSH were similar across men and women. Cutting was the most frequently endorsed type of DSH. Women were more likely to have engaged in cutting than men, whereas men were more likely to have put themselves in a violent situation where risk of harm was high. There were no differences in the number of different types of DSH acts reported by men and women. Hierarchical multiple regression revealed several significant positive correlates of DSH acts, including greater depressive symptoms, higher levels of sensation seeking and openness to experience, a history of emotional abuse, and illicit drug use. These findings have important implications for the assessment and treatment of DSH among university students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)