Risk of juvenile justice systems referral among children in a public mental health system

This study established the risk of police referral among a cohort of children who were recipients of public mental health services. Investigators used secondary data to calculate the incidence of criminal referral among 645 children, ages 10 to 17, who entered community-based public mental health programs in King County, Washington. Children receiving public mental health services were nearly three times more likely to be referred to the juvenile justice system compared to children of similar age and gender in the general population. Relative risks were particularly high for younger children (10-13 years) and for children of Hispanic, Native American, and Caucasian origin. Understanding the characteristics and experiences of children who use multiple-service systems has important implications for services delivery. In addressing the needs of youth who have both mental illness and criminal involvement, age- and culturally specific interventions and advocacy efforts are warranted.     

Representativeness of clinical samples of youths with mental disorders: A preliminary population-based study.

In a household community sample of 1,285, 9–17 year-olds with mental disorders who had received outpatient specialty mental health services in the past year were compared with youths with mental disorders who had not received those services to determine if samples drawn from clinical settings are representative of youths with mental disorders in the general population. Those who had used services were more impaired, less competent, more likely to have comorbid disorders, more likely to belong to non-Hispanic White relative to other ethnic groups, and less likely to be prepubertal girls. Their parents were more educated, but less satisfied with family life, engaged in less monitoring of their children, and more likely to have used mental health services themselves. These findings suggest the hypothesis that samples of youths with mental disorders drawn from outpatient clinical settings are not representative of all youths with mental disorders. If confirmed, this would indicate the importance of population-based samples for the study of psychopathology in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among elderly Chinese immigrants: an exploratory study

Despite an increase in the population of elderly Chinese immigrants, little is known about their mental health problems. The most prevalent mental health problem of elderly people-depression-often goes unrecognized and untreated. In an interview format, the author administered the Geriatric Depression Scale and measures of health status, living situation, stressful life events, and informal support to a community sample of 50 elderly Chinese immigrants recruited at senior centers and meal sites. Respondents who rated their health as good, who lived with others, and who were satisfied with help received from family members were least likely to be depressed. The impact of these factors on the mental health of elderly Chinese immigrants can be understood in light of their unique cultural values.     

The impact of deployment on U.S. military families.

Several recent articles have explored the effects of military deployment on U.S. service members' mental health outcomes. Although increased attention has also begun to focus on the effects of deployment on military families, providing a conceptualization for the mechanisms of this process can help organize existing information and inform future efforts. In this article we seek to draw greater attention to the effects of deployment on service members and to provide an overview of recent literature on the impact of deployment on service members and military families. A further goal is then to provide one conceptual perspective—a model of family stability—that may help inform our understanding of the impact of military deployment on families. Beyond informing research, the issues presented in this article have far-reaching consequences not only for American military families and their current mental health and primary care providers but also for practitioners in the broader mental health community who will be increasingly called upon to provide services to this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The critical importance of personal involvement.

Suggests that the deliberations surrounding Medicare may once again become the key to the enactment of national health care reform legislation and argues that if psychologists want to directly influence public policy, more of them must become personally involved in full-time advocacy and public policy work. Examples of federal policies that affect psychologists are discussed as well as the importance of joint psychology-law programs and the efforts of a psychologist and associate commissioner in Maine to shape a unified, outcome-driven mental health and mental retardation system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who uses psychological services in Canada?

This paper used data collected in the 1994–95 National Population Health Survey to provide a profile of consumers of psychological services. The survey was designed to assess the health status of Canadians by collecting data from a representative sample of 12+ yr olds in Canadian households. Approximately 515,000 Canadians indicated that they had consulted a psychologist in the 12 mo prior to the survey. The demographic profile of consumers of psychological services is consistent with patterns of utilization of mental health services found in other studies. Consumers were more likely to be female, to be middle-aged and to be separated, divorced or widowed. Those with higher education and higher income were more likely to receive psychological services. Consumers of psychological services reported poorer health status than the general population, a higher number of past and recent stressors, higher levels of distress, and were more likely to have received psychotropic medication. The majority of those likely to meet criteria for a diagnosis of depression did not receive psychological services. Another important theme was the apparent underutilization of psychological services, especially by people with the greatest mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sharing our world: perioperative nurses have the vision

1. Perioperative nurses must bridge the information gap and eliminate public misconceptions about surgery and OR nursing. Fear of the unknown realm of surgery and televised inaccuracies about surgical procedures magnify the lack of awareness of health care consumers about surgery and the holistic nursing care perioperative nurses provide for their patients. 2. There is a national need for more aggressive general promotion of health care awareness and education. This need can be successfully facilitated at the grassroots level with minimal efforts from members of our surgical departments. 3. One effective way to solve this problem is to invite health care consumers into our facilities.     

Mental health service use among young children receiving pediatric primary care

OBJECTIVE: To investigate the factors associated with mental health service use among young children. METHOD: Five hundred ten preschool children aged 2 through 5 years were enrolled through 68 primary care physicians, with 388 (76% of the original sample) participating in a second wave of data collection, 12 to 40 months later. Consensus DSM-III-R diagnoses were assigned using best-estimate procedures. The test battery included the Child Behavior Checklist, a developmental evaluation, the Rochester Adaptive Behavior Inventory, and a videotaped play session (preschool children) or structured interviews (older children). At wave 2, mothers completed a survey of mental health services their child had received. RESULTS: In logistic regression models, older children, children with a wave 1 DSM-III-R diagnosis, children with more total behavior problems and family conflict, and children receiving a pediatric referral were more likely to receive mental health services. Among children with a DSM-III-R diagnosis, more mental health services were received by children who were older, white, more impaired, experiencing more family conflict, and referred by a pediatrician. CONCLUSIONS: Young children with more impairment and family conflict are more likely to enter into treatment. Services among young children of different races with diagnoses are not equally distributed. Pediatric referral is an important predictor of service use.     

Enhancing family advocacy networks: an analysis of the roles of sponsoring organizations

Family participation in shaping system reforms in children's mental health has increased over the past ten years. In 1990 the National Institute of Mental Health funded the development and enhancement of 15 statewide advocacy organizations that were to be controlled and staffed by families of children who have serious emotional disorders. These family advocacy organizations had three major goals: to establish support networks, to advocate for service system reforms, and to develop statewide family advocacy networks. Seven family advocacy networks worked with sponsoring organizations because they needed assistance and/or could not receive funding directly. State and local chapters of the National Alliance for the Mentally Ill and the National Mental Health Association served in this capacity. Because there were no guidelines to educate sponsoring organizations about their interorganizational roles and responsibilities, staff of some sponsoring organizations used approaches that were supportive and effective, while staff in other organizations used methods that were counterproductive. The information and recommendations discussed in this paper are based on evaluation data and observations of the relationships between seven sponsoring organizations and family advocacy groups over a three-year period. This paper proposes a conceptual framework that includes: (1) a clear definition of the sponsoring organization's roles, and (2) an analysis of the advantages, limitations, and critical issues for the sponsoring organization.     

On consumer advocacy and the diagnosis of mental disorders.

This article provides a brief overview of the development of consumer and family advocacy activity during the past 40 years, mentioning the involvement of these groups in the treatment and research arenas and describing a dearth of such activities related to matters of diagnosis. In an attempt to address this relative inattention to diagnostic issues, the article continues by proffering a relative personal account and then reporting the results of a quasi-qualitative study that collected opinions about the diagnostic process from a selected sample of consumers. The results of the latter process indicate that these consumers' opinions primarily focus on issues of billing and insurance, labeling and stigma, axis issues, and multiple and/or changing diagnoses. The article concludes with guarded recommendations as to how mental health professionals can possibly improve the process of diagnosing persons with mental illnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrast-sensitivity testing with scanning-laser ophthalmoscope stimulation in normal, ocular hypertensive, and glaucomatous patients

This article reviews the history, growth, and evolution of managed care in mental health and substance abuse treatment. Specific issues described are stigma, the important social dimensions and chronicity of some types of mental illness and chemical dependency, and reliance on the public sector for care. Opportunities and challenges for occupational therapists in the rapidly changing mental health system are discussed, including the use of interdisciplinary teams, the importance of measuring functional outcomes of interventions, the need to develop clinical guidelines, the importance of the community setting and a continuum of services, ethical dilemmas, and the importance of assertive occupational therapy advocacy and involvement in health care reform.     

Family involvement in expanded school mental health

Expanded school mental health (ESMH) programs address the limitations of traditional mental health agencies in meeting the needs of youth by providing a full range of services in a familiar and nonstigmatizing setting. Because of the central role families play in the lives of children, their involvement in ESMH can enhance the effectiveness of treatments and ensure that services are responsive to the needs of the larger community. Increasing family involvement, however, is a complex and resource-intensive endeavor, and requires consideration of the goals of the ESMH program and potential obstacles to meeting those goals. The challenges of involving family members in ESMH, guidelines for determining the program's goals with respect to family involvement, and strategies for achieving these goals are described. Underlying the strategies is the need to be flexible, creative, and respectful of the beliefs and concerns of the families served by the ESMH program.     

Advancing disability policy: Opportunities and obstacles.

This article highlights opportunities for psychologists to advance disability policy. Obstacles discussed include disabling attitudes, lack of knowledge, and financial interests. The article calls for increased involvement of consumers in research design and greater emphasis on research related to social participation and environmental accommodation for persons with a disability. The need for advocacy in promoting adequate research funding and informing policymakers regarding research findings is emphasized. Continued efforts are needed to broaden psychology training to include more content regarding the social and environmental aspects of disability. Active recruitment into psychology training programs of students with a disability can enhance these efforts. The development of psychological interventions in collaboration with consumer-run organizations is a useful model. Public policies related to reimbursement for services will require continued advocacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical management of obesity

CONTEXT: Since the initiation of managed health care, little information has been available on whether family planning agencies are seeking ways to serve (and obtain reimbursement for serving) the growing number of clients who are managed care enrollees. METHODS: A 1995 mail survey sought information from a nationally representative sample of publicly funded family planning agencies about the agencies' involvement with managed health care plans and related clinic services, policies and practices. Completed surveys were received from 603 agencies, for an overall response rate of 68%. RESULTS: One-half of all publicly funded family planning agencies had served known enrollees or managed care plans. One-quarter (24%) had served managed care enrollees under contract, while others sought out-of-plan reimbursement for services provided to enrollees (13%) or used other sources to cover the cost of these services (12%). Family planning clinics administered by hospitals and community health centers were more likely than other types of clinics to have contracts to provide full primary-care services to managed care enrollees, whereas Planned Parenthood affiliates were more likely to have contracts that covered the provision of contraceptive care only. Clinics administered by health departments rarely had secured managed care contracts (10%), and only 36% reported even serving managed care enrollees. CONCLUSIONS: The challenges presented by managed care, and agencies' responses to these challenges, vary according to the type of organization providing contraceptive care. Family planning agencies need to seek relationships with managed care organizations based on those services that their clinics can best supply.     

Child custody resolution: A study of social science involvement and impact.

To explore the use of mental health professional expertise in the legal system, legal professionals' sources of social science information, and the legal profession's perspectives on the appropriate roles of mental health professionals in the process, we solicited information from attorneys and judges on (a) the extent to which they actively seek the involvement of mental health professionals in child custody cases, (b) the factors that influence such involvement, and (c) the degree to which these attitudes and practices are influenced by social science data or theory. Among the most striking features of these results was the report by the overwhelming majority of legal professionals that they did not consider either social science data or mental health professionals' involvement or recommendations in child custody cases as critical to their practice of family law. Specifically, mental health participation was rarely solicited, and when it was, this decision rested primarily on the paradigmatic regularities of the legal system or practical needs of the case rather than on a view that such involvement was central to the client's or child's mental health. The implications of these findings for collaboration between the mental health and legal disciplines in the area of family policy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accreditation and associated quality assurance efforts.

Discusses accreditation programs and the quality assurance efforts associated with them. The demands of consumers and purchasers of services, expressed in governmental action, have forced more direct and systematic efforts to assess and assure service quality. Time- and cost-efficient methods for assessing quality are available, but their use is resisted by organized medicine, which controls most accreditation and quality assurance activities in health care. The involvement of psychologists in the programs is discussed. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving access to family support organizations: a member survey of the AMI-Quebec Alliance for the Mentally Ill

Family support organizations such as the Quebec Alliance for the Mentally Ill (AMI-Quebec) provide services for mentally ill individuals and their families. Despite possible benefits, there is often a lengthy period between identification of mental illness and involvement of family members with family support organizations. A survey of AMI-Quebec members was undertaken to assess this delay. Of the 186 respondents, 47 percent experienced a delay of more than two years. Only 10 percent were referred to the organization by psychiatrists. The majority would have liked to have become involved with AMI-Quebec earlier. Some approved of more proactive methods of recruitment by AMI-Quebec, such as a telephone call after an initial hospitalization.     

The medication information line for the elderly: an 8-year cumulative analysis

OBJECTIVE: To present an 8-year (1985-1992) cumulative analysis of the 12,743 calls received by the Medication Information Line for the Elderly (MILE), a consumer-oriented drug information service. DESIGN: Data on all calls received by MILE were documented using a standard format. Certain calls were selected by the pharmacist for follow-up based on the nature and predicted severity of the inquiry. SETTING: MILE is located within the Faculty of Pharmacy of the University of Manitoba and staffed by experienced, practicing pharmacists. Calls were received from the elderly and their care providers. Calls were initially taken on a local Winnipeg line, although in 1987 a toll-free number was made available to rural Manitoba residents. RESULTS: The majority of the calls received by MILE were from women aged 65 years or older who accessed MILE on their own initiative. Ninety-one percent of the calls were rated as not serious. Only 6% of calls were from outside Winnipeg. Although 94% of the older consumers reported having a regular pharmacist, they commonly never thought of using their pharmacist for inquiries. The drugs cited most often by consumers, nurses, physicians, and dentists were the nonsteroidal antiinflammatory agents, cardiac drugs, diuretics, antihypertensives, benzodiazepines, and antidepressants. The type of inquiries most frequently involved adverse drug reactions, drug interactions, and therapeutic use. The drugs cited and inquiries made by pharmacist callers were more diverse than those of consumers and other healthcare professionals. CONCLUSIONS: Many older drug consumers have medication information needs that are not being met. Since a large proportion of the callers appeared to be self-motivated women, MILE may not be accessing all older consumers in need of information. This analysis also suggests that many older consumers are not aware that the pharmacist is available and capable of providing drug information.     

Federal impact on psychology in medical schools.

The impact of federal legislation on medical education and in turn on the role of psychology in that process is examined, and the efforts of psychology to impact legislation are reviewed. The federal Medicare program, and its consideration of the functions and costs of medical education under the prospective payment system for hospital care, is examined in detail. Psychologists can no longer maintain the expatriate role with which they have been content in medical schools and must assume a more responsible and proactive role. Psychologists must increase their involvement in the administrative and fiscal activities of medical colleges and universities and their understanding and advocacy efforts regarding the federal legislative issues that affect health care and medical education. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Association of hypersensitivity and carriage of dermatophytes in clinically normal sites in patients with Tinea cruris

In April 1993, Governor Miller signed House Bill (HB) 100, intended to reform Georgia's mental health system. This legislation called for, among other things, the creation of Regional and Community Service Boards designed to empower consumers and families served by the mental health system. This report reviews the rationale behind HB 100 and progress made toward implementing the legislation. Several problems are discussed which may severely impede actual reform, including the system fragmentation created by the new Regional Board system. A proposal is made to further improve Georgia's mental health system by creating a separate Department of Mental Health governed by a Board having significant consumer and family membership, reducing the number of Regional Boards, and developing a system of performance measures to monitor the progress of reform and to improve accountability.