A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Collaborative care models among pediatric primary care and child and adolescent mental health providers are increasingly emphasized to improve quality of and access to mental health services. The current case example of a multi-site clinical training opportunity in school-based collaborative care settings illustrates the success of a learning collaborative approach to improve children's mental health care in schools. Quality improvement data from participating sites indicated an increase in use of evidence-based practices (i.e., “core skills”) and an improvement in quality service delivery indicators for children's mental health (i.e., screening, risk assessment, diagnostic processes, associated diagnostic coding, use of core skills, associated procedural coding, and follow-up assessment and referral) over time. Clinician self-report and chart review data are supplemented by qualitative data from site leader interviews conducted following completion of the project. Implications for mental health workforce development to improve the quality of care to children and adolescents in schools and other community mental health settings are discussed.     

The mental health recovery movement and family therapy, part II: a collaborative, appreciative approach for supporting mental health recovery

A continuation of Part I, which introduced mental health recovery concepts to family therapists, Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts. This approach draws primarily upon postmodern therapies, which have numerous social justice and strength-based practices that are easily adapted in recovery-oriented contexts. The model outlined in this article includes an overview of the recovery partnership (i.e., therapeutic relationship), mapping recovery (i.e., assessment and case conceptualization), recovery planning (i.e., treatment planning), facilitating recovery (i.e., intervention), accessing resources (i.e., case management), recovery maintenance, and service contexts as well as a case study.     

Measuring the Influence of Social Context Referents in Substance Abuse Treatment: An Instrument Validation Study

ABSTRACT

This paper introduces a newly developed assessment tool, the Ecological Assessment of Substance abuse Experiences (EASE) that has been designed to measure the influence of social context referents (i.e., family, peers, and community) on clients' attitudes and outcome beliefs related to substance abuse and recovery. An initial exploratory factor analysis was conducted with a small sample of adult treatment-seekers (N =103) to identify its underlying factors and to examine the instrument's item-factor fit. Items clustered onto four orthogonal factors: “belonging-recovery,” “belonging-drugs/alcohol,” “disconnect-recovery,” and “attitudinal congruence-recovery.” Preliminary findings suggest that socio-emotional outcome beliefs and attitudes about drug use and recovery behaviors, as related to family, peers, and community contexts, may be significant areas to address during routine assessment practices that may lead to more comprehensive and contextually appropriate treatment plans.     

A National Survey of Child Advocacy Center Directors Regarding Knowledge of Assessment,Treatment Referral,and Training Needs in Physical and Sexual Abuse

Mental health services are a core component of child advocacy centers in the United States. Child advocacy center directors were surveyed about (a) trauma and posttraumatic stress disorder; (b) referral criteria for treatment of abuse victims; (c) evidence-based treatments for abused children; (d) reliable, valid, and normed measures helpful in assessment; and (e) training needs. Directors accurately identified posttraumatic stress disorder symptoms, but additional symptoms were misidentified. Directors identified best practices for assessment and treatment, but they misidentified non-evidence-based practices. Primary reasons for referral for services included severity of abuse and emotional response of the child. However, referrals based on assessment findings were not a high priority. Directors expressed some training needs for staff consistent with issues identified in the study.     

Recreation and agroforestry: Examining new dimensions of multifunctionality in family farms

Multifunctionality serves as an analytical framework to recognize many services that farms provide to their surrounding communities and society. This study explores an often overlooked dimension of multifunctionality by examining different recreational services provided by landowners in Missouri and analyzing the relationship between recreational multifunctionality and the practice of agroforestry. The latter provides multiple economic, environmental and beautification benefits that involve trees in the landscape. Results show that family farms provide several recreational services for their household members and others, and the existence of synergies between the recreational function of the farmland and agroforestry practices, consistent with the transition to strong multifunctionality. The recreational use of the land is positively associated to the cognitive (i.e., perceived knowledge) and affective (i.e., willingness to adopt) attitudes towards agroforestry. Results also show that the higher the perception of intrinsic (i.e., planting trees for wind protection and carbon sequestration) and economic (i.e., perceived economic benefits and flood protection) values of agroforestry, the more recreational use of the land. This study exemplifies the interactions between two little examined farmland functions providing insights for a comprehensive value assessment of family farms. Other academic and practical implications of the study are also detailed.     

Cybernetic appropriateness review: Does it change physician hospital utilization patterns?

All hospital care can be characterized as either appropriate (i.e., efficatious and necessary) or inappropriate (i.e., services without benefit or services that could be provided in a less costly setting). A demonstration project combining an appropriateness determination methodology with a cybernetic control system was implemented in a study area that included six hospitals and approximately 400 practicing physicians. Project results to date indicate substantial improvements in the ratio of appropriate to inappropriate care for both hospitals and individual physicians. Evaluation research design problems and areas of future research are also discussed.     

Kinship liaisons: A peer-to-peer approach to supporting kinship caregivers

Relative caregivers are invaluable to the child welfare system. Although most states have a preference for relative placement, the support and assistance provided to relatives during and beyond the initial child placement period are inadequate. Through a U.S. Children's Bureau System of Care Demonstration project, a peer-to-peer approach (based in social cognitive theory) which paired a new relative caregiver (n = 74) with a full-time, paid kinship liaison (a current or former relative caregiver) was studied. Findings show that kinship liaisons are extremely helpful to caregivers and reveal 27 support categories that caregivers find most useful. One of the most significant services (i.e., information and referral) provided by the liaisons increased caregivers' knowledge of accessing available services and the permanency process. Data results show significant increases in caregivers' coping abilities and willingness to become a permanent resource for the children in their care. Policy and practice insights are provided.     

Stakeholder perspectives on integrated services for people who experience chronic homelessness

This article concerns a SAMHSA-funded service intervention, Pathways to Independence, that combined the use of SAMHSA’s SSI/SSDI Outreach, Access, and Recovery approach to facilitating disability entitlement claims with financial management classes, mental health assessment and referral, and access to employment and housing for people experiencing chronic homelessness. The purpose of this study was to explore perceptions of this form of service delivery and the benefits and challenges of the program model from the perspective of those who experienced it. Focus groups were conducted with a total of 17 program stakeholders, including program participants, program staff, collaborating case management staff of the parent agency, and a landlord and an employer, with questions to each regarding the program and its impact. Focus groups were analyzed through independent coding followed by discussion to reach consensus on key themes. Five themes were identified across the groups: (a) the importance of relationships, (b) staff specialization and provision of individualized services, (c) an orientation to outcomes, (d) comprehensiveness of services and facilitation of connections to community resources, and (e) systems challenges. The Pathways to Independence program provides a working model for integrated employment, entitlement assessment and application, housing, and behavioral health treatment for persons experiencing chronic homelessness.     

Assessing the Effects of the Physical,Psychological, and Social Dimensions of Health on the Use of Health Services*

In this paper we examine two major assumptions inherent in the literature relating health status to the use of health services: (1) that each of the three dimensions of health (i.e., the physical, the psychological, and the social) has an equal impact on the use of health services; and (2) that the effects of these three dimensions of health are manifest in an additive rather than in an interactive fashion. To test these assumptions, multiple regression analyses are performed using a modified version of the generic model of access to medical care in order to predict eight different types of health services utilization. The results compel us to accept the additivity assumption, while rejecting the equality assumption. Moreover, contrary to Mechanic's assertion, psychological health was found to have the least impact of any of the three dimensions of health on the use of health services. We then discuss two possible explanations (i.e., differences in the populations studied and the measurement of the independent variables) that might account for the disparity between Mechanic's and our own findings. Although further study is needed before any firm conclusions may be drawn, the evidence suggests that Mechanic's findings may be specific to the HMO populations that he sampled.     

A Three-Pronged Approach to Addressing Racial Disproportionality and Disparities in Child Welfare: The Santa Clara County Example of Leadership, Collaboration and Data-Driven Decisions

Disproportionality and disparities in the treatment of children of color has been a growing concern in the child welfare system. System stakeholders have begun to recognize the problem through data, which help identify discrepancies within their jurisdictions. Nationally, the primary concern is the overrepresentation of African American children within the child welfare system, where African Americans represent proportions of the foster population at a level more than twice as high as they are represented in the community at large. In some jurisdictions, however, this is only one piece of the disproportionality concern. San Jose, for example, has both an overrepresentation of African American and an overrepresentation of Hispanic children in the child welfare system. Because San Jose’s child welfare population is unique, they have had to take a unique approach to addressing these concerns. This article outlines strategies and tools used to begin reducing disproportionality within the child welfare and juvenile dependency court system, using San Jose’s experience as an example. Some of the key approaches to addressing disproportionality include ensuring a systems approach (creating a Cross Agency Systems Team that prioritizes services for parents and children in various systems, e.g., mental health, substance abuse, etc.); addressing disproportionality from multiple perspectives and examining the roles’ of caseworkers, supervisors, service providers, judges, and attorneys; gaining community and system stakeholder buy-in by maintaining momentum and providing opportunities for dialogue about the complex issues facing families of color; using a data-driven approach to inform ongoing initiatives and changes in policy and practice (e.g., closely examining policies and practices such as the frequency of recommendations to by-pass reunification services); and implementing changes in practice at multiple levels including child welfare and on the bench. The examination of San Jose’s approach reveals challenges, successes, and lessons learned.     

On-Campus Programs to Support College Students in Recovery

Abstract

The author argues that referral of alcohol-abusing college students to off-campus treatment services, although necessary for some, is not optimal for many. He advocates the implementation of comprehensive on-campus services for students committed to recovery in order to optimize their treatment while allowing them to remain in school and work towards their degree. The author suggests that such on-campus recovery services provide additional benefits to the college or university as well as to other students, and he proposes that on-campus alcohol-abusing students in recovery can serve as important opinion leaders and role models for their peers.     

Workplace stress among psychiatric nurses. Prevalence,distribution, correlates, & predictors

Vicarious trauma and burnout are serious manifestations of workplace stress. Both can have substantial consequences for health care professionals, health services, and consumers. This article reports results of a study examining the prevalence, distribution, correlates, and predictors of vicarious trauma and burnout among registered psychiatric nurses (RPNs). A survey was distributed to all practicing RPNs in Manitoba, Canada (N = 1,015). The survey contained the Maslach Burnout Inventory, the Traumatic Stress Institute Belief Scale (i.e., a measure of vicarious trauma), and a section on symptoms of posttraumatic stress disorder (PTSD). The RPNs were found to be experiencing high levels of emotional exhaustion (i.e., high burnout) and even higher levels of personal accomplishment (i.e., low burnout). No significant differences were found between respondents' total scores on the Traumatic Stress Institute Belief Scale and instrument norms for mental health care professionals. Predictors of burnout and vicarious trauma also are presented in this article. Stress experienced by RPNs, as well as strengths on which to build, clearly are evident in the study results. Strategies for reduction in workplace stress may benefit psychiatric nurses, clients, and health services.     

What really happened? A validation study of rape survivors' help-seeking experiences with the legal and medical systems

Much of what is known about rape survivors' experiences with the legal and medical systems has come from victims' accounts; rarely have researchers collected "the other side of the story" to find out what system personnel say did or did not happen in these interactions. In the current study, rape survivors who sought emergency medical care were interviewed before their hospital discharge about what services they received and how they were treated by social system personnel. Corresponding accounts were then collected from doctors, nurses, and police officers. There was significant interrater reliability between the survivors and legal and medical system personnel regarding what services were or were not provided ("service delivery") and if system personnel engaged in "secondary victimization" behaviors (i.e., statements/actions that could be distressing to victims). However, police officers and doctors significantly underestimated the impact they were having on survivors. Victims reported significantly more post-system-contact distress than service providers thought they were experiencing.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Revisiting the Effectiveness of Base Crisis Response Strategies in Comparison of Reputation Management Crisis Responses

This experimental study found that employing reputation management crisis-response strategies was no better than adopting only the base crisis-response strategy (i.e., instructing and adjusting information) in terms of generating positive responses from the public. Two-sided messages (i.e., sharing both positive and negative information) in crisis communication were found to be more effective than one-sided messages in a victim crisis. In addition, even in a preventable crisis, one-sided messages (i.e., sharing only positive information) were not more effective than two-sided messages. Finally, the study found little support for Situational Crisis Communication Theory (SCCT)'s recommendations for the best crisis response strategy selections.     

Trying to come home: Substance exposed infants, mothers, and family reunification

Substance abusing mothers comprise a significant proportion of caregivers in public child welfare, and achieve low reunification rates. Unfortunately little is known about treatment options intended to facilitate recovery and increase reunification. This study focuses particular attention on the relationship between specific treatment modalities (e.g., residential and outpatient), recovery from substance abuse and family reunification. Analyzing a sample of 160 mothers and their substance exposed infants, the findings clearly identify the benefits of residential treatment in terms of both treatment progress (directly) and family reunification (indirectly), but only when residential services are delivered in combination with transitional services.     

Examining Factors Associated With Program Completion Among Women Participants in a Statewide Drug Court Program

The study purpose was to examine factors affecting women in completing drug court. Participants were 212 women drug court participants selected via stratified random sampling (by county) from the larger Kentucky Drug Court participant population. Various secondary data sources were used (e.g., participant assessment, Management Information System), and multivariate logistic regression examining 17 independent variables showed 4 variables were significantly associated with program completion for women: employment at program assessment, intravenous opiate use, number of times hospitalized for psychological or emotional problems, and conviction of a misdemeanor-eligible violent crime before drug court. Study findings can be used by social workers and other practitioners to better understand women’s drug court participation and to identify ways to tailor program services for women’s unique needs.     

Linking child welfare and mental health using trauma-informed screening and assessment practices

An abundance of research suggests that children in the child welfare system (CWS) have experienced numerous traumatic events and are exhibiting traumatic stress symptoms. Therefore, it is critical that the CWS work closely with the mental health system to ensure that these children receive the appropriate trauma screening, trauma-focused assessment, and referral to the appropriate trauma-focused mental health services. This paper will begin by providing a concrete definition of trauma-focused screening and highlighting how that differs from a more comprehensive trauma-focused assessment process and a psychological evaluation. From there, the authors will highlight existing trauma-focused screening and assessment tools that are used widely within CWSs and the challenges related to integrating trauma-focused screening practices into CWSs. The authors will provide recommendations for ways in which child welfare jurisdictions can integrate trauma-focused screening practices into their daily practice.     

Relationship of risk assessment to placement characteristics in a statewide child welfare population

Risk assessments allow child and youth services to identify children who are at risk for maltreatment (e.g., abuse, neglect) and help determine the restrictiveness of placements or need for services among youth entering a child welfare system. Despite the use of instruments by many agencies within the U.S. to determine the appropriate placements for youth, research has shown that placement decisions are often influenced by factors such as gender, age, and severity of social–emotional and behavior problems. This study examined ratings of risk across multiple domains using a structured assessment tool used by caseworkers in the Rhode Island child welfare system. The relationship between ratings of risk and placement restrictiveness was also examined. Risk levels varied across placement settings. Multivariate analyses revealed that lower caseworker ratings of parent risk and higher ratings of youth risk were associated with more restrictive placements for youth. Implications for the child welfare system are discussed.     

When the Norwegian child-welfare services get involved: parents making sense of referrals

There is limited research exploring parents' views and understanding of referrals to the child-welfare services (CWS). This study explores parents' understanding of the circumstances leading to a child-welfare referral, and their understanding of the reporter's objectives in making the referral. Qualitative content analysis and frequency analysis was performed on open-ended survey responses from a sample of 683 Norwegian parents in contact with the CWS. The results showed that the majority (60.2%) of the parents perceived the referral to be initiated solely because of parental difficulties and multiple family life stressors. Some of the parents (22.8%) believed the referrals were initiated exclusively because of their children's problems, whereas a few (13.3%) perceived it to be a combination of parental/familial difficulties and children's problems. The findings reveal that close to half of the parents (46.4%) felt the objective of the person making the referral was to help the child, their parents and the family. Some (36.5%) saw it as a routine or mandated action by public or official services, while others (18.7%) reported that they did not know why referrals had been made, or gave no answer to the question. A small group of parents (6%) viewed the referral as an act of harassment. The main implications of these findings are discussed.