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)     

New directions in children's mental health policy: Psychology's role.

The policies that influence the practice of children's mental health affect psychologists across the nation. Major recent events have brought this topic to the attention of national policymakers at the highest level and have created opportunities for psychologists to present information regarding recent scientific advances in the treatment of childhood disorders and to be involved in the development of solutions to address the needs of our nation's children. This article reviews these recent events, summarizes current knowledge in the field, and addresses specific issues and critical gaps in current national policies on children's mental health. (PsycINFO Database Record (c) 2010 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)     

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)     

Empirically guided coordination of multiple evidence-based treatments: An illustration of relevance mapping in children's mental health services.

Objective: Despite substantial progress in the development and identification of psychosocial evidence-based treatments (EBTs) in mental health, there is minimal empirical guidance for selecting an optimal set of EBTs maximally applicable and generalizable to a chosen service sample. Relevance mapping is a proposed methodology that addresses this problem through structured comparison of client characteristics in a service sample to participant characteristics from studies of EBTs. Method: The authors demonstrate the feasibility of relevance mapping using data from 1,781 youths in a statewide mental health system and a study data set including 437 randomized clinical trials. Relevance mapping (a) reveals who is “coverable” by any EBT, under different definitions of matches between study participants and clients, and (b) identifies minimum sets of treatments needed to serve maximum numbers of clients, across different levels of analysis for defining treatment operations. Results: In the illustration sample, all problems targeted by the study data set review were fully coverable when matching only required clients to have the same problem as EBT study participants. At the other extreme, when matching also required age, gender, ethnicity, and setting, the percentage of noncoverable youths increased to 86% in this sample. Two minimal sets of only 8 EBTs were identified that, when added to the one EBT already in place in that system, covered 100% of coverable youths when matching required problem, age, and gender. Conclusions: This methodology offers promise for the empirically guided selection and coordination of EBTs, thereby addressing one aspect of the gap between knowledge and practice. (PsycINFO Database Record (c) 2011 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)     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward adoption of evidence-based practices: A comparison of autism early intervention providers and children’s mental health providers.

Across the country, states are reporting increases in the number of children with autistic spectrum disorders (ASDs) served each year in the early intervention system. Research examining factors impacting the successful dissemination and implementation of evidence-based practices (EBPs) into service systems for these children is limited. Preliminary information indicates that adoption of EBPs is variable. Provider attitudes toward the adoption of EBPs may be one factor that limits or facilitates implementation of efficacious treatments and these attitudes vary by organizational context and provider individual differences. The current study examines cross-context differences in provider attitudes toward EBPs by comparing the attitudes of 71 education-based early intervention providers working with children with ASD to the attitudes of 238 mental health providers in the public mental health system. This provides the first examination of ASD early intervention provider attitudes toward EBP. Results indicated that early intervention providers reported significantly more favorable attitudes toward adopting EBPs than did mental health providers. Early intervention providers with extended experience in the field perceived less divergence between their current practice and EBPs. Implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teacher key opinion leaders and mental health consultation in low-income urban schools.

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes.

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Innovations in disaster mental health: Psychological first aid.

Professional psychologists are called upon to deal with a broad array of crises and traumatic events. However, training and expertise in crisis response varies widely among practitioners, and there has been considerable controversy about the value of widely disseminated mental health crisis intervention protocols that include "debriefing" as an essential feature. This article gives an overview of the developmental process, guiding principles, and core actions of the Psychological First Aid Field Operations Guide (PFA Guide), which provides guidance for practitioners in responding to immediate mental health needs of children, adults, and families who have recently experienced a disaster or terrorist event. Issues in training, provider self-care, and evaluation research are also presented. The PFA Guide presents approaches thought to be most consistently supported by current research and practice so that they can be taught, used, and evaluated in field settings. Although we expect further refinement as more systematic research becomes available, the PFA Guide represents a sustained collaborative effort to define current evidence-informed best practices that can be utilized now by practitioners involved in disaster mental health responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating children with serious emotional disturbances in schools and community: The intensive mental health program.

Children with serious emotional disturbances pose challenges to psychologists and school personnel to find optimal ways to improve functioning. An intensive mental health program (IMHP) is described for providing comprehensive psychological services in a school-based therapeutic environment. Case vignettes illustrate the type and severity of the children's problems served in the IMHP with both successful and less successful outcomes. The article describes the principles and organization of services, including individual and group psychotherapy and behavioral management systems, and service coordination with caregivers, agencies, and the children's neighborhood schools. Challenges facing psychologists working with children, such as resolving turf issues and working collaboratively with other involved providers, are also addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating practice changes in mental health clinics: A guide for implementation development in health care systems.

For more than a decade, health care systems have attempted to implement evidence-based practices and guidelines. These efforts have demonstrated the difficulty in making practice changes in complex systems of care. Many health care systems, including the Department of Veterans Affairs (VA) and state community mental health systems, have made adoption of evidence-based treatments, especially psychotherapies, a priority. Psychologists, as behavioral change experts and clinical leaders, are positioned to aid local implementation efforts but may have limited knowledge of the “implementation science” literature. This article provides a brief introduction to the implementation literature and offers a guide for developing an implementation plan to adopt evidence-based psychotherapies in local health care settings illustrated by a hypothetical example. Challenges to implementation are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Putting empirically supported treatment into practice: Lessons learned in a children's mental health center.

With the increasing focus on service accountability, there is an urgent need to identify empirically supported treatments (ESTs) and disseminate their use in the daily practice of mental health organizations. This article describes the authors' experiences of implementing an EST at a children's mental health center by involving the collaboration of clinicians, administrators, and innovator(s). Initially, a small group of clinicians voluntarily commit to pilot test the EST, with the intention of evaluating the adoption and integration of the treatment model into the organization's full-service delivery system. Using E. A Rogers's (1995) work on the diffusion of innovations, the current case study example suggests that ESTs can be flexibly and successfully implemented with integrity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Innovative brief pithy psychotherapy: A contribution from corporate managed mental health care.

The managed health care movement has reached a stage of maturity that has allowed it to begin to invest in the development of new clinical intervention approaches. Modern managed mental health care therapy, also known as pithy therapy, is expected to replace more traditional, lengthier forms of therapy by the year 2000. This article presents sections of the new treatment manual for purposes of illustrating the newly developed techniques. (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)     

Cultural competence and evidence-based practice in mental health services: A complementary perspective.

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed. (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)     

Of values, value lag, and mental health.

"When the anthropologist studies the value structure of a culture, he declares himself most competent to do so where the society under study is small and its institutions stable." The transforming and changing of values requires a great deal of time. "Can we scientists invade critically the area of values with no convictions, no moral banners, no preaching of gloom, no concept of right and wrong, invoking only the operational concept of 'adjustment'?" (PsycINFO Database Record (c) 2010 APA, all rights reserved)