Mental Illness,Social Construction,and Managed Care

Abstract

Managed care is creating a social reality that affects the lives of millions. Mental health coverage under health care plans is a function of how mental illness and its proper treatment are defined. These definitions are shaped by social actors competitively seeking to satisfy their particular interests. This paper examines the influence of privatized managed behavioral health care on these evolving social definitions, as evidenced in published works, written reports, and legal actions. It is written from the perspective of social workers as providers of services and advocates for social justice. Options for social work responses to managed behavioral health care are explored.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

Uptake of HPV vaccine in traditional-age undergraduate students: Knowledge,behaviors, and barriers

Abstract

Objective: This study investigated potential factors associated with HPV vaccine uptake in a diverse population of traditional-age undergraduate students. Participants: One hundred and twenty-nine undergraduate students aged 18–24 attending a small southeastern university completed surveys in January to March of 2013. Methods: Questionnaires included demographic information, basic HPV knowledge, HPV vaccine uptake, and factors influencing uptake decision. Survey results were analyzed with chi-square and t-test analyses. Results: Vaccine uptake was significantly higher in students who reported that health care provider, public health information, parents, and access to vaccine were important factors in their decision to get vaccinated. Female students had a significantly higher vaccine uptake in comparison to males and the HPV knowledge scores differed significantly by race but not gender. Conclusions: It is especially important to consider how public health campaigns and communication with parents and health care providers help promote HPV vaccine uptake in this high-risk group.     

Health Services Utilization Among Graduate Students: Patterns of Use,Access, and Satisfaction

Abstract

Utilization of health services by graduate students has been a neglected area of college health research. This paper describes the access problems and utilization patterns of a systematic random sample of the graduate student population at the University of Mississippi.

Survey methodology was used to assess sociodemographic, health status, and attitudinal characteristics of the study sample. In addition to type and number of visits for various health services, other utilization-related items included access to and satisfaction with care, and information received about these health services.

The results indicated that graduate students and their dependents were reliant to a large degree on local health care. Inadequacy of information was viewed as a major problem relating to access. Satisfaction with care appeared to be a function of the quality of care received.     

Sexual health programming for vulnerable youth: Improving knowledge,attitudes, and behaviors

PurposeAmong girls in foster care, 48% become pregnant at least once by age 19 (Dworsky & Courtney, 2010). Youth in or at-risk for foster care (YFC) report limited knowledge about, access to, and use of condoms; ambivalent attitudes towards teen parenting; and participation in other risky behaviors. For the current study, we adapted and supplemented an evidence-based sexual health program called SiHLE, using a systematic adaptation framework (ADAPT-ITT, Wingood & DiClemete, 2008), to address the unique and targeted needs of youth living in a temporary shelter due to lack of housing. Youth in this study were either in foster care and awaiting placement, or having serious family problems and were at-risk of entering the foster care system.MethodsThirty-six youth participated in SiHLE-YFC during their stay at a temporary shelter. Four 90-minute sessions focused on increasing sexual health knowledge, improving attitudes towards and self-efficacy of condom use, and developing core skills such as problem-solving and communication.ResultsAs hypothesized, youth showed high satisfaction with the intervention and significant improvement in sexual health knowledge from pre to post. At one-month follow-up, youth continued to show significant improvement in sexual health knowledge, along with a significant reduction in risky sexual behaviors. Though not significant, there were moderate effect sizes for changes in attitudes towards teen pregnancy and condoms. There were no changes in attitudes towards teen parenting.ConclusionTaken together, findings suggest that sexual health education directly targeting the unique needs of YFC may improve sexual health knowledge and behavior, and are discussed in the context of challenges associated with intervention and research with this population.     

Infusing Integrated Behavioral Health in an MSW Program: Curricula,Field, and Interprofessional Educational Activities

ABSTRACT

An essential aspect of integrated care is the coordination of medical and behavioral health needs concurrently. This has sparked renewed emphasis on interprofessional (IP) education and practice. The impetus for IP efforts was crystalized in large part because of health care reforms, and federal funding to expand the behavioral health work force. Using an ecological systems perspective, this article describes how one school is preparing a new generation of MSW students to work in integrated behavioral health care using a three-pronged approach involving curricula, field education, and IP activities. Social work education must ensure that new and experienced professionals can (a) understand the profession’s role in IP health care settings, and (b) navigate an evolving and complex health care environment.     

Urban college student self-report of hookah use with health care providers

Objective: This study's purpose was to describe urban college students’ communication about hookah with health care providers. Participants: Participants included a random sample of undergraduate urban college students and health care providers. Methods: Students surveyed determined the epidemiology of hookah use in this population, how many health care providers asked about hookah, and how many students admitted hookah use to a physician. Results: Of 375 students surveyed, 78 (20.8%) had never tried it, 284 (75.7%) had smoked hookah at least once, and 64 students (22.6%) were classified as frequent hookah smokers. Only 15 (4.7%) reported a health care provider asking about hookah during visits, whereas 36 (12.7%) admitted their hookah use to a health care provider. Conclusion: Hookah use was found to be highly prevalent among students in one urban university. This study supports the hypothesis that few health care providers broach the topic with patients. Additional research on health consequences of hookah use, education, and improved screening is warranted.     

Brief Screening and Intervention for Alcohol and Drug Use in a College Student Health Clinic: Feasibility,Implementation, and Outcomes

Abstract

Objective: Evaluation of the Brief Alcohol Screen and Intervention in College Students (BASICS) in a university primary care setting. Participants/Methods: Undergraduates (N = 449) participated in BASICS and electronic surveys assessing frequency/quantity of alcohol and drug use, psychosocial and mental health outcomes, and demographic information. Data were collected at baseline and 6-month follow-up between August 2006 and August 2008. Results: Drinking and drug use decreased between baseline and 6 months. Participants reported an increase in protective factors and in readiness to change alcohol-related behaviors, and a decrease in alcohol-related consequences and in distress symptoms. Heavy episodic drinking at baseline significantly moderated the changes in number of drinks in a typical week and in a typical weekend, and number of drinks on the occasion drank most on a weekend. Conclusions: BASICS can be implemented in a primary health care setting and university students may reduce their alcohol and/or drug use.     

College Health as a Partner in the Care of Pediatric Cancer Survivors

Abstract

Objective: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center. Participants: Participants were University of Georgia (UGA) college health providers. Methods: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction. Results: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms. Conclusions: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.     

Implementation of an intimate partner violence screening program in a university health care clinic

Abstract

Objectives: To examine whether an intimate partner violence (IPV) screening program is related to a positive change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening. Participants: Eleven health care providers at a university health care clinic participated in the IPV screening program. Methods: A one-group pretest-posttest design was used to examine whether an IPV screening program was related to a change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening. Results: Findings indicated that there was a significant difference (p?<?000) between the posttest scores and the pretest scores on the Domestic Violence Healthcare Provider Survey Scale. Domain analysis of the scale revealed a significant difference in perceived self-efficacy (p?=?.001), system support (p?=?<.002), victim provider safety (p?=?.015), and beliefs of blaming victims (p?=?<.004). No statistical difference was found in professional role resistance/fear of offending (p?=?.158). Conclusions: A university health care clinic IPV screening program was related to a positive change in health care providers’ knowledge, attitudes, and self-efficacy of IPV screening.     

Exploring the Climate for Overweight and Obese Students in a Student Health Setting

Attitudes and beliefs of health care providers, in conjunction with a nonthreatening physical environment, are important components in establishing a constructive and supportive climate for care of overweight and obese students. Objective: The authors explored providers' attitudes about obesity and assessed the physical environment in a student health clinic to identify areas that may be detrimental to the care of overweight and obese students. Participants: Eighteen direct care providers participated in the project. Methods: The authors conducted focus groups with direct care providers and assessed their experiences and perceived challenges in working with overweight and obese students. The authors also conducted a walk-through assessment of the physical environment. Results: Direct care providers expressed discomfort in deciding how and when to discuss weight with students. The authors found that elements of the physical environment could present barriers to care for overweight and obese students. Conclusions: The authors make recommendations for improving the health care climate for overweight and obese students.     

Lifetime exposure to abuse,current stressors,and health in federally qualified health center patients

ABSTRACT

Purpose: The purpose of this study was to examine the impacts of lifetime exposure to abuse and current stressors on health, an integrative concept of physical, mental and social health, among patients of a Federally Qualified Health Center.

Method: The sample included 1,055 patients (male: N = 346; female: N = 709) who were at least 18 years of age and completed an assessment on their first visit between January 2015 and March 2017 at a Federally Qualified Health Center. The assessment contained subscales of the DUKE Health Profile measuring physical, mental, and social health; four questions assessing lifetime exposure to abuse; and a relational and socioeconomic stressor checklist.

Results: Results from structural equation modeling analyses showed that for both male and female groups, lifetime exposure to abuse, relational stressors and socioeconomic-related stressors were strongly associated with health. In the male group, socioeconomic-related stressors were the strongest predictor of health, while in the female group, lifetime exposure to abuse was the strongest predictor of health.

Conclusions: Understanding the relationships between health and the combined factors of a lifetime exposure to abuse, relational stressors, and socioeconomic stressors can provide insight to patient care professionals who treat patients in lower income, underserved communities. Ecological Systems Theory provides a framework to plan interventions or to prevent potential negative outcomes associated with these stressors.     

Predisposing,Enabling, and Need Predictors of Community versus Institutional Long-Term Care

Abstract

This research explored characteristics of the elderly that are associated with the use of long-term care services. Using the 1999 National Long Term Care Survey, logistic regression was employed to examine the relationship of race with the use of formal and informal long-term care. This study also examined the relationship of health insurance with the use of formal and informal long-term care. The Andersen Model on health services utilization was used as the theoretical framework. The findings indicated that race was not associated with the use of long-term care but rather with predisposing, enabling, and need variables. Health insurance was found to be associated with the use of long-term care even after controlling for predisposing enabling and need variables.     

A comprehensive health service evaluation and monitoring framework

ObjectiveTo develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services.MethodA targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders.ResultsThe framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable.ConclusionData collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle.     

Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

An Interview with Joyce Edward: Exemplary Clinician, Advocate, and Scholar

Over the years, noteworthy social workers have been interviewed for the Clinical Social Work Journal. This article features an interview with Joyce Edward who is recognized for her many extraordinary contributions to clinical social work. Joyce has co-written or co-edited three exceptional books for the social work clinician, she has been an esteemed teacher and a vocal activist for quality mental health care. In this interview Joyce reflects on family influences, her work as a social caseworker, the psychoanalytic luminaries with whom she trained, her concerns about the clinical education of today's social work students, and finally, her perspective on managed mental health care.     

The meaning of nursing-home: ‘Waiting to go up to St. Peter,OK! Waiting house,sad but true’ — An Australian perspective

BackgroundThis article is derived from a larger Australian research study using multiple qualitative methods to investigate truth-telling in aged-care.AimTo analyse and discuss findings associated with residents', personal care assistants' (personal carer, enrolled nurse) and the registered nurses' perceptions about the nursing-home. The thesis is that the health of the resident in a nursing-home is directly linked to care provision that encourages autonomy.MethodsResearch participants' personal journals, group discussions, follow-up in-depth discussions and the author's field journal across five nursing-homes.ResultsThe nursing-home is described as endowed with suspicious awareness and mutual pretence, overloaded with tasks, short of staff and starved of time with little engagement with the residents.DiscussionResidency that claims to have as its primary focus ‘the resident’ ought to take seriously the residents' health and therefore the residents' autonomy. However, the nursing-home, as described here, fails to adequately understand this link.     

Drinking Patterns,Problems, and Motivations Among Collegiate Bisexual Women

Objective and Participants: The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N = 2,788; n = 86 bisexual women). Methods: Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma. Results: They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women. Conclusions: More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women.