Mindfulness-Based Stress Reduction for Health Care Professionals: Results From a Randomized Trial.

The literature is replete with evidence that the stress inherent in health care negatively impacts health care professionals, leading to increased depression, decreased job satisfaction, and psychological distress. In an attempt to address this, the current study examined the effects of a short-term stress management program, mindfulness-based stress reduction (MBSR), on health care professionals. Results from this prospective randomized controlled pilot study suggest that an 8-week MBSR intervention may be effective for reducing stress and increasing quality of life and self-compassion in health care professionals. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Monitoring challenges: A closer look at parental monitoring, maternal psychopathology, and adolescent sexual risk.

The present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Associating supplemental case management activities with ethnic minority children’s reduced use of psychiatric emergency services.

Studying children and adolescents receiving publicly financed outpatient treatment, the authors investigated whether receipt of supplemental case management was associated with reduced odds of ethnic minority children’s and adolescent’s receipt of crisis care, and whether the minority’s reduction was greater than the reduction for Whites. The data were 97,618 Medicaid records of mental health services provided to children and adolescents ages 0–18 years in California’s public mental health system. The study’s quasi-experimental research capitalized on a large, multisystem, and multiyear data set to address key challenges to internal and external validity. Results indicated that receiving case management along with outpatient treatment was associated with significantly reduced odds of crisis service use for Blacks, Asian Americans, and Latinos especially. The results provide preliminary evidence that supplementing outpatient care with case management helps to close a troubling disparity in mental health treatment access. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training.

Preparation for the role of therapist can occur on both professional and personal levels. Research has found that therapists are at risk for occupationally related psychological problems. It follows that self-care may be a useful complement to the professional training of future therapists. The present study examined the effects of one approach to self-care, Mindfulness-Based Stress Reduction (MBSR), for therapists in training. Using a prospective, cohort-controlled design, the study found participants in the MBSR program reported significant declines in stress, negative affect, rumination, state and trait anxiety, and significant increases in positive affect and self-compassion. Further, MBSR participation was associated with increases in mindfulness, and this enhancement was related to several of the beneficial effects of MBSR participation. Discussion highlights the potential for future research addressing the mental health needs of therapists and therapist trainees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is adoption a risk factor for the development of adjustment problems?

The extent to which being adopted increases a child's risk for the development of adjustment problems has been debated for decades. Results from studies examining prevalence of adopted children and adolescents in outpatient and inpatient mental health treatment suggest that the risk associated with adoption is modest or nonexistent. This body of research is reviewed and critiqued. Two possible explanations for the apparent disparate findings of the clinically based and nonclinically based studies are explored: biases in referral for mental health treatment and the influence of the shape of the distribution of adjustment problems in the adopted and nonadopted populations. Implications for clinical practice and future research are explored.     

The outpatient treatment of suicidality: An integration of science and recognition of its limitations.

The clinical assessment of suicidality is one of the most challenging tasks the mental health clinician can face. This article offers 22 recommendations for the outpatient psychotherapeutic treatment of suicidality in adults and adolescents. These recommendations cut across all domains of clinical practice. A rationale is presented that the stated recommendations need an empirical base, in contrast to the existing litigation-determined standard of care that has emerged over the last several decades. The authors review empirical literature, acknowledge identifiable limitations, and emphasize implications for day-to-day clinical practice and the continuing evolution of standards of care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions.

Reviews the book, Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions by Ronald T. Brown, David O. Antonuccio, George J. Dupaul, Mary A. Fristad, Cheryl A. King, Laurel K. Leslie, Gabriele S. McCormick, William E. Pelham Jr., John C. Piacentini, and Benedetto Vitiello (see record 2007-15067-000). This volume stands as a significant contribution to the current state of affairs in child and adolescent mental health. Unassuming in size (a total of 207 pages including references and author and subject indexes), this compilation is not only of value to researchers and clinicians within the professions of psychology and psychiatry but holds significance across other professions (e.g., social work, occupational therapy, nursing) that serve and support the mental health care of children. This book consists of 13 chapters, of which 11 address common child and adolescent mental health disorders. The authors offer readers a concise summary of the status of support for psychosocial, pharmacological, and combined interventions balanced in the context of safety and potential harm. Recommendations are offered on the most appropriate first-line treatment for a particular disorder (which predominantly favours psychosocial interventions over psychoactive medications). This is a book that will be a significant resource for those seeking evidence-based guideposts to intervention with children, adolescents, and their families. It is a timely, accessible, well-organised text, giving fair consideration to pharmaceutical, psychosocial, and combined interventions. As the authors allude, this compilation represents a "snapshot in time" but sets forth a strong foundation for practise and an agenda to further clinical and research attention to children's mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Getting the cost right in cost-effectiveness analyses

OBJECTIVE: The authors examined different ways of measuring unit costs and how methodological assumptions can affect the magnitude of cost estimates and the ratio of treatment costs in comparative studies of mental health interventions. Four methodological choices may bias cost estimates: study perspective, definition of the opportunity cost of resources, cost allocation rules, and measurement of service units. METHOD: Unit costs for outpatient services, individual therapy, and group therapy were calculated under different assumptions for a single community mental health center (CMHC). Using hypothetical service utilization profiles, the authors used the unit costs to calculate the costs of mental health treatments provided by two programs of the CMHC. RESULTS: The unit costs for an hour of outpatient services ranged from $108 to $538. The unit costs for an hour of therapy varied by 156%; unit costs were lowest if the management perspective was assumed and highest if the economist perspective was assumed. The ratio of the outpatient costs in the two treatment programs ranged from 0.6 to 1.8. CONCLUSIONS: The potential errors introduced by methodological choices can bias cost-effectiveness findings based on randomized control trials. These errors go undetected because crucial methodological information is not reported.     

Children in low-income, urban settings: Interventions to promote mental health and well-being.

Urbanization provides unique political, cultural, economic, and educational opportunities for children and families. However, it may also have a negative impact on the mental health and well-being of children and adolescents, particularly when they are exposed to settings with high rates of crime, violence, delinquency, substance use, abuse, and poverty. Psychologists are well suited to intervene in problems associated with urbanization. However, most psychological services have been directed toward children who are experiencing problems, and there has been less focus on population-based or preemptive interventions that prevent problems before they occur. This review presents 11 recommendations for urban interventions that build on individual, family, and community strengths to promote the mental health and well-being of urban children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed behavioral health services for children under carve-out contracts

OBJECTIVE: Service costs and utilization patterns of children in carved-out behavioral health care plans were examined and compared with those of adults. METHODS: Twelve-month data on utilization and costs of behavioral health care from one managed behavioral health care carve-out organization, United Behavioral Health, were examined for three age groups of children--birth to five years, six to 12 years, and 13 to 17 years-and for adults. More than 600,000 enrollees in 108 different plans were included in the data. Rates of use and intensity of use were examined separately by type of service-inpatient, outpatient, and partial hospitalization. RESULTS: Only a small number of all enrollees used any behavioral health care services--4.2 percent used outpatient services, .3 percent used inpatient services, and .2 percent used partial hospitalization services. Adolescents were more than twice as likely as adults and about seven times as likely as children aged 6 to 12 to use inpatient services. Adolescents also had a slightly higher probability of using outpatient care than adults, while younger children had lower rates of outpatient use than adolescents or adults. Adolescents were also more likely than adults and other children to have very high costs of inpatient care (mean costs=$8,975 for adolescents and $4,750 for adults). Adults were more likely than other groups to have higher outpatient costs ($640 for adults and $513 for all children). CONCLUSIONS: The finding that children, and adolescents in particular, are more likely to have very high inpatient costs compared with adults implies that they may benefit most from the elimination of caps on mental health care costs covered by insurance. This profile of children's behavioral health care utilization patterns can be useful to policy makers in considering expansions in children's health insurance coverage.     

Introduction: Methodological issues in school-based mental health services research.

New research directions on the effectiveness of mental health services for children and adolescents offer the opportunity for school psychology to apply its knowledge base to the systemic juncture between mental health and school systems. Models of service delivery to children, adolescents, and their families that integrate school, mental health, and other service sectors are being actively studied to answer questions about the outcomes of these services for children with mental health problems. The papers in this journal were first presented at the 6th Annual Research Conference of the Florida Mental Health Institute on "A System of Care for Children's Mental Health: Expanding the Research Base." The papers describe state-of-the art studies of school-based mental health interventions for children, adolescents, and their families. In each of the papers, particular attention is paid to the salient methodological issues researchers face in conducting these studies within school settings. It is hoped that these articles will foreground the healthy and creative tensions that exist between different research paradigms and multiple service communities, especially mental health and school systems, by encouraging new research on important and as yet unanswered questions about the effectiveness of school-based service delivery to children and adolescents with mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence for clinical smoking cessation for adolescents.

Objective: This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. Design: Qualitative literature review. Results: Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. Conclusion: There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phonological codes are early sources of constraint in visual semantic categorization

Current statistics show a marked increase in suicides among adolescents 15 to 19 years of age. The literature suggests an increase in the use of lethal methods such as firearms by young suicide attempters. Studies show that most adolescent suicide completers have never received mental health treatment, although the majority had exhibited psychiatric symptoms previous to their deaths. This review of the literature identifies the characteristics and precipitants of suicidal behavior among adolescents. The literature clearly indicates a need for suicide awareness and prevention programs and for the early identification of teenagers at risk for suicidal behaviors. The most logical location for suicide prevention programs and activities is in the schools where the greatest number of adolescents can be reached. The master's-prepared psychiatric mental health nurse in a consultive and collaborative role can be instrumental in the successful formation and execution of these programs. In a joint effort, school personnel and the psychiatric mental health nurse specialist may be able to decrease significantly the number of suicidal behaviors among adolescents.     

Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung's disease and low anorectal anomalies

BACKGROUND/PURPOSE: Recent studies of adolescents with Hirschsprung's disease (HD) and low anorectal anomalies (LARA) showed persistent impairment of fecal control in both groups, but very different mental and psychosocial outcome. METHODS: To explore possible reasons for these differences, 19 adolescents with HD (aged 10 to 20 years; median, 16) operated on by the Duhamel technique were compared with 17 adolescents with LARA (aged 12 to 20 years; median, 15). The 36 adolescents were assessed for treatment procedures, bowel function, and mental and psychosocial outcome by data collected from medical records, physical examination, semistructured interview, and standardized questionnaires. The parents of 30 adolescents were also interviewed and completed questionnaires. RESULTS: Duration of anal invasive treatment procedure and current bowel function were associated with mental and psychosocial outcome. The treatment variable, duration of anal dilation, was the most significant predictor of the adolescents's mental health (R2 = .41, P < .01), whereas chronic family difficulties and parental warmth together with the current bowel function variables, fecal and flatus continence function, best explained the variance in psychosocial outcome (R2 = .77, P < .0001). Thus, the differences in treatment procedures and continence function between the HD and LARA groups may partially explain differences in mental and psychosocial outcome. CONCLUSIONS: These findings suggest that anal dilatation and continence dysfunction may have negative impact on mental health and psychosocial functioning. Indications for and ways of performing the procedure of dilation, and the treatment of persistent incontinence problems, are questioned.     

Improving quality in psychotherapy.

Discusses quality improvement (QI) in psychotherapy, and suggests that the managed care movement may have the effect of stimulating higher quality outpatient care. QI may stimulate better compliance with treatment protocols. Academic clinical psychology has produced treatment protocols and indicators of good psychotherapy but these may be ignored by the practicing psychotherapist as unwieldy and impractical. Continuous QI is a behavioral data-driven technology that can be applied to mental health services. The present article gives an example of nonadversarial data-driven process and outcome improvements. A shift of paradigm toward feedback loops in psychotherapy, collecting data on therapeutic change, and patient satisfaction at each session guide therapy. Data collected may help guide the individual sessions and can be collected to establish a dose–effect relationship for a particular therapist, or for a clinic or group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting adolescent mental health in primary care: a review of the literature

High levels of psychological disturbance amongst adolescents have been linked to behaviours which can damage physical health, and with mental health problems in adulthood. The aim of this review was to see if published literature supports the hypothesis that primary care is a suitable setting in which mental health problems in adolescents can be prevented by early detection and treatment. Medline, BIDS, SIGLE and Psychlit databases (January 1990-February 1997) were systematically searched for English language studies on adolescent health promotion and mental health in primary care; reference sections were checked for earlier work. When offered, adolescent health checks and clinics have been well received with attendance rates of 73% and 83% reported, respectively. Primary care offers a setting for the prevention and detection of mental health problems in adolescents. Further research is needed to determine cost effective ways of using these opportunities.     

Mental health intensive outpatient programming: An outcome and satisfaction evaluation of a private practice model.

The current economic climate of mental health care requires an adaptation of traditional treatment paradigms for practitioners to succeed in the marketplace. Psychologists have not really capitalized on their training and expertise in developing outpatient treatment models for acute care. A private practice outpatient program, based in crisis intervention and group therapy, is described. The effectiveness of a mental health intensive outpatient program (IOP) in a private practice setting is demonstrated. IOPs represent an opportunity for private practice groups to collaborate with larger systems of care while providing clinically effective, consumer friendly, and safe treatment for acute patients in traditional outpatient settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care is harmful to outpatient mental health services: A call for accountability.

Substantial evidence indicates that managed care is harmful to outpatient mental health services. The thesis is presented that two underlying causes of these harmful effects are (1) inappropriately focusing on cutting outpatient mental health expenses and (2) dramatically reducing outpatient services as a result of managed care economics. Due to the reduced services, it is likely that treatment quality will suffer as well. The probably negative results are as follows: denying services to many who need treatment, systematically undertreating the clients who are served, and denying psychologically necessary longer term treatment to those with moderate to severe problems. To protect against these dangers, it is recommended that managed care be held accountable for reporting its economic efficiency and the quantity of services provided. Because of the inherent weaknesses in managed care, alternative cost-control strategies are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs about the helpfulness of interventions for mental disorders: a comparison of general practitioners, psychiatrists and clinical psychologists

OBJECTIVE: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders. METHOD: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful. CONCLUSIONS: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.