Developing a New Approach to Case Management in Youth Mental Health: Strengths Model for Youth Case Management

Strengths Model (SM) case management has been utilized as a community based intervention with adults diagnosed with a mental illness since the 1980s. This paper describes the developmental, familial, and systemic adaptations made to the model so that it can be used with youth with mental illness. The resulting SM for Youth provides an alternative framework for providing case management to youth with mental illness which allows the youth to drive goal development and attainment by identifying and capitalizing on the youth’s strengths and resources. The model has the potential to positively impact youth mental health services by equipping supervisors and case managers with a formal model and tools, helping the case managers to feel more prepared and less stressed in their roles, and by empowering youth to engage in services that are positive and driven by their desires.     

Youth Sexual Exploitation on the Internet: DSM-IV Diagnoses and Gender Differences in Co-occurring Mental Health Issues

This paper explores conventional (non-Internet-related) mental health issues and DSM-IV diagnoses seen among a sample of 512 youth receiving mental health services for an Internet-related problem, with particular attention to victims of online sexual exploitation. Youth victims of online sexual exploitation were more likely to have a post-traumatic stress disorder than youth with other Internet-related problems. Specific attention was given to differences among subgroups of female and male youth victims of online sexual exploitation as compared with same-gender youth with other Internet-related problems. Findings suggest the importance of including Internet use and victimization as part of a standard clinical assessment.     

Motivations to Pursue Accreditation in Children's Mental Health Care: A Multiple Case Study

Accreditation is a growing, worldwide phenomenon that has spread to a range of industries and fields, including nonprofit social services and mental health care. Thousands of organizations are accredited, but it is not known what is driving the growth of this phenomenon. Using a multiple case study design, this exploratory study aimed to understand children's mental health agencies' motivations to pursue accreditation. In‐depth interviews, focus groups, document reviews, and limited observations were conducted at five children's mental health agencies that had recently undergone or were undergoing the Council on Accreditation process. Agencies were influenced by external factors, such as policies that require accreditation, wanting to assert their positions in the field, and the need to increase funding opportunities. Other factors were internal, related to agency leadership using accreditation as a platform for change and agencies' genuine intent to improve services. Implications for agencies, accreditors, and future research are offered.     

Children in Educational Residential Care: A Cohort Study of Israeli Youth

Abstract

This article reports preliminary findings from a national cohort study in Israel on the educational outcomes of 82,342 Jewish citizens born in 1981. We compare the educational outcomes of 2002 alumni of youth villages and their peers in the general population with respect to differences among cultural subgroups. The Israeli Central Bureau of Statistics generated the database by combining different official data files based on a personal identification number that each Israeli citizen receives. This database covers the entire cohort and includes information on their background and educational status. The findings indicate that the educational status of alumni of youth villages at the age of 27 is less positive compared to that of their peers in the general population. Cultural differences are discussed with respect to the role of youth villages as a means for upward mobility of disadvantaged youth, and implications for policy and future research are suggested.     

Family Reunification of Youth in Foster Care with Complex Mental Health Needs: Barriers and Recommendations

This study presents findings of a formative evaluation of an innovative pilot program designed to reunify and reintegrate foster youth with complex mental and behavioral needs in residential treatment centers or therapeutic foster care with their families in the community. Data collection methods included in-depth structured case file reviews and semi-structured interviews with the youth, as well as their caregivers, Child Protective Services caseworkers, and pilot program staff. The participants provided important insights regarding system, program, and case-level barriers to the successful reunification of these youth back into the community. Training, practice, and policy recommendations are discussed.     

The Relation Between Therapeutic Alliance and Treatment Motivation in Residential Youth Care: A Cross-Lagged Panel Analysis

This study investigated the longitudinal relation between therapeutic alliance and treatment motivation in a sample of 174 adolescents receiving residential treatment in the Netherlands. Structural equation modeling with a cross-lagged panel design was used to examine the relation between therapeutic alliance and treatment motivation up to 9 months of treatment. Results revealed that autoregressive associations between initial therapeutic alliance and alliance at subsequent time points were significant, whereas for treatment motivation a significant association was found after 6 months, but not after 9 months. Results also showed that a higher level of therapeutic alliance after 3 months was predictive of a higher level of treatment motivation after 6 months. Furthermore, a higher level of therapeutic alliance after 6 months was predictive of a higher level of treatment motivation after 9 months. Implications for research and clinical practice are discussed.     

Prevention of Mental Health and Behavior Problems Among Sexually Abused Aboriginal Children in Care

This agency-based study explored the preventive impact of a multi-method intervention program for children in care who had been sexually abused. Participants were Aboriginal children of the Stól:lö Nation in British Columbia, Canada. It suggested that such programs offered in child welfare contexts could actually prevent many mental health and behavioral problems that otherwise would be more prevalently experienced by such traumatized children in care.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.     

Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis

Abstract

Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between January and April 2006. Methods: A standardized 2-tiered screening approach for an inception cohort of students utilizing primary services. Primary care providers were trained to triage students with depressive symptoms. Results: Six percent of participants had clinically significant depressive symptoms (CSD). Severe depressive symptoms were found in less than 1.0% of participants. Male rates of severe depressive symptoms were more than double that of females. Only 35.7% of untreated depressed participants started treatment within 30 days following identification. Conclusions: Systematic primary care depression screening in a college health center is a promising approach to identify untreated students with depression. More study is needed to improve rates of treatment engagement.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Racial/Ethnic Disparities in Mental Health Service Use for Older Foster Youth and Foster Care Alumni

Studies have shown that foster care alumni have disproportionally high rates of poor mental health outcomes compared to the general population. The purpose of this study was to examine differences in mental health service use for Latino, African American, and White youth while in foster care and upon exit from the foster care system. Secondary data were used to identify youth 1 year prior to exiting the foster care system (N?=?934) and 1 year after exit from the foster care system (N?=?433). Racial/ethnic disparities in mental health service use upon exit from the foster care system were found, with Latino youth using the least amount of services after foster care exit. Racial/ethnic service disparities in type of services used were also found. Findings suggest that a lack of support (e.g., mandatory or voluntary) may be significant in overcoming challenges in the continuation or disruption of services.     

Flourishing: Exploring Predictors of Mental Health Within the College Environment

Abstract

Objective: To explore the predictive factors of student mental health within the college environment. Participants: Students enrolled at 7 unique universities during years 2008 (n = 1,161) and 2009 (n = 1,459). Methods: Participants completed survey measures of mental health, consequences of alcohol use, and engagement in the college environment. Results: In addition to replicating previous findings related to Keyes’ Mental Health Continuum, multiple regression analysis revealed several predictors of college student mental health, including supportive college environments, students’ sense of belonging, professional confidence, and civic engagement. However, multiple measures of engaged learning were not found to predict mental health. Conclusions: Results suggest that supportive college environments foster student flourishing. Implications for promoting mental health across campus are discussed. Future research should build on exploratory findings and test confirmatory models to better understand relationships between the college environment and student flourishing.     

Engaging with a Mental Health Service: Perspectives of At-Risk Youth

Studies suggest that only a small number of young people with diagnosable mental health difficulties are referred for treatment. Of these a significant proportion fail to engage in treatment or terminate prematurely. This situation is exacerbated when the young people are homeless or at risk of homelessness, and considered to be at-risk. With this at-risk population the process of engagement is likely to be a critical aspect of successful interventions. Using qualitative methodology, at-risk clients of a mental health service (n = sixteen) were interviewed, and four primary themes crucial to the engagement process were identified. The data indicated the importance of considering the young person and their multifarious life-experiences; the attractiveness and accessibility of the service; and the follow-up offered by the service provider. The implications for mental health services that provide counseling for young people are discussed.     

Engagement in Mental Health Treatment Among Adolescents and Young Adults: A Systematic Review

The purpose of the present study is to review empirical evidence of the effects of interventions designed to improve engagement in mental health services among adolescents, young adults and their families. Investigators searched relevant databases, prior reviews, and conducted hand searches for intervention studies that met the following criteria: (1) examined engagement in mental health services; (2) included a comparison condition; and (3) focused on adolescents and/or young adults. Effect sizes for all reported outcomes were calculated. Thirteen studies met inclusion criteria. Conceptualizations of engagement and measurement approaches varied throughout studies. Approaches to improving engagement varied in effectiveness based on level of intervention. Individual level approaches improved attendance during the initial stage of treatment. While family level engagement interventions increased initial attendance rates, the impact did not extend to the ongoing use of services, whereas service delivery level interventions were more effective at improving ongoing engagement. The review illuminated that engagement interventions framed in an ecological model may be most effective at facilitating engagement. Implications for future research and practice are discussed.     

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.     

Patient Abuse and Trauma: A Policy Analysis of the Regulation of Seclusion and Restraint in Mental Health Care

Historically, justifications for the seclusion and physical restraint of hospital patients have stereotyped individuals with mental illness as “dangerous” to themselves and others (Huckshorn, 2004a). It can be argued, however, that it is the policies that regulate the use of seclusion and physical and chemical restraints that are dangerous. This article analyzes the Patients’ Rights section of the Hospital Conditions of Participation (CoPs), Part 482 of CFR 42, including sub-sections: e. Standard: Restraint or seclusion; f. Standard: Restraint or seclusion: Staff training requirements; and g. Standard: Death reporting requirements. The set of CoPs regarding Patients’ Rights are analyzed from a value-critical, process-oriented perspective. This article proposes the following six-point framework as uniquely suited to evaluating 42 CFR 428.13: 1) introduction to the background and historical significance of the problem; 2) evaluation of the clarity and measurability of the goals and objectives of the policy; 3) overview of the intended impact of the policy; 4) examination of the value criteria; 5) examination of existing power struggles for those impacted by the policy; and 6) examination of the actual impact of the policy. Results of the policy analysis suggest that the policy does not go far enough to reach its stated goals and objectives in full. In the conclusions, suggestions for further protection of patients’ rights are provided. Examples of alternatives to restraint and seclusion are discussed. Finally, the grave importance of reshaping the culture of mental health care, in terms of life-and-death consequences, is considered.     

Walgreens: A Case Study in Health Care Issues and Conflict Resolution

The major problems for Walgreens in the health care reform debate and its primary stakeholders are identified, as well as the possible strategies to resolve the conflicts between Walgreens and its stakeholders. The overt positions, underlying interests, and best alternatives for resolution between Walgreens and its stakeholders are evaluated. Additionally, a conflict resolution model for public relations is developed as a guideline in suggesting strategies for solution. The three major issues for Walgreens were (a) cost of drugs, (b) freedom to choose the drug provider, and (c) mail-order drugs. Walgreens should collaborate with its stakeholders on the cost of drugs issue, accommodate on the freedom of choice issue, and seek compromise on the mail-order drug issue.     

The Role of Religion and Stress in Sexual Identity and Mental Health Among Lesbian,Gay, and Bisexual Youth

This study investigated religious stress, gay‐related stress, sexual identity, and mental health outcomes in lesbian, gay, and bisexual (LGB) adolescents and emerging adults. The model examined negative LGB identity as a mediator of the relationships between (1) religious stress and mental health, and (2) gay‐related stress and mental health. The data indicated that negative LGB identity fully accounted for both relationships. Findings suggest that a negative sense of sexual identity for LGB youth helps explain the links between religious and gay‐related stressors and mental health. As LGB youth may have limited control over these stressors, the importance of helping LGB youth maintain a positive LGB identity, despite homonegative messages from others, is discussed.