Predictors of preintake attrition in a rural community mental health center.

[Correction Notice: An erratum for this article was reported in Vol 6(2) of Psychological Services (see record 2009-06563-006). The article contains data that were obtained from archival records of the same community mental health center (serving adults, adolescents, and children), and that reflect information from initial consumer contacts made with the center during the same period of time, as that reported in “Clinical Intake of Child and Adolescent Consumers in a Rural Community Mental Health Center: Does Wait-time Predict Attendance?” by Marne L. Sherman, David D. Barnum, Adam Buhman-Wiggs, and Erik Nyberg (Community Mental Health Journal, 2009, Vol. 45, No. 1, pp. 78–84). Information is provided in this clarification about the data used in both articles.] Preintake attrition presents a challenge in outpatient mental health settings, in part due to the waste of limited clinical resources when potential consumers do not attend appointments. While understanding the phenomenon of mental health consumer attrition has received clinical and empirical attention for more than 40 years, the data remain somewhat mixed as to the key predictors of preintake attrition. Additionally, little attention has been directed at understanding missed intake appointments in community mental health centers within rural settings. This study examines predictors of attended appointments for intake in a rural community mental health center, with particular attention to the effect of intake delay or wait-time between call for appointment and scheduled appointment. Wait-time is identified as a significant predictor of appointment attendance in logistic regression analysis, even after controlling for consumer variables, such as referral source and payor source. The impact of wait-time on the likelihood of attending the intake appointment was not moderated by the case urgency. Considerations for applying these results to the organization of clinical service delivery in a rural community mental health center are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Predictors of preintake attrition in a rural community mental health center”: Clarification.

Reports an error in "Predictors of preintake attrition in a rural community mental health center" by Marne L. Sherman, David D. Barnum, Erik Nyberg and Adam Buhman-Wiggs (Psychological Services, 2008[Nov], Vol 5[4], 332-340). The article contains data that were obtained from archival records of the same community mental health center (serving adults, adolescents, and children), and that reflect information from initial consumer contacts made with the center during the same period of time, as that reported in “Clinical Intake of Child and Adolescent Consumers in a Rural Community Mental Health Center: Does Wait-time Predict Attendance?” by Marne L. Sherman, David D. Barnum, Adam Buhman-Wiggs, and Erik Nyberg (Community Mental Health Journal, 2009, Vol. 45, No. 1, pp. 78–84). Information is provided in this clarification about the data used in both articles. (The following abstract of the original article appeared in record 2008-16478-003.) Preintake attrition presents a challenge in outpatient mental health settings, in part due to the waste of limited clinical resources when potential consumers do not attend appointments. While understanding the phenomenon of mental health consumer attrition has received clinical and empirical attention for more than 40 years, the data remain somewhat mixed as to the key predictors of preintake attrition. Additionally, little attention has been directed at understanding missed intake appointments in community mental health centers within rural settings. This study examines predictors of attended appointments for intake in a rural community mental health center, with particular attention to the effect of intake delay or wait-time between call for appointment and scheduled appointment. Wait-time is identified as a significant predictor of appointment attendance in logistic regression analysis, even after controlling for consumer variables, such as referral source and payor source. The impact of wait-time on the likelihood of attending the intake appointment was not moderated by the case urgency. Considerations for applying these results to the organization of clinical service delivery in a rural community mental health center are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The community and the community mental health center.

The community has responsibility "for the quality and adequacy of the mental health services that it gets. The opportunities are now open for communities to employ the mechanism of the comprehensive mental health center to take major strides toward more intelligent, humane, and effective provision for their people. If communities rise to this opportunity, the implications for the national problem of mental health and for the quality of American life are immense." Guidelines are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient pharmacotherapy in a community mental health center

A 78-year-old man underwent ectropion repair with a monopolar electrosurgical unit. A flash fire occurred, resulting in a loss of eyelashes of the left upper and lower eyelids. A retrospective analysis of the case was conducted, including a review of the relevant literature. Although rare, the possibility of a flash fire should be considered when performing surgery with an electrosurgical unit. Minimizing supplemental oxygen and electrosurgical power settings may help to avoid such an incident.     

Evaluating therapy outcome at a community mental health center.

Describes a multiple-criteria method for evaluating the therapy outcome of 42 walk-in community mental health center clients (mean age 29 yrs 6 mo) for whom complete pre- and posttherapy data were available. Significant improvement was found on client- and therapist-rated target problems and general well-being ratings. Up to 75% of the Ss made significant gains in therapy. Improvement, however, was not related to type of termination (mutual vs unilateral decision) or number of therapy sessions. The assessment procedure was demonstrated to be a comprehensive, effective, and simple means of measuring therapeutic outcome that could be developed for use in any treatment setting. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost effectiveness of clinical training in a community mental health center.

The future of professional psychology may well rest on psychology training programs successfully defending their existence in purely monetary terms. This article examines the effectiveness of the training program of an urban mental health center that includes an American Psychological Association-accredited psychology internship. The training program was found to produce net revenues for the facility and to meet the training needs of its participants. Variables related to producing a cost effective psychology training program are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment outcome and follow-up evaluation based on client case records in a mental health center.

Assessed the outcome of treatment of 121 mental health center clients (11–70 yrs of age), using therapist and independent global improvement ratings and independent ratings of notes in case records based on a client-specific goal-oriented outcome technique (Goal Attainment Scaling; GAS). Telephone follow-up of 50 clients provided a 2nd GAS assessment, client global improvement ratings, and 3 consumer satisfaction ratings. Findings indicate that (a) independently determined GAS scores and therapist and independent global ratings converged significantly, (b) the GAS procedure provided some increase in accuracy as well as an increase in specificity of outcome, and (c) client global ratings may reflect satisfaction with treatment rather than outcome. In view of the intercorrelations among measures and the relationship between GAS scores determined from case records and telephone interviews, case records may provide for accurate assessment of client problems and treatment success. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient feedback at a community mental health center: Year three.

Follow-up of 99 former patients (ages ranged from 13 to over 55 yrs) at a community mental health center revealed that more than 85% felt they had been helped by therapy; that income and education variables did not influence perceived degree of help received, number of therapy sessions, or perceived interest of the counselor in the patient; and that most Ss neither sought further help nor felt that they needed it after termination. The more that Ss felt the therapists were interested in them, the more they felt helped. Results replicate those of E. Kaschak (see record 1980-23693-001). New variables included in the current study suggest that therapists may be more stringent evaluators of therapy outcome than patients. Sex of client also appeared to influence therapist's ratings, as women were considered improved more often than men. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conducting research through a community mental health center: A research team's experiences.

Shares the professional and personal experiences of a diverse research team in conducting research over a 5-yr period. The team consisted of center staff, university professors, and graduate students. In addition to meeting the research and evaluation requirements of the center, the team successfully conducted projects that resulted in a continuing series of publications, convention presentation, and several dissertations and theses. The problems and rewards of this endeavor are discussed from the perspectives of the team members. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating the effectiveness of innovative design for a community mental health center

The effectiveness of the design of the inpatient and day patient areas of a community mental health center was evaluated in 1969, soon after the center was opened, and again in 1974. The focal area is a large, irregularly shaped communal space; it opens onto a wide, encircling corridor ringed with bedrooms, multiuse rooms, and offices. The center was designed to encourage different behaviors and varied uses of space, to promote interaction, and to stimulate and challenge patients. In 1974 the evaluators found the design still worked well for the unit that still operated the same kind of program the center was designed for, a therapeutic community, even though the unit admitted sicker patients than planned. The design did not work as well for the second unit, which had become a crisis intervention program for patients who were often highly agitated, suicidal, or determined to escape; security and surveillance were major problems.     

A method for quality assurance in a community mental health center. Community psychiatry in Copenhagen

The purpose was to describe a method for quality assurance in community mental health centres. Three psychiatrists and a multiprofessional treatment team conceived the method. The community mental health center--which was the basis for the work--was the Copenhagen centre for the sectors Vesterbro and Kongens Enghave. The target group for the centre is people with serious mental illness. The work is done according to the principles for clinical case managers. Data are registered in a national database in combination with the centre's own registration system. Eleven indicators for process quality and eight for outcome quality were selected. Measurement parameters for there indicators were defined. Criteria and standard were defined according to existing knowledge and the author's clinical experience. The necessary programs for calculating the value of the chosen standards are constructed. With the use of existing data and a limited extra registration it was possible to evolve a method for quality assurance in a community mental health centre.     

Psychologist as a mental health center director.

The psychologist functioning as executive director (ED) of a new community mental health center must be a leader-strategist, business manager, motivator-staff developer, and organizational representative. The position requires creativity and problem solving. Frustrations of the position involve slow bureaucratic decision making, lack of control over circumstances, ill-defined expectations for services, and insecurity surrounding the ED position. Psychological training contributing to management performance includes interpersonal skills, family dynamics as a model to analyze organizations, group dynamics, applied behavioral analysis to reinforce an employee's behavior, and evaluation research for decision making. Career opportunities are in mental health centers, private psychiatric hospitals, wellness programs, and training and development departments. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive therapy for depression in a community mental health center: A benchmarking study.

The current study examined the feasibility and effectiveness of transporting an empirically supported treatment for depression, cognitive therapy (CT), to a community mental health center setting. CT was delivered to 192 adult outpatients with major depression, and a benchmarking strategy compared results with those of 2 randomized controlled trials (RCTs). The 3 samples were largely similar in terms of initial severity of depression, and CT was as effective in reducing depressive symptoms in the current sample as in the RCTs. More favorable outcome was associated with less severe initial depression, more therapy sessions, more years of education, and absence of a comorbid personality disorder. This study demonstrates that an empirically supported treatment can be transported effectively to a clinical setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental disorders of Eskimos seen at a community mental health center in western Alaska

The charts of 343 Eskimos seen at a community mental health center in northwestern Alaska were reviewed, and data on demographic characteristics, DSM-III-R diagnoses, and history of suicide attempts were collected. Substance use disorders were the most common group of mental disorders. Substance use patterns differed substantially according to age and gender. Both children and adults had high rates of attempted suicide (66 percent and 67 percent). Rates of bipolar disorder and eating disorders were substantially lower than those seen in mental health clinics serving the general U.S. population.     

Toward reflective practice: A multicultural competence training model from a community mental health center.

Despite the importance of multicultural competence in clinical practice and training, there is a surprising dearth of innovative training models from fieldwork sites that would be replicable in other practicum settings. The authors illustrate a multicultural competence training model from a community mental health center that highlights the Guidelines on Multicultural Education, Training, Research, Practice, and Organization Change for Psychologists (American Psychological Association, 2003). The model focuses on providing multicultural training through two separate but linked training teams for the dual purposes of internal reflection and reflective practice. The authors conclude with a discussion of the implications of this training model for practice, research, and organizational change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Psychologist in community mental health.

It is "our belief that the field of community mental health is a challenging and stimulating field for research oriented psychologists. We feel strongly that the identity of the psychologist may be best maintained through a scientist-professional model." Recommendations are made for the future training of psychologists in this field. The individual psychologist "must be assisted by adequate post-doctoral interdisciplinary training in a university setting." Major sections are: Maintenance of an Identity, Scientist and Professional, and Training the Scientist-Professional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of suicidal and nonsuicidal elders referred to a community mental health center program

Sociodemographics, clinical characteristics, and life stressors of community-dwelling suicidal risk and nonsuicidal risk elders referred to a community aging and mental health provider were compared in this study. Information was collected through case manager surveys and agency records on 683 older adults referred to the Elder Services Program of Spokane Mental Health in 1994 and the first 6 months of 1995. This sample included 109 individuals who were clinically judged to be at suicide risk by case managers at the time of initial assessment. Comparisons between suicidal risk and nonsuicidal risk elders indicated that suicidal elders were younger, more likely to be separated or divorced, and more likely to report a previous history of suicidal behavior. Results of a logistic regression analysis indicated that living alone, depression or anxiety disorder, and higher levels of emotional disturbance predicted suicide risk status. In addition, medical problems, family conflict, and relationship loss predicted suicide risk status in this particular sample. Individuals at suicide risk were also more likely to have a family physician than others. Implications of findings for identification and treatment of suicidal elders are discussed.     

Establishing an integrated care practice in a community health center.

In a progressively complex and fragmented health care system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the United States have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe a working integrated primary care model, currently utilized in a large community health center system in Colorado, that encompasses universal screening, consultation, psychotherapy, and psychological testing. With appreciation for the way an organization's unique circumstances inform the best approach for that particular organization, we highlight the clinical-level and system-level variables that we consider necessary for successful practice development and address how our behavioral health program operates despite funding limitations. We conclude that organizations that aim for integrated primary care must mobilize leadership to implement systemic changes while making difficult decisions about program development, financing, staffing, and interagency relationships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)