The Starting Early Starting Smart Integrated Services Model: Improving Access to Behavioral Health Services in the Pediatric Health Care Setting for At-Risk Families with Young Children

We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral health services (parenting, mental health, and drug treatment) into the pediatric health care setting for families with young children. Data are presented from five pediatric care (PC) sites, drawing from families at risk due to demographic and behavioral health factors, with infants less than 12 months of age (n = 612). Families were randomly assigned to either the SESS program or a standard care Comparison group. We utilized longitudinal analyses to estimate differences in utilization rates for parenting, mental health, and drug treatment over 6 follow-up time points (3, 6, 9, 12, 15 and 18 months). Our findings indicate that SESS caregiver participants were 4.6 times (p < 0.001; CI = 3.33–6.26) more likely to receive parenting services, 2.1 times (p < 0.001; CI = 1.48–2.86) more likely to receive outpatient mental health treatment, and 1.8 times (p = 0.025; CI = 1.08–3.14) more likely to receive drug treatment than Comparison group participants. Our results demonstrate the success of the SESS program in coordinating and improving access to behavioral health services for high-risk caregivers within the pediatric health care setting and highlight the importance of continuing to focus public health policy on the behavioral health care needs of families with young children.     

Intensive Home Based Services Within a Comprehensive System of Care for Youth

Within a comprehensive mental health service array for youth, Intensive Home Based Services (IHBS) are designed to meet the needs of youth with significant emotional and behavioral problems in their home communities, avoiding the need for out-of-home services, particularly residential care. We examined youth receiving IHBS as their first service in the state of Hawaii system of care (N = 163) to determine how successful IHBS were in preventing the need for more restrictive services within 12 months of intake. Subsequently, we investigated characteristics that might be predictive of a youth’s need for service intensification within 12 months. Logistic regression analyses found that greater age, level of service need, and functional impairment at intake predicted use of more restrictive services within 12 months of intake, whereas gender, ethnicity, diagnosis, service intensity, and clinician credentials did not. Overall, our findings suggested that IHBS were reasonably successful in preventing residential placements, and provided some basis for determining characteristics of youth likely to require more restrictive placements within a one year period.     

Access to Child and Adolescent Mental Health Services

Adequate access to child and adolescent mental health services for young people in high need populations is an important concern of service systems researchers and program evaluators. We present results of a statewide study of access to community mental health services for eight populations of special concern. The analysis relied exclusively on existing databases in conjunction with innovative statistical techniques to provide comprehensive measures of access to care. Our findings indicate that access to care varied substantially across special populations, although children and adolescents in each of our eight “special populations” had greater access to public mental health services than members of the general population of the state. The interpretation of the findings and directions for future research are discussed.     

Predictors of Recent Mental Health Service Use in a Medical Population: Implications for Integrated Care

This study investigated the relationship between physical and mental health and psychosocial variables and recent (within the last 12 months) mental health service use among 240 medical patients recruited from general and specialty outpatient clinics at an academic medical center. Results indicated 43.3% of the participants had recently received mental health services in the form of psychotropic medication (75%), psychotherapy (2%), or a combination of these treatments (20.2%). Among patients with moderate to severe symptoms of anxiety or depression, approximately two-thirds were receiving mental health treatment. Moreover, four variables (healthcare provider referral for mental health services, perceived need for mental health services, prior use of mental health services, and frequency of medical appointments) were significant unique predictors of recent mental health service use. This suggests collaborative/integrated medical care may increase needed mental health service use.     

Exploring the Use of the Interactive Systems Framework to Guide School Mental Health Services in Post‐disaster Contexts: Building Community Capacity for Trauma‐Focused Interventions

Over the past two decades schools have been identified as the de facto mental health system for youth. Therefore, improving and expanding school mental health (SMH) has become a pressing agenda item for researchers, practitioners, policy makers, and funders. Advancing this agenda includes not only translating intervention research into practice within schools, but building capacities for these interventions to occur. The interactive systems framework (ISF) of Wandersman and colleagues, and the focus of this special issue, provides guidance in bridging the gap between research and practice through multisystem capacity building. There is some evidence that application of the ISF has helped to build capacity for SMH in states, but this evidence is preliminary. In addition, application of the ISF has not occurred in SMH at the community level or in relation to the specific stresses a community undergoes in relation to a disaster. The purpose of this article was to conduct a preliminary attempt to connect these three areas—the ISF, SMH and strengthening SMH through the ISF to better address impacts of a community level disaster; in this case, we explore the impacts of Hurricane Katrina on New Orleans schools, their students and families, and SMH programming within them. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith     

Adolescent Satisfaction with School-Based Mental Health Services

Examining adolescents' satisfaction with mental health services is an important program evaluation activity. Their perceptions of whether services were beneficial and resulted in improved functioning are indices of treatment quality. Assessment of adolescent satisfaction with school-based mental health programs has been limited. In our study, adolescents receiving services from a School Mental Health Program (SMHP) completed satisfaction surveys. Participants were predominantly minority youth residing in an urban area. Results indicated that students were highly satisfied with their mental health services. Students valued the therapeutic relationship, catharsis associated with therapy, and skills they learned during therapy. Several factors influenced satisfaction ratings including clinician training and availability.     

Termination of Mental Health Services for Children

In this paper, we examine the termination of children's mental health services. Analyses were based on the 901 families in the Fort Bragg Evaluation Project who participated at Wave 1 and Wave 2 six months later. The project compared a full continuum of care provided at a demonstration site with traditional care at two comparison sites. The results showed that in most cases families and providers were partners in decisions to terminate treatment. About half of the clients self-terminated or were terminated solely at the discretion of the provider. Providers tended to play a more dominant role in terminating restrictive services; families played a more central role in terminating outpatient care. Regardless of initial psychopathology, children in single-headed households, whose parents were dissatisfied with services, did not expect their child to cooperate with treatment and did not expect treatment to help their child, were more likely to terminate care than others. While the Demonstration site had significantly fewer terminations, the sites did not differ with regard to the reasons for termination, who participated in termination decisions, or the factors that affected the likelihood to terminate care. Of most interest, mental health outcomes among children who had terminated all care did not vary by reasons for termination or by who participated in the termination decision.     

Expanding Mental Health Services to Older High-Utilizing HMO Patients: A Pilot Study

Background: Expanded mental health benefits were offered to older HMO patients who were high medical utilizers. Outcomes of interest were use of services, subjective well-being, and psychopathology. Methods: Sixty-nine (25 male, 44 female) patients age 55 or above seeking frequent outpatient medical care completed the SF-36 health survey and the revised Symptom Check List (SCL-90-R). Patients were assigned to usual care, health education, or expanded mental health benefit conditions. Results: Patients showed high initial levels of psychopathology and distress. Over the 6 months of the study, patients in the expanded benefits group made a mean of 11.5 visits to mental health professionals versus a mean of 3.4 visits by usual care patients. Patients in the expanded benefits group showed significant improvement in SF-36 General Health and Mental Health well-being scores. Patients in the health education group showed no improvement. Patients in the usual care group showed improvements in Vitality scores. Psychopathology summary scores showed improvement for both usual care and enhanced benefit groups. Conclusions: Mental health treatment may improve well-being and reduce psychopathology in older high-utilizing patients. Creativity will be needed in expanding access to mental health services for this population.     

Family-Involved Mental Health Care Among OEF/OIF Veterans With and Without PTSD Using VHA Administrative Records

Prior research indicates that veterans are interested in including family members in health care and that family-inclusive mental health treatment can improve treatment outcomes. Consequently, the Veterans Health Administration’s (VHA) directive requires providers to offer family-inclusive mental health services to veterans. However, the extent to which veterans engage in family-inclusive mental health services at the VHA remains unclear. Using data from a longitudinal registry of male and female veterans with and without posttraumatic stress disorder, we examined the extent to which veterans included family members in their mental health care and predictors of engagement in family-involved therapy visits using VHA administrative records over a 5-year time span. Of the 1,329 veterans who received mental health care during the study, 8.4% received a family therapy visit—the number of visits per veteran ranged from 1 to 34. Results from logistic regressions indicate that relative to White veterans, Black veterans were 61.0% less likely to receive a family-involved therapy visit. Married veterans or veterans living with a partner, and veterans with poor romantic relationship functioning, were more likely to receive a family-involved therapy visit. These findings indicate that only a small percentage of veterans received a family therapy visit across 5 years. Efforts to understand barriers to family-involved therapy visits and strategies to increase engagement in family-involved visits may improve clinical outcomes and promote patient-centered care.     

Health-Related Quality of Life and Perceived Need for Mental Health Services in Adolescent Solid Organ Transplant Recipients

The purpose of the current investigation was to assess interest in mental health services among parents of adolescent solid organ transplant recipients and the relationship between parent perceived need for mental health services and patient health-related quality of life (HRQOL). Sixty-three parents rated interest in receiving 10 mental health services, and patient HRQOL ratings were gathered from adolescent transplant recipients and their parents. Ninety-four percent of parents expressed some level of interest in at least one of the proposed services, with over 40 % indicating maximum interest. Parents’ perceived need for mental health services was inversely related to adolescent and parent reports of HRQOL on the behavior, mental health, family cohesion, and parental impact-emotional domains. Results suggest that parents of adolescent solid organ transplant recipients are interested in receiving mental health services for their families. Assessment of need for mental health services and HRQOL may inform the medical team of families requiring intervention.     

Identification Reduces Stigma of Mental Ill‐Health: A Community‐Based Study

The stigma surrounding mental ill‐health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill‐health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill‐health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill‐health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill‐health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well‐being.     

The Use of Mental Health Services Among Victims of Partner Violence on College Campuses

The present study investigated the relationship between past victimization of different types of intimate partner violence (IPV; physical, psychological, and sexual) and the likelihood of using mental health services. Results indicate 86% of participants reported experiencing some form of IPV, but only 16% of those victims used mental health services to address emotional problems. The participants reported embarrassment, expense, ineffectiveness, and social stigma as the most prominent barriers to seeking help from a mental health professional. The study also found that participants who experienced physical and psychological IPV, but not sexual IPV, reported using mental health services. Sexual IPV may elicit different barriers in help-seeking behaviors. Implications for college IPV prevention programs and mental health services are discussed.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.     

Latino Family Participation in Youth Mental Health Services: Treatment Retention,Engagement, and Response

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.     

Cultural Mistrust of Mental Health Professionals Among Black Males Transitioning from Foster Care

We examined cultural mistrust of mental health professionals among Black males who are transitioning from the foster care system (N = 74) and its relationship to their level of satisfaction with child welfare services and the frequency of negative social contextual experiences. Results of hierarchical regression analysis showed that the level of satisfaction with child welfare services moderated the relationship between negative social contextual experiences and cultural mistrust of mental health professionals. Specifically, more frequent negative social contextual experiences were related to greater cultural mistrust of mental health professionals for Black males reporting low satisfaction with child welfare services, but not for those reporting high satisfaction with child welfare services. Implications for service delivery are discussed.     

Factors Associated with Achieving Complete Mental Health among Individuals with Lifetime Suicidal Ideation

The objective of this study was to identify factors associated with complete mental health among Canadians who had ever seriously considered suicide. Data for this study were obtained from Statistics Canada's 2012 Canadian Community Health Survey–Mental Health (N = 2,844). The outcome variable examined in this study was complete mental health and was analyzed using binary logistic regression. Of the 2,844 respondents with lifetime suicidal ideation, 1,088 (38.2%) had complete mental health (i.e., had flourishing mental health, no mental illness, and no suicidal ideation in the past 12 months). Those who had a confidant were seven times more likely to have complete mental health. Other factors associated with achieving complete mental health among formerly suicidal respondents include being older, being a woman, having higher income, use of religious coping, and never previously having a mental illness. Considering the importance of these protective factors in formulating public health policies will allow for a more wide‐reaching approach to suicide prevention.     

Mental health attitudes among Middle Eastern/North African individuals in the United States

ABSTRACT

Middle Eastern/North African (MENA) individuals may have heightened risk for developing mental health problems due to unique cultural stressors. However, traditional cultural and religious practices and beliefs socialised within the family environment may reduce the likelihood of seeking mental health services. This qualitative study aimed to better understand the intersection of cultural, religious, and mental health attitudes among MENA individuals. Semi-structured telephone interviews were conducted with MENA adults who had received therapy services (N?=?13) and were analysed for emergent themes. Respondents reported lack of understanding of mental illness within their communities, and prominent levels of perceived and self-stigma. Families and religious practices/beliefs played an important role in responding to mental illness. Results suggest that incorporating psychoeducation and community awareness campaigns alongside religious services may help to reduce barriers to receiving mental health treatment.     

The effects of the Newborn Behavioral Observations (NBO) system in early intervention: A multisite randomized controlled trial

The purpose of this pilot study was to evaluate the effect of an infant mental health intervention, the Newborn Behavioral Observations system (NBO), versus usual care (UC) on infant neurodevelopment and maternal depressive symptoms in early intervention (EI). This multisite randomized trial enrolled newborns into the NBO (n = 16) or UC group (n = 22) and followed them for 6 months. Outcome measures included the Battelle Developmental Inventory (BDI-2), Bayley Scales of Infants Development (BSID-III), and Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D and BSID-III were collected at 3- and 6-months post EI entry and the BDI-2 was collected at EI entry and 6-months post-EI entry. We estimated group differences [95% CI], adjusting for program characteristics. At 6 months, the NBO group had greater gains in Communication (b = 1.0 [0.2, 1.8]), Self-Care (b = 2.0 [0.1, 3.9]), Perception and Concepts (b = 2.0 [0.4, 3.6]), and Attention and Memory (b = 3.0 [0.4, 6.0]) than the UC group. The NBO group also had greater decline in maternal postnatal depressive symptoms (b = −2.0 [−3.7, −0.3]) than the UC group. Infants receiving the NBO infant mental health intervention had greater gains in cognitive and adaptive functions at 6 months than infants receiving UC. Caregivers receiving NBO care had greater improvements in maternal depressive symptoms than caregivers receiving UC.     

Cancer Genetics Service Interest in Women with a Limited Family History of Breast Cancer

Women with a limited family history of breast cancer may be interested in cancer genetics information although their objective risk of breast cancer may not indicate routine referral to cancer genetics services. This study examined factors related to interest and use of cancer genetics services in a community sample of women with a limited family history of breast cancer (N = 187) who had no previous contact with cancer genetics services. Participants provided demographic information and ratings of perceived risk, cancer distress, attitudes, and intentions to initiate cancer genetics services. Participants were given information about a cancer genetics clinic that served women having concerns about their breast cancer risk. Women were contacted within 6 weeks and 8 months following their study appointment. Six weeks following their study appointment, 25% of women had initiated cancer genetics services. Eight months following their study appointment, 18% of women reported having completed a cancer genetics service appointment. Baseline intentions independently predicted both initiation at 6 weeks and appointment at 8 months. Cancer distress was positively associated with cancer genetics service initiation and appointment. Results suggest that some women with a limited family history of breast cancer are interested in seeking out cancer genetics information. Women with a limited family history of breast cancer may benefit from the availability of cancer genetics information provided through primary healthcare settings.     

Organizational climate in Spanish Public Health Services: Administration and Services Staff

The main goal of this research is to explore the organizational climate perceived by administrative and healthcare personnel working in Spanish healthcare services, analyzing the differences according to their health specialization, sex, age and professional status. The sample was made up of 3,787 individuals working in the administrative and healthcare services of the Public Health System of the Principality of Asturias, 88.7 % were working in specialist care and 11.3 % in primary care. Mean age was 51.88 (standard deviation of 6.28); 79.9 % were women and 20.1 % men. The organizational climate was assessed with the CLIOR scale. The organizational climate perceived is moderately positive, with a global mean of 3.03 on a scale of 1 to 5 points. The differences are statistically significant (p < .01) according to specialty, age and profession. A better working climate is perceived in primary care than in specialist care, and among older as compared to younger workers. The results indicate that the working climate perceived by administration and services staff employees in the Spanish healthcare context is moderately positive, with a better perceived climate in primary care than in specialist care.