Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.     

‘And what about residential…?’ Re‐conceptualizing residential treatment as a stop‐gap service for youth with emotional and behavioral disorders

The need for residential services for youth with the most intractable emotional and behavioral problems continues to exist despite advances made in developing community‐based systems of care. Residential treatment centers (RTCs), considered one of the most restrictive service settings, have changed little over the years and have not fared well in outcome evaluations. Despite these factors, admissions to RTCs continue to increase. In an attempt to contemporize and bring the RTC more in line with current practice, a stop‐gap model of service delivery is recommended. The stop‐gap model, incorporating evidence‐based practices, is intended to have an immediate and positive impact on the barrier behaviors that keep youths in the most restrictive environments. The twofold goal of the stop‐gap model is to interrupt the youth's downward spiral imposed by increasingly disruptive behavior and, simultaneously, to prepare the post‐discharge environment for the youth's timely reintegration. Strategies for evaluating the effectiveness of the stop‐gap model are recommended. Copyright © 2004 John Wiley & Sons, Ltd.     

Correctional treatment for co-occurring disorders: results of a national survey

The significant expansion of correctional populations in the last decade, coupled with the gradual erosion of community treatment infrastructure and health insurance, have brought greater attention to the needs of offenders who have co-occurring mental health and substance use disorders. Individuals with co-occurring disorders frequently cycle through acute care facilities in the community and increasingly are placed in jails or prisons. Approximately 16% of inmates in correctional facilities have major mental health disorders (Bureau of Justice Statistics, 1999), and a large majority of these inmates have co-occurring substance use disorders. Few studies have examined the effectiveness of correctional treatment for co-occurring disorders, and there is little information available regarding clinical and programmatic approaches used with this population. The current study provides findings from a comprehensive national survey of co-occurring disorder treatment programs in correctional settings. A total of 20 co-occurring disorder treatment programs from 13 state correctional systems were identified and surveyed. Many of the programs featured modified therapeutic communities, but there was significant diversity in the duration of treatment and type of services provided. Several unique structural and clinical modifications to treatment have been developed in these settings. Implementation of co-occurring disorder treatment programs has led to enhanced collaboration with prison health services and community supervision and treatment agencies, and greater use of interdisciplinary staff to provide outreach and case management services. Research is now being conducted to examine outcomes in several of these correctional treatment programs.     

Infant mental health home visiting therapists’ fidelity to the Michigan IMH-HV model in community practice settings

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant–parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.     

Prevalence of severe behavior disorders in persons with mental retardation and treatment procedures used in community and institutional settings

A statewide survey of moderate and severe behavior disorders in persons with mental retardation in institutional and community settings was conducted. Information on the treatment procedures used and the adequacy of available resources in both settings was also gathered. Results indicated that community staff had considerably less experience than institutional staff in dealing with serious behavior disorders exhibited by persons with substantial cognitive and physical impairments. The types of aberrant behaviors with the highest prevalence rates showed differences in the institutions and the community. The largest differences in prevalence rates for severe behavior disorders in the two settings occurred for aggressive and self-injurious behaviors. Community staff thus had appreciably less experience than institutional staff in designing interventions for severe aggressive and self-injurious behaviors. About half of the identified individuals in both settings received psychotropic medications. Institutional staff were most likely to use restrictive behavioral procedures than community staff. Findings indicated that the most restrictive procedures were used primarily with only certain severe behavior disorders. Subjective ratings of the overall effectiveness of interventions were lower by community than institutional staff. The usefulness of the obtained data base for statewide planning in the area of behavioral supports is discussed.     

Use of Psychiatric Medications in Juvenile Detention Facilities and the Impact of State Placement Policy

The use of psychotropic medications is a significant factor in the overall effort to respond to detained youth with mental illness, yet there are very few studies of psychotropic medication use in juvenile detention settings. It is important to understand the factors that influence the use of mental health services and psychoactive medications in these settings since youth with emotional problems are overrepresented in them. This paper addresses the proportion of youth in these settings who receive mental health services and psychoactive medications. In addition, the impact of a major statewide policy change—the shift of juvenile placement responsibility from the state to local government—on these proportions was examined using 8 years of publicly available data from county probation departments. Multivariate regression analyses of 1,760 observations of quarterly reports from 55 counties showed that the use of both mental health services and psychoactive medications in detention facilities increased concurrently with the policy change. While these proportions had already been gradually increasing in these facilities, it appears that after the policy change they increased even more. This contradicts the aim of most juvenile justice planners—to divert non-violent youth offenders with emotional problems away from incarceration settings and towards community based treatment alternatives. If adequately available, these support services could provide diversion alternatives to prevent inappropriate detentions, and to provide post-detention treatment to prevent lapses in continuity of care and, ultimately, to prevent reoffending.     

Comprehensive community-based education and neurorehabilitation for children and adolescents with traumatic brain injury

Children and adolescents who experience a traumatic brain injury (TBI) typically have sensory, cognitive, behavioral, and functional skill challenges that must be addressed in acute and post-acute rehabilitation settings. This article describes a community-based school that combines educational, medical, nursing, family, residential-living, and psychological services in a comprehensive program of pediatric neurorehabilitation. The operational, administrative, and clinical features of these service components are presented. A critical aspect of the program is an emphasis on applied behavior analysis procedures for purposes of assessment, treatment formulation, and evaluation. Data are reviewed to demonstrate demographics, patterns of service delivery, and outcome. The school program represents an educational alternative for students with TBI who are discharged from acute-care settings and require comprehensive support services to facilitate their transition and re-entry to public school and community living. © 1998 John Wiley & Sons, Ltd.     

Community-based co-occurring disorder (COD) intermediate and advanced treatment for offenders

Against a backdrop of increasing concern about the adequacy of treatment for co-occurring substance use and mental disorders (typically known as "co-occurring disorders," or COD) in the criminal justice system, this article attempts to provide empirical evidence for a typology of levels of COD treatment for offenders in both prison and community settings. The paper investigates two levels of treatment programs for COD; "intermediate" programs, in which treatment programming has been designed primarily for offenders with a single disorder, and "advanced" programs, in which programming has been designed to provide integrated substance abuse treatment and mental health services. Findings from a national survey of program directors indicated that both intermediate and advanced COD treatment programs were similar in their general approach to substance abuse treatment, but differed considerably in their treatment of mental disorders, where the advanced programs employed significantly more evidence- and consensus-based practices. Results provide support for the distinction between intermediate- and advanced-level services for offenders with COD and support a typology that defines advanced programs as integrating a range of evidence- and consensus-based practices so as to modify treatment sufficiently to address both diseases.     

USING PARENTS AS THERAPISTS TO EVALUATE APPROPRIATE BEHAVIOR OF THEIR CHILDREN: APPLICATION TO A TERTIARY DIAGNOSTIC CLINIC

We conducted a preliminary analysis of maintaining variables for children with conduct disorders in an outpatient clinic. Eight children of normal intelligence between the ages of 4 and 9 years were evaluated during 90-min sessions. The children's parents conducted the assessments by varying task demands (easy and difficult) and parental attention (attention and no attention) within a multielement design. The assessment focused on appropriate child behavior and was conducted to formulate hypotheses regarding maintaining contingencies. Results demonstrated that the children's appropriate behavior varied across assessment conditions and, for 7 of the 8 children, occurred at a higher rate during one condition than during other conditions. In addition, treatment integrity data demonstrated that parents were able to implement the procedures as intended. The recommended treatments were rated as being both effective and acceptable to parents for up to 6 months following the evaluation. Our results extend previous studies of functional analytic procedures conducted by trained experimenters with severely handicapped children in more controlled settings.     

The Effectiveness of Functional Family Therapy in Reducing Adolescent Mental Health Risk and Family Adjustment Difficulties in an Irish Context

To evaluate the effectiveness of Functional Family Therapy (FFT) 42 cases were randomized to FFT and 55 to a waiting‐list control group. Minimization procedures controlled the effects of potentially confounding baseline variables. Cases were treated by a team of five therapists who implemented FFT with a moderate degree of fidelity. Rates of clinical recovery were significantly higher in the FFT group than in the control group. Compared to the comparison group, parents in the FFT group reported significantly greater improvement in adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) and both parents and adolescents reported improvements in family adjustment on the Systemic Clinical Outcomes and Routine Evaluation (SCORE). In addition, 93% of youth and families in the treatment condition completed FFT. Improvements shown immediately after treatment were sustained at 3‐month follow‐up. Results provide a current demonstration of FFT's effectiveness for youth with behavior problems in community‐based settings, expand our understanding of the range of positive outcomes of FFT to include mental health risk and family‐defined problem severity and impact, and suggests that it is an effective intervention when implemented in an Irish context.     

Ageism in Mental Health and Health Care: A Critical Review

Discussions of aging and mental health widely assume that ageism among mental health providers is an important factor limiting access to mental health services for older adults. Given the widespread citation of ageism as a problem, we critically review the history of the ageism construct, and evidence for its existence in both mental health and medical professionals. There is surprisingly little empirical evidence for age bias among mental health providers. Considerable evidence does suggest differential medical treatment for older adults in such diverse areas as physician–patient interaction, use of screening procedures, and treatment of varied medical problems, although it is unclear whether age bias accounts for these differences. We suggest that innovations in delivery of psychological services, such as collaborative medical/psychological care in primary care settings, may ultimately prove more useful in improving access to mental health services than efforts to combat ageism.     

The prevalence of in-vehicle driving distractions in road traffic collisions as a function of road type

While some previous research suggests that conversing with passengers is the most prevalent in-vehicle distraction while driving, others have concluded instead that it is mobile phone use. One possible explanation for these differences is that distraction prevalence varies with road type. To test this proposal the current study investigated the prevalence of in-vehicle driving distraction in road traffic collisions (RTCs) as recorded in national records from the US and New Zealand. Analysis using odds ratios suggested conversing with passengers to be a more prevalent distraction in RTCs on minor roads than on major roads, and mobile phone use to be a more prevalent distraction on major roads than on minor roads. These results show the importance of considering the type of road when investigating the prevalence of driving distractions in RTCs in future research.     

Preferences of older adults and experts for policies and services in group living facilities

The Policy and Program Information Form-Ideal Form (POLIF-I) was developed to assess preferences of older adults for the policies and services of group living facilities. Compared with older community residents (n = 205), congregate apartment residents (n = 229) prefer facilities that have higher behavioral standards, deemphasize supportive services and formal avenues for resident influence, and emphasize privacy. In contrast to older respondents, experts (n = 44) prefer settings with lower behavioral standards, more supportive services, more resident input, and more privacy. Sociodemographic characteristics (marital status, occupation, education, age, gender) and functional ability are weakly associated with the policy and service preferences of older respondents. The POLIF-I has several applications, including examination of the congruence between residents' preferences and the actual policies and services of group living facilities.     

Substance abuse in borderline personality disorder: clinical and etiological correlates.

This work examines differences between female borderline patients with and without substance abuse problems and between borderline patients from different treatment settings. A total of 64 female borderline patients were recruited from mental health services (n = 34) and addiction treatment services (n = 20); 35 had a substance abuse problem. Patient groups were compared with regard to both clinical and etiological factors using multivariate analysis of variance for 47 continuous variables and logistic regression for 15 dichotomous variables. Borderline patients with substance abuse problems reported less hostility, suspicion, and anger but more anxiety, insufficiency, and suicide attempts. Patients from addiction treatment services reported less avoidant and more antisocial behavior. The differences between borderline patients with and without substance abuse problems are limited in number and size. Therefore, there is no empirical justification for the exclusion of borderline patients with substance abuse problems from general treatment services or clinical trials.     

Counseling Rejected Applicants: Feedback for Career Development

In this article the author points out the need for more adequate counseling with an often neglected segment of the population: rejected applicants to higher education. He delineates the roles, functions, and problems of the counselor in this situation, using as an example current procedures for counseling rejected applicants in the Yale Physician's Associate Program. The article contains recommendations for counselors, so that they might become more familiar with the problems and functions of admissions committees, and for admissions committees, so that they might enlist the aid of those with counseling training in both the admissions process and the counseling of rejected applicants.     

Surveying the drug service users' perspective through self-help groups

Survey data is presented from a questionnaire designed and distributed through Victorian drug self-help groups. This survey yielded 203 returns representative of Melbourne metropolitan admissions to drug treatment services on the variables of sex and region. The survey is examined both from the perspective of its methodological potential for providing entry to this hard-to-access population and also on the basis of its findings. Questioning of this sample concerning the difficulties they had encountered when seeking help revealed that the most frequently listed difficulties were waiting periods for access to services. Respondents that had previously used particular services were asked how beneficial they had found these services: Respondents most frequently listed self-help groups, residential and methadone services as beneficial and least frequently listed medical (hospital casualty) and doctor services as beneficial. Stepwise logistical regression revealed six variables significantly predicting selfhelp treatment. Those reporting having sought self-help groups were predicted by more frequently listed problems with alcohol and ‘over the counter’ drugs, reports of having sought counselling services and more frequently reported difficulties due to a lack of information and admission restrictions when seeking services. Despite a number of methodological weaknesses identifiable in the survey, experience with this project suggested collaboration between researchers and those active in self-help networks as a useful model for future research into the drug service users perspective. Such collaboration should, however, begin at an earlier phase than occurred in the present study.     

Using Geospatial Research Methods to Examine Resource Accessibility and Availability as it Relates to Community Participation of Individuals with Serious Mental Illnesses

Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self‐report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non‐urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses.     

Mindfulness-Based Stress Reduction in Medical Settings

Meditation, as a psychological intervention, has become of increasing interest to psychologists who conduct clinical research with or provide clinical services to medical populations. Mindfulness-based stress reduction (MBSR) is a manualized program which teaches a variety of meditation techniques and has frequently been used in medical settings with mixed medical populations. The following is a review of the literature, which provides preliminary support for the effectiveness of MBSR in specific medical populations, including persons with chronic pain, cancer and heart disease. Despite these encouraging findings, experts agree that continued research is needed, especially controlled studies with more rigorous methodology.     

Occupational stress and burnout amongst staff working with people with an intellectual disability

The Occupational Stress Inventory (Osipow & Spokane, 1987) and the Maslach Burnout Inventory (Maslach, 1982) were used to assess the levels of occupational stress and burnout amongst staff providing services to people with an intellectual disability both in an institutional and community settings. Data were analyzed to determine the effects of direct client contact, staff mental health, and working environment (institution vs. community). While levels of burnout and occupational stress were not high overall, staff working in an institutional setting scores more highly.     

A Little Goes a Long Way: The Impact of Distal Social Support on Community Integration and Recovery of Individuals with Psychiatric Disabilities

Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted—focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.