Improving Mental Health Service Utilization for Children and Adolescents.

Approximately 10% of children and adolescents have mental health problems necessitating intervention, but well below 50% of these children receive needed services, and far fewer receive the quality of care required to effectively reduce their impairments. Although system reform is needed to improve service utilization and quality of care for all children, preschoolers, girls, individuals of minority status, and the uninsured are most at risk for being underserved. Factors contributing to poor service utilization can be classified into two broad sets: sociopolitical factors referring to issues related to funding and access, and cultural/familial factors including beliefs about mental health services, providers, and treatments. This article describes the help-seeking process and focuses on cultural and familial factors that contribute to movement through these stages, with a particular focus on variables that are amenable to change by practitioners in the school and community, including school psychologists. Guidelines for understanding and changing the help-seeking behavior of families, including suggestions for creating service options, providing family education, and offering individualized family services, are described. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Promoting and Protecting Youth Mental Health Through Evidence-Based Prevention and Treatment.

For decades, empirically tested youth interventions have prevented dysfunction by addressing risk and ameliorated dysfunction through treatment. The authors propose linking prevention and treatment within an integrated model. The model suggests a research agenda: Identify effective programs for a broadened array of problems and disorders, examine ethnicity and culture in relation to intervention adoption and impact, clarify conditions under which programs do and do not work, identify change mechanisms that account for effects, test interventions in real-world contexts, and make tested interventions accessible and effective in community and practice settings. Connecting the science and practice of prevention and treatment will be good for science, for practice, and for children, adolescents, and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infant Mental Health: Making a Difference.

Practicing psychologists are increasingly identifying serious problems in behavior, emotional development, and regulation in infants and very young children that result in impaired family functioning and relationships. Often these child challenges are in combination with a range of parental concerns including addictions, homelessness, teen parenthood, and unresolved feelings from the past. Infant mental health (IMH) is a broad field encompassing theory, research, and interventions with very young children and their families. This article provides an overview of IMH concepts, with special focus on assessment and interventions that can be integrated into the psychologist's current practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's Mental Health as a Primary Care and Concern: A System for Comprehensive Support and Service.

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists and Mental Health Programs.

The author expresses surpise hat the APA Board of Directors is concerning itself with the relationship of the psychologist to mental health activities (Amer. Psychologist, 1954, 9, 208). But more surprising was the Board's impression that "medically dominated 'do-good' organizations" might be to blame for the lack of more active participation by psychologists. The author explains why he does not share this perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How Stigma Interferes With Mental Health Care.

Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may impede treatment participation: It diminishes self-esteem and robs people of social opportunities. Given the existing literature in this area, recommendations are reviewed for ongoing research that will more comprehensively expand understanding of the stigma-care seeking link. Implications for the development of antistigma programs that might promote care seeking and participation are also reviewed (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building Systems of Care for Children With Chronic Health Conditions.

Objective: To describe the leadership role that rehabilitation psychologists can play in improving the health care delivery system for children with special health care needs (CSHCN). Setting: Midwest academic health center and surrounding communities. Participants: Children with chronic health conditions and disabilities and their families. Intervention: A model research demonstration project designed to promote family-centered, comprehensive, coordinated, and community-based care for CSHCN. The project aims to enhance environmental supports for CSHCN and their families in 2 ways: (a) by improving the ability of primary care providers to deliver effective chronic care management and (b) by integrating this improved clinical practice into an enhanced Medicaid managed care service delivery system for persons with chronic illness and disabilities. Conclusions: Psychologists have the potential to improve the quality of life of CSHCN and their families by intervening not only through direct services but also by promoting positive changes in the larger health care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Services and Health Care Economics: The Health Psychology Marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

History, Politics, and Transformational Change in Canadian Health Care: A Rejoinder.

Our rejoinder addresses two common themes raised in the responses by Arnett et al (see record 2004-17185-005), by Hunsley and Crabb (see record 2004-17185-006) and by Mikail and Tasca (see record 2004-17185-007) to our article (see record 2003-09748-001) concerning the potential role of psychological services in the future of public health care in Canada. The first concerns the current system's capacity to evolve beyond the medical-hospital illness model of the 1960s to incorporate psychological treatments aimed at illness prevention and health promotion. This would be more likely if psychologists were to participate directly in primary-care and home-based mental health-care reform. The second theme is the presumed negative role of "politics" rather than scientific evidence in decisions concerning public coverage or subsidy. We argue that democratic decision-making is the proper basis upon which decisions concerning public coverage are made, but it need not be in opposition to evidence-based decision-making. As recommended in the final report of the Commission on the Future of Health Care in Canada, the Health Council of Canada along with applied research institutes can make politicians and policy-makers more aware of the growing body of evidence supporting the efficacy of psychological treatments relative to the alternatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Investing in Children, Youth, Families, and Communities: Strengths-Based Research and Policy.

Investing in Children, Youth, Families, and Communities: Strengths-Based Research and Policy edited by Kenneth I. Maton, Cynthia J. Schellenbach, Bonnie J. Leadbeater and Andrea L. Solarz (see record 2003-88390-000). This book advocates a strengths-based approach to family-based research and social policy. Instead of deficit-based models of social problems, resiliency models are advocated in which factors associated with competence and positive developmental outcome are identified and promoted (see Masten & Coatsworth, 1998). Instead of an emphasis on diagnostic issues for existing problems, prevention is stressed so that negative outcomes do not arise and positive outcomes do. This book consists of 19 chapters and provides excellent reviews of strength-based approaches to children and families, and would have a broad appeal to family- relevant practitioners and policy-makers. Although some of the material seems most germane to an American audience, there is substantial relevance to the Canadian context of children and families. In academic settings, the book could be useful in advanced courses in either applied developmental or community psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Women's Mental Health: A Comprehensive Textbook.

Reviews the book, Women's Mental Health: A Comprehensive Textbook edited by Susan G. Kornstein and Anita H. Clayton (2004). The reviewer notes that this book was so helpful that I could not put it down to write a review. In my opinion, many readers, including clinicians in psychology and psychiatry, researchers, graduate students, and sophisticated undergraduates would all benefit from perusing this text and examining chapters related to specific disorders and aspects of the reproductive stages of women's lives. This book is definitely a gold mine for busy academics preparing comprehensive lectures on women's mental health issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental Illness and/or Mental Health? Investigating Axioms of the Complete State Model of Health.

A continuous assessment and a categorical diagnosis of the presence (i.e., flourishing) and the absence (i.e., languishing) of mental health were proposed and applied to the Midlife in the United States study data, a nationally representative sample of adults between the ages of 25 and 74 years (N = 3,032). Confirmatory factor analyses supported the hypothesis that measures of mental health (i.e., emotional, psychological, and social well-being) and mental illness (i.e., major depressive episode, generalized anxiety, panic disorder, and alcohol dependence) constitute separate correlated unipolar dimensions. The categorical diagnosis yielded an estimate of 18.0% flourishing and, when cross-tabulated with the mental disorders, an estimate of 16.6% with complete mental health. Completely mentally healthy adults reported the fewest health limitations of activities of daily living, the fewest missed days of work, the fewest half-day work cutbacks, and the healthiest psychosocial functioning (low helplessness, clear life goals, high resilience, and high intimacy). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Geriatric Mental Health Policy: Impact on Service Delivery and Directions for Effecting Change.

The treatment of mental health problems in older adults has advanced considerably over the past several decades. Nevertheless, the mental health needs of the nation's elderly population remain substantially unmet. This article identifies the significant but previously neglected role of regulatory policies and administrative practices in limiting the use and provision of geriatric mental health services. Such factors are the least recognized and understood by psychologists, although they are the very factors on which psychologists can have the most potential influence. This article subsequently identifies salient legislative proposals and regulatory developments, while addressing the importance of advocacy on agenda setting and policy change. The final section provides specific proposals and mechanisms at micro and macro levels for improving the geropsychology service system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foundations for Medical Care.

Notes that, in California, what began as the San Joaquin County Medical Society's answer to Kaiser-Permanente (i.e., the San Joaquin Foundation for Medical Care) has spread to a growing movement that is now nationally recognized as a viable, effective, competitive model of health care delivery. Each foundation is a federation of fee-service practitioners into an organizational entity that can contract to provide designated services on a prepaid basis within a geographical area. This gives the foundation for medical care (FMC) many of the attributes of the health maintenance organization, and indeed, they are recognized in the Health Maintenance Organization Act of 1973, PL 93-222, as individual practice associations (D?rken, 1974). Additional details about the foundations are provided, including the participation of practicing psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An expanded perspective on children's mental health.

Comments on three articles (see records 2005-11115-003, 2005-11115-004, and 2005-11115-005) on the status of children's mental health services in the United States, which appeared in the September 2005 issue of the American Psychologist. The current authors suggest that, although this series of articles provides important information, the articles fall short in meeting the mark of comprehensively describing the solutions necessary to effectively address the crisis facing children's mental health in this country. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance Measurement, Health Care Policy, and Implications for Rehabilitation Services.

Provision of reliable, valid, and informative data to the public for evaluating the performance of health care services has been inconsistent at best and erroneous at worst. This article examines how private and governmental agencies are addressing this issue by concentrating on a well-defined set of performance indicators for several key diseases. In order to fully consider the implications of these developments for rehabilitation, the author discusses 4 topics: (a) how quality and safety concerns influence health care policy, (b) watershed events over the past half century that have contributed to a quality and safety dilemma in health care, (c) the difference between process and outcome indicators and implications for robust performance measurement, and (d) emerging coordination efforts by accreditation and regulatory agencies that will shape clinical service delivery in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal to unite two different worlds of children's mental health.

Responds to comments made by Holden and Blau (see record 2006-11202-017) on the current authors' original article (see record 2005-11115-005). The current authors suggest combining the complementary strengths of the community-based approaches identified by Holden and Blau (2006) and the evidence-based approaches discussed in their original article, rather than argue about the comparative limitations of each approach. Given that the contents of both systems of care and wraparound are free to vary with available services in the community, they suggest ensuring that those specific services are, in fact, interventions that have been tested and shown to work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)