JBHSR Recent Issues
The Table of Contents and abstracts for recent issues of the JBHS&R are listed below.
Volume 38, 2011
Number 1 / January 2011
Addressing Trauma in Mental Health and Substance Use Treatment...1-2
Linda Rosenberg
Abstract: Individuals with histories of violence, abuse, and neglect from childhood onward make up the majority of clients served by public mental health and substance abuse service systems. The greater the trauma, the greater the risk for alcoholism and alcohol abuse, depression, illicit drug use, suicide attempts, and other negative outcomes. Clearly, we cannot begin to address the totality of an individual’s healthcare, or focus on promoting health and preventing disease, unless we address trauma. Trauma-informed care is now the expectation, not the exception, in behavioral health treatment systems.
Are Smoking and Alcohol Misuse Associated with Subsequent Hospitalizations for Ambulatory Care Sensitive Conditions?...3-15
Ryan B. Chew, Chris L. Bryson, David H. Au, Matthew L. Maciejewski and Katharine A. Bradley
Abstract: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are used to assess quality of care, but studies rarely adjust for health behaviors. This study evaluated whether results of smoking or alcohol screening were associated with hospitalizations for ACSCs. Participants included 33,273 male Veterans Affairs general medicine outpatients who returned mailed surveys. The main outcome was hospitalization with a primary discharge diagnosis for an ACSC in the year following screening. Analyses were adjusted for demographics, comorbidity, and other health behaviors. Current and previous smoking and abstaining from alcohol were associated with significantly increased risk of hospitalization for ACSCs, but alcohol misuse was not. However, severe alcohol misuse was associated with increased risk of hospitalizations with a primary or secondary ACSC discharge diagnosis. When ACSCs are used to evaluate the quality of care, health systems caring for populations with higher rates of smoking or nondrinking could falsely appear to have poorer quality care if alcohol and tobacco use are not considered.
Gender Differences and Risk of Arrest Among Offenders with Serious Mental Illness---16-28
Marion A. Becker, Ross Andel, Timothy Boaz and Robert Constantine
Abstract: Despite the increasing number of men and women with serious mental illness (SMI) incarcerated in America's jails, little research exists on the role gender may play in arrest among persons with SMI. This study examined correlates of arrests among offenders with SMI, specifically the role of gender. County criminal justice records, as well as county and statewide social service archival databases, were used to identify jail inmates with SMI in a large urban county in Florida. Of the 3,769 inmates identified, 41% were female. This study identified three distinct classes of male and female offenders within which persons had similar trajectories of arrests over the 4-year study period representing those with minimal, low, and high arrest rates. Findings suggest some important differences between women and men in risk factors for re-arrests. Attention to these factors may improve the ability to prevent future recidivism among men and women with SMI.
The Effect of Social Networks and Social Support on Mental Health Services Use, Following a Life Event, among the Baltimore Epidemiologic Catchment Area Cohort...29-50
Pallab K. Maulik, William W. Eaton and Catherine P. Bradshaw
Abstract: The study examined the association between life events and mental health services use, accounting for social networks and social support. Main and stress-buffering effects were estimated using longitudinal data from the Baltimore Epidemiologic Catchment Area cohort (1,920 participants in 1993–1996, of whom 1,071 were re-interviewed in 2004–2005). Following a life event, the odds of using general medical services were increased by almost 50% when there was increased social support from spouse/partner (referral function). The odds of using mental health services within general health setup were reduced by 60% when there was increased support from relatives (stress-reduction function). Increased social support from friends and relatives was associated with a 40–60% decreased odds of using specialty psychiatric services after experiencing different life events (stress-reduction function). Overall, social support rather than social networks were more strongly associated with increased mental health service use following a life event. The implications for service delivery and program development are discussed.
Social Integration of People with Serious Mental Illness: Network Transactions and Satisfaction...51-67
Yin-Ling Irene Wong, Jason Matejkowski and Sungkyu Lee
Abstract: Social integration involves a process through which an individual establishes and maintains meaningful interpersonal relationships characterized by mutual exchange with community members in nonclinical settings. Using self-report data from a probability sample (n = 252) of supportive independent housing residents, transactional (i.e., support exchanges) characteristics of social networks, paying particular attention to reciprocation of exchanges between residents and their network members, were analyzed. The study also examined the extent to which transactional characteristics are related to satisfaction with social relations. Findings indicated considerable reciprocity in social relationships. Controlling for sociodemographic variables and network structure characteristics, mutual exchanges of tangible and problem-solving support were positively associated with network satisfaction. Results suggest that supported socialization services aimed at network and resource development with this population could facilitate more frequent exchanges of tangible resources and problem-solving opportunities between consumers and network members, which, in turn, might promote social integration.
Pediatric Emergency Consultations: Prior Mental Health Service Use in Suicide Attempters...68-79
Emily Frosch, Jill McCulloch, Yesel Yoon and Susan dosReis
Abstract: This study investigated the relationship between presenting complaints and prior mental health encounters in youth seen for emergency psychiatric consultation. Records of youths aged 9–17 years old receiving a psychiatric consultation in a pediatric emergency department from 2002 to 2007 were examined (N = 1,900). Youth were classified by presenting complaint: suicide attempt, suicidal ideation, and behavioral problems. Nearly half of the youth presented with behavior problems, and 39% presented with suicidal ideation and/or attempt. Those presenting with both suicide attempt and behavior problems were most likely to have made a prior suicide attempt. Those presenting with suicide attempt alone were least likely to report current mental health treatment, while youth presenting with behavior problems alone were the most likely to report current mental health treatment. Further research is needed to better understand the role that emergency departments play in the course of care and to maximize the opportunity to make lasting and effective community-based care connections.
Supervisory Turnover in Outpatient Substance Abuse Treatment...80-90
Danica K. Knight, Kirk M. Broome, Jennifer R. Edwards and Patrick M. Flynn
Abstract: Staff turnover is a significant issue within substance abuse treatment, with implications for service delivery and organizational health. This study examined factors associated with turnover among supervisors in outpatient substance abuse treatment. Turnover was conceptualized as being an individual response to organizational-level influences, and predictors represent aggregate program measures. Participants included 532 staff (including 467 counselors and 65 clinical/program directors) from 90 programs in four regions of the USA. Using logistic regression, analyses of structural factors indicated that programs affiliated with a parent organization and those providing more counseling hours to clients had higher turnover rates. When measures of job attitudes were included, only parent affiliation and collective appraisal of satisfaction were related to turnover. Subsequent analyses identified a trend toward increased supervisory turnover when satisfaction was low following the departure of a previous supervisor. These findings suggest that organizational-level factors can be influential in supervisory turnover.
Feasibility of Dissemination of Cognitive Behavioral Therapy to Texas Community Mental Health Centers...91-104
Molly A. Lopez and Monica Ramirez Basco
Abstract: State mental health systems are actively seeking to disseminate empirically supported treatment approaches to improve the outcomes of adults with serious mental illnesses. However, many of these interventions have not been studied within public mental health settings. Cognitive behavioral therapy (CBT) has been shown to be effective for major depression in well-controlled trials, but its effectiveness in public mental health settings is less known. The present study examines the feasibility of dissemination of CBT in the Texas public mental health system. Seven clinicians were trained by a CBT expert and supervised for 5 months, during which time their skills approached competency levels of therapists in randomized controlled trials. Forty clients were treated during the therapists’ training phase, attending an average of ten sessions and experiencing a significant reduction in depressive symptoms. Study results are compared with previously published studies of CBT.
Effective Mental Health Consumer Education: A Preliminary Exploration...105-113
Sarann Bielavitz, Jennifer Wisdom and David A. Pollack
Abstract: People with serious mental illnesses are increasingly becoming more active participants in their treatment and recovery. At times, their participation may be limited by incomplete, unclear, or insufficient information. The authors used a grounded theory approach to look at the unmet informational needs described by consumers. Participants in this study called for materials appropriate to their level of understanding, assistance with interpreting and comprehending information when necessary, and information on policies that affect the treatment they receive. Ultimately, an informed consumer is one empowered to make decisions about the course of his or her recovery and participate meaningfully in the patient–provider relationship.
Stakeholder Benefit from Depression Disease Management: Differences by Rurality?...114-121
Stanley Xu, Kathryn Rost, Fran Dong and L. Miriam Dickinson
Abstract: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. This paper investigates whether two proposed stakeholders (health plans and employer purchasers) economically benefit from depression care management (reduced outpatient utilization and work costs, respectively) in two delivery systems (rural and urban). This study examined the main and differential effects of depression care management on outpatient utilization and work costs over 24 months in a preplanned secondary analysis of 479 depressed patients from rural and urban primary care practices in a randomized controlled trial. Over 24 months, the intervention did not significantly reduce outpatient utilization costs in the entire cohort (−$191, 95% confidence interval (CI) = −$2,083 to $1,647), but it did decrease work costs (−$1,970, 95% CI = −$3,934 to −$92). While not statistically significant, rural–urban differences in work costs were in the same direction, while rural–urban differences in utilization costs differed in direction. These findings provide preliminary evidence that employers who elect to cover depression care management costs should receive comparable economic benefits in the rural and urban employees they insure. Given the limited sample size, further research may be needed to determine whether health plans who elect to cover depression care management costs will receive comparable economic benefits in the rural and urban enrollees they insure.
The Evolving Private Psychiatric Inpatient Market...122-131
Erica C. Hutchins, Richard G. Frank and Sherry A. Glied
Abstract: The private psychiatric hospital market has exhibited great volatility over time. From 1976 to 1992, the number of hospitals more than doubled, while in the decade following, the number of facilities dropped by half. Recently, however, the industry has begun to grow again. The evolution of this market reflects the response of a private industry with access to capital markets to changes in both the supply of substitutes and the demand for services. Most recently, the limited supply of facilities and expanded demand for psychiatric services have spurred renewed growth. The two leading firms today, Universal Health Services, Inc., which rode the market crest and downturn since the 1980s, and Psychiatric Solutions, Inc., a newer entrant, have employed different strategies to take advantage of these opportunities. The rapid responsiveness of the private psychiatric hospital market, as exemplified by these two firms, presents significant potential for shaping future mental health policy.
Integrating Mental Health Services into Humanitarian Relief Responses to Social Emergencies, Disasters, and Conflicts: A Case Study...132-141
Robert Henley, Randall Marshall and Stefan Vetter
Abstract: Utilizing lessons learned from development and implementation of “Project Liberty” in New York City, created in response to the attacks of September 11, 2001, this paper explores the importance of integrating structured mental health services with community-based social service programs offered in large-scale humanitarian relief responses. Relevant international research studies illustrating similar integrated programs are also reviewed. The primary approach is community-based and resilience-enhancement focused, offering structure, stability, support, and community cohesion, with an added integrated screening component to identify persons with severe treatable mental health conditions. Because there is thus far little evidence that resilience-enhancing programs are effective for severe mental health conditions, a secondary program initiated in parallel would be staffed with more specialized providers offering services for those referred from the primary program. The key implication supports the establishment of more effective links between programs and professionals from different disciplines, who then can more effectively implement integrated program responses to large-scale disasters.
Number 2 / April 2011
Mental Health First Aid: A “Radical Efficiency” in Health Promotion...143-145
Linda Rosenberg
Without Abstract
The Impact of Youth and Family Risk Factors on Service Recommendations and Delivery in a School-Based System of Care...146-158
Melissa L. Whitson, Christian M. Connell, Stanley Bernard and Joy S. Kaufman
Abstract: The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed.
Mental Health Screening of Adolescents in Pediatric Practice...159-169
Mathilde M. Husky, Kathleen Miller, Leslie McGuire, Laurie Flynn and Mark Olfson
Abstract: This study examines routine computerized mental health screening for adolescents scheduled for a routine physical examination in a group pediatric practice. Medical records of adolescents aged 13 to 17 who were offered screening (n = 483) were reviewed. Approximately 44.7% (95% confidence interval (CI) 40.3–49.2) were screened, and 13.9% (95% CI 9.3–18.5) were identified as being at risk. Screening was associated with significantly increased odds of receiving either pediatric mental health care or a referral for specialty mental health care (adjusted odds ratio (AOR): 2.6 95% CI 1.2–5.6). Among patients who received either mental health intervention, those who were screened were significantly more likely to be referred to specialty care (AOR: 15.9 95% CI 2.5–100.4), though they were less likely to receive pediatric mental health care (AOR: 0.10 95% CI 0.02–0.54). The findings support the feasibility of routine mental health screening in pediatric practice. Screening is acceptable to many parents and adolescents, and it is associated with referral for specialized mental health care rather than care from the pediatrician.
The Incremental Value of Self-Reported Mental Health Measures in Predicting Functional Outcomes of Veterans...170-190
Susan V. Eisen, Kathryn A. Bottonari, Mark E. Glickman, Avron Spiro and Mark R. Schultz, et al.
Abstract: Research on patient-centered care supports use of patient/consumer self-report measures in monitoring health outcomes. This study examined the incremental value of self-report mental health measures relative to a clinician-rated measure in predicting functional outcomes among mental health service recipients. Participants (n = 446) completed the Behavior and Symptom Identification Scale, the Brief Symptom Inventory, and the Veterans/Rand Short Form-36 at enrollment in the study (T1) and 3 months later (T2). Global Assessment of Functioning (GAF) ratings, mental health service utilization, and psychiatric diagnoses were obtained from administrative data files. Controlling for demographic and clinical variables, results indicated that improvement based on the self-report measures significantly predicted one or more functional outcomes (i.e., decreased likelihood of post-enrollment psychiatric hospitalization and increased likelihood of paid employment), above and beyond the predictive value of the GAF. Inclusion of self-report measures may be a useful addition to performance measurement efforts.
Access to Adequate Outpatient Depression Care for Mothers in the USA: A Nationally Representative Population-Based Study...191-204
Whitney P. Witt, Abiola Keller, Carissa Gottlieb, Kristin Litzelman and John Hampton, et al.
Abstract: Research related to mental health service use among vulnerable young adults is limited. This study used an expanded version of Andersen’s Behavioral Model of Health Services Use to evaluate factors associated with the use of different types of mental health services among a sample of predominantly African-American 16–24 year olds (n = 500) in an employment training program in Baltimore City. Results indicated that participants were more likely to have received mental health services in correctional facilities than in community- or school-based contexts. Use of mental health services in correctional facilities was significantly greater among males, those less than 18 years, and those who experienced more stressful events. Findings illustrate the need to develop seamless mental health services for vulnerable young adults in multiple contexts, including the criminal justice system.
Factors Associated with Mental Health Services Use among Disconnected African-American Young Adult Population...205-220
Pallab K. Maulik, Tamar Mendelson and S. Darius Tandon
Abstract: Research related to mental health service use among vulnerable young adults is limited. This study used an expanded version of Andersen’s Behavioral Model of Health Services Use to evaluate factors associated with the use of different types of mental health services among a sample of predominantly African-American 16–24 year olds (n = 500) in an employment training program in Baltimore City. Results indicated that participants were more likely to have received mental health services in correctional facilities than in community- or school-based contexts. Use of mental health services in correctional facilities was significantly greater among males, those less than 18 years, and those who experienced more stressful events. Findings illustrate the need to develop seamless mental health services for vulnerable young adults in multiple contexts, including the criminal justice system.
Patterns of Substance Abuse Treatment Seeking Following Cocaine-Related Emergency Department Visits...221-233
John C. Fortney, Shanti Prakash Tripathi, Maureen A. Walton, Rebecca M. Cunningham and Brenda M. Booth
Abstract: The development and implementation of provider performance and consumer outcome measures for behavioral health care have been growing over the last decade, presumably because they are useful tools for improving service quality. However, the extent to which providers have successfully used performance measurement results has not been adequately determined. To this end, two methods were used to better understand the use of data obtained from an annual survey of behavioral health care consumers: a cross-sectional survey of executive directors, clinical program directors, and quality improvement directors and follow-up interviews with a subsample of survey respondents. Results revealed information about the use of consumer survey data, factors that facilitate and hinder the use of results, as well as respondents’ opinions about consumer survey administration procedures. These findings provide valuable information for the application of performance measures and, ultimately, improving consumer outcomes.
This research was performed at the Virginia Commonwealth University, Institute for Drug and Alcohol Studies, 1112 East Clay Street, Suite B-08, Richmond, VA 23298.
Assessing the Utility of Consumer Surveys for Improving the Quality of Behavioral Health Care Services...234-248
J. Randy Koch, Alison B. Breland, Mary Nash and Karen Cropsey
Abstract: The development and implementation of provider performance and consumer outcome measures for behavioral health care have been growing over the last decade, presumably because they are useful tools for improving service quality. However, the extent to which providers have successfully used performance measurement results has not been adequately determined. To this end, two methods were used to better understand the use of data obtained from an annual survey of behavioral health care consumers: a cross-sectional survey of executive directors, clinical program directors, and quality improvement directors and follow-up interviews with a subsample of survey respondents. Results revealed information about the use of consumer survey data, factors that facilitate and hinder the use of results, as well as respondents’ opinions about consumer survey administration procedures. These findings provide valuable information for the application of performance measures and, ultimately, improving consumer outcomes.
This research was performed at the Virginia Commonwealth University, Institute for Drug and Alcohol Studies, 1112 East Clay Street, Suite B-08, Richmond, VA 23298.
Substance Abuse Treatment Programs’ Data Management Capacity: an Exploratory Study...249-264
Jennifer P. Wisdom, James H. Ford, Meg Wise, Deirdre Mackey and Carla A. Green
Abstract: Despite treatment improvement and performance management imperatives, little research describes the data management capacity of substance abuse treatment programs, and useful metrics are not available to gauge capacity. This exploratory study evaluates clinical and administrative data management at eight substance abuse treatment programs in four US states to identify factors for developing an appropriate metric. Findings indicate that programs tend to manage data inefficiently and have few protocols guiding information management. Barriers to better data management included lack of integrated information technology (IT) systems; limited funding, time, and staff for developing and implementing IT-related changes; and divergent staff skills in and attitudes toward IT. This snapshot of substance abuse treatment programs’ data management capabilities suggests a need for a metric to examine data management capability in these settings. Infusion of expertise, training, and funding are needed to improve substance abuse treatment programs’ IT-related systems and data management processes.
Gender Differences in Patterns of Child Risk across Programmatic Phases of the CMHI: A Multiple Group Latent Class Analysis (LCA)...265-277
Lucas Godoy Garraza, Melissa Azur, Robert L. Stephens and Christine M. Walrath
Abstract: Data from 18,437 children enrolled in the national evaluation of the Children’s Mental Health Initiative between 1994 and 2005 were used to examine the evolution of patterns of risk among boys and girls across funding phases using multigroup latent class analysis. Consistent with previous research, this study identified four subgroups of children with similar patterns of child risk. Membership to these risk subgroups varied as a function of age and was associated with differences in impairment levels. Changes in the distribution of boys and girls in the risk classes suggest that, over time, an increasing proportion of boys have entered the system of care program with complex histories of risk. Information on children’s exposure to child risk factors can aid policy makers, service providers, and clinicians in identifying children who may need more intensive services and tailoring services to their needs.
Mental Health Services: A Public Health Perspective, Third Edition. Edited by Bruce Lubotsky Levin, Kevin D. Hennessy, and John Petrila. New York: Oxford University Press, 2010...278-279
Elizabeth L. Merrick and Constance M. Horgan
Without Abstract
Number 3 / July 2011
Be the Change...281-285
Linda Rosenberg
Abstract: Excerpts from the Plenary Address at the 41st National Council Mental Health and Addictions Conference, May 2, 2011
Introduction to Special Section on the System of Care Implementation Survey (SOCIS)...286-287
Robert M. Friedman and Krista Kutash
Without Abstract
Development of a Measure to Assess the Implementation of Children’s Systems of Care: The Systems of Care Implementation Survey (SOCIS)...288-302
Roger A. Boothroyd, Paul E. Greenbaum, Wei Wang, Krista Kutash and Robert M. Friedman
Abstract: The children’s system of care framework has been extensively implemented in the U.S. Since its inception in 1993, the Comprehensive Community Mental Health Services for Children and Their Families Program has invested in excess of $1 billion supporting the development of systems of care in 164 grantee sites across the country. Despite these efforts to implement children’s systems of care nationally, little is known about the extent to which the principles and values actually have been put into practice outside of the funded grantee sites. This paper describes the development of the Systems of Care Implementation Survey, a measure designed specifically for the first ever study assessing the level of implementation of factors contributing to effective children’s systems of care in a nationally representative sample of counties throughout the U.S.
Multilevel Confirmatory Factor Analysis of the Systems of Care Implementation Survey (SOCIS)...303-326
Paul E. Greenbaum, Wei Wang, Roger Boothroyd, Krista Kutash and Robert M. Friedman
Abstract: A major impediment to obtaining national information on systems of care implementation has been the lack of a psychometrically sound large-scale survey instrument. The present study provided information on the factorial and concurrent validity of the Systems of Care Implementation Survey scales. Multilevel confirmatory factor analysis and multilevel regression analysis were used to test these indicators of internal and external validity. Two hundred twenty-five counties were randomly selected and stratified by population size and poverty level. Nine hundred ten informants responded to the survey questionnaire, M = 4.04 informants per county (SD = 3.17). Results indicated that all models had at least adequate fit to the data, with nine of the 14 factor models having excellent fit. Overall, 11 of the 14 factors had some indication that receiving federal funding to create systems of care was associated with higher scores on the factors. Implications for future research were discussed.
Community Characteristics and Implementation Factors Associated with Effective Systems of Care...327-341
Laurel M. Lunn, Craig Anne Heflinger, Wei Wang, Paul E. Greenbaum and Krista Kutash, et al.
Abstract: How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.
Levels of System of Care Implementation: A National Benchmark Study...342-357
Krista Kutash, Paul E. Greenbaum, Wei Wang, Roger A. Boothroyd and Robert M. Friedman
Abstract: The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed.
Substance Use, Depression, and Mental Health Functioning in Patients Seeking Acute Medical Care in an Inner-City ED...358-372
Brenda M. Booth, Maureen A. Walton, Kristin L. Barry, Rebecca M. Cunningham and Stephen T. Chermack, et al.
Abstract: The study investigated the behavioral health of a consecutive sample of 5,641 adult emergency department (ED) patients aged 19 through 60 presenting for medical care in a large, inner-city hospital ED. Twenty-three percent met the criteria for major depression; average mental health functioning, as measured by the mental health component of the SF-12, was half of a standard deviation lower than in the general population; 15% met the criteria for alcohol or drug abuse/dependence in the past year. Comorbidity was high. These behavioral health disorders may complicate treatment and diagnosis of the chief presenting complaint. These findings, coupled with the high rates of these disorders, suggest the importance of screening and either beginning appropriate treatment or offering appropriate referral for such disorders in ED settings.
Depression and the Onset of Chronic Illness in Older Adults: A 12-Year Prospective Study...373-382
Mustafa C. Karakus and Lisa C. Patton
Abstract: The relationship between depression and development of chronic illness among older adults is not well understood. This study uses data from the Health and Retirement Study to evaluate the relationship between depression at baseline and new onset of chronic illnesses including cancer, heart problems, arthritis, and diabetes. Analysis controlling for demographics (age, gender, race, education), health risk indicators (BMI and smoking), functional limitations (gross motor index, health limitations for work), and income show that working-age older people (ages 50–62) with depression at baseline are at significantly higher risk to develop diabetes, heart problems, and arthritis during the 12-year follow-up. No significant association was found between depression and cancer. Prevention efforts aimed at chronic illnesses among the elderly should recognize the mind–body interaction and focus on preventing or alleviating depression.
Performance-Based Contracting Within a State Substance Abuse Treatment System: A Preliminary Exploration of Differences in Client Access and Client Outcomes...383-397
Debra L. Brucker and Maureen Stewart
Abstract: To explore whether the implementation of performance-based contracting (PBC) within the State of Maine’s substance abuse treatment system resulted in improved performance, one descriptive and two empirical analyses were conducted. The first analysis examined utilization and payment structure. The second study was designed to examine whether timeliness of access to outpatient (OP) and intensive outpatient (IOP) substance abuse assessments and treatment, measures that only became available after the implementation of PBC, differed between PBC and non-PBC agencies in the year following implementation of PBC. Using treatment admission records from the state treatment data system (N = 9,128), logistic regression models run using generalized equation estimation techniques found no significant difference between PBC agencies and other agencies on timeliness of access to assessments or treatment, for both OP and IOP services. The third analysis, conducted using discharge data from the years prior to and after the implementation of performance-based contracting (N = 6,740) for those agencies that became a part of the performance-based contracting system, was designed to assess differences in level of participation, retention, and completion of treatment. Regression models suggest that performance on OP client engagement and retention measures was significantly poorer the year after the implementation of PBC, but that temporal rather than a PBC effects were more significant. No differences were found between years for IOP level of participation or completion of treatment measures.
Mental Health Service Use Before and After Diagnosis of Early-Onset Bipolar Disorder...398-413
Sara E. Evans-Lacko, Susan dosReis, Elizabeth Kastelic and Anne W. Riley
Abstract: To investigate patterns of mental health services, psychotropic treatments, and psychiatric diagnoses received by youth diagnosed with bipolar disorder, insurance claims of 323 youth (ages 6–18 years) were examined from the 2000–2001 Thomson/Medstat-MarketScan(c) database. Longitudinal patterns are assessed 6 months prior and following a new treatment episode of bipolar disorder. Youth subgroups (i.e., continuous, intermittent, and discontinuous services), defined by persistence of claims associated with a bipolar diagnosis, are compared by demographic and clinical characteristics. Virtually all youth had high rates of mental health service use and treatment immediately following initial bipolar diagnosis, but only half continued to receive services 6 months following diagnosis. A continuous pattern of claims associated with a bipolar diagnosis was associated with using more resources, receiving initial diagnosis from a mental health professional, being in a managed care plan, and having more psychiatric diagnoses following index bipolar diagnosis. Further research should examine how continuity of claims for bipolar is related to treatment quality and clinical outcomes.
Outcome Assessment via Handheld Computer in Community Mental Health: Consumer Satisfaction and Reliability...414-423
Lizabeth A. Goldstein, Mary Beth Connolly Gibbons, Sarah M. Thompson, Kelli Scott and Laura Heintz, et al.
Abstract: Computerized administration of mental health-related questionnaires has become relatively common, but little research has explored this mode of assessment in “real-world” settings. In the current study, 200 consumers at a community mental health center completed the BASIS-24 via handheld computer as well as paper and pen. Scores on the computerized BASIS-24 were compared with scores on the paper BASIS-24. Consumers also completed a questionnaire which assessed their level of satisfaction with the computerized BASIS-24. Results indicated that the BASIS-24 administered via handheld computer was highly correlated with pen and paper administration of the measure and was generally acceptable to consumers. Administration of the BASIS-24 via handheld computer may allow for efficient and sustainable outcomes assessment, adaptable research infrastructure, and maximization of clinical impact in community mental health agencies.
