SAMHSA urges treatment programs to test for HIV

Last month, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) called on public health and substance use disorder (SUD) treatment providers to help make sure patients who are negative for human immunodeficiency virus (HIV) stay that way, and that those who are HIV‐positive are tested, receive antiretroviral treatment and stay “adherent” to the treatment. The directive came in the form of a “Dear Colleague Letter” from SAMHSA Director Elinore F. McCance‐Katz, M.D., Ph.D., assistant secretary for mental health and substance use for the Department of Health and Human Services.     

Briefly Noted

A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention published in Drug and Alcohol Dependence this month, based on a national survey of 46 opioid treatment programs (OTPs), concludes that buprenorphine and Vivitrol are not given equal footing with methadone as medications used by OTPs. All three are approved by the Food and Drug Administration for the treatment of opioid use disorder. Barriers, including costs, are identified. In addition, the report charges that services for HPV, HIV and other infectious diseases are not adequately integrated into OTPs, and that the reach of OTPs should be expanded. The report, “Characteristics and Current Clinical Practices of Opioid Treatment Programs in the United States,” is by Christopher M. Jones and colleagues; Elinore F. McCance‐Katz, M.D., Ph.D., is the senior author.     

Briefly Noted

Last week, a letter from Senators Edward J. Markey (D‐Mass.), Elizabeth Warren (D‐Mass.), Jeanne Shaheen (D‐N.H.), Dianne Feinstein (D‐Calif.) and Maggie Hassan (D‐N.H.) asked the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to immediately increase the patient cap — the maximum number of patients a physician can prescribe buprenorphine for — from 275 to 500. In addition, the letter requests that SAMHSA immediately process requests for emergency patient‐limit increases. “You can and should take immediate action to ensure that patients with OUD [opioid use disorder] are not denied the medication they need, do not exacerbate the strain on our nation's emergency departments and hospitals, and, most importantly, are not added to the COVID‐19 death count,” write the senators in their letter to HHS Secretary Alex Azar and SAMHSA Assistant Secretary Elinore McCance‐Katz, M.D. “We must empower our heroic health care providers to treat and save as many lives as possible in this time of crisis.” For the letter, go to https://www.markey.senate.gov/imo/media/doc/HHS%20SAMHSA%20Letter%20re%20Buprenorphine%20Prescriber%20Limits.pdf .     

NAMA and AATOD warn Senators not to raise cap

Last week, Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), and Zachary Talbott, president of the National Alliance for Medication Assisted Recovery (NAMA Recovery), wrote a letter to Congress warning against raising the DATA 2000 (buprenorphine prescribing) patient cap from 275 to 500 during the pandemic. The letter to Senators Ed Markey (D‐Mass.), Jeanne Shaheen (D‐N.H.), Maggie Hassan (D‐N.H.), Elizabeth Warren (D‐Mass.) and Dianne Feinstein (D‐Calif.) was in response to an April 17 letter from the senators to Health and Human Services Secretary Alex Azar and Assistant Secretary Elinore McCance‐Katz urging them to increase the cap.     

Does Family Intervention for Adolescent Substance Use Impact Parental Wellbeing? A Longitudinal Evaluation

Adolescent substance abuse is a common problem and family interventions are emerging as a strategy to prevent it and assist family coping. The effectiveness of a prevention‐focussed family intervention was evaluated for its secondary impacts on improving parental mental health and family functioning. Twenty‐four secondary schools in Melbourne Victoria were randomly assigned to either a control condition or an intervention titled Resilient Families. The two intervention levels analysed were: (1) a parenting booklet only and; (2) combining the booklet with face‐to‐face parent education sessions. Parent surveys at baseline were followed up one year and four years later. Repeated‐measures analysis (n = 560) found parents attending parent education demonstrated reductions in mental health symptoms, however this had negative effects on family cohesion and no impact on family conflict. These findings were interpreted in terms of parent education assisting parent mental health by promoting assertive parenting styles that may increase adolescent‐parent tension by encouraging firmer parental boundaries and strategies to reduce adolescent substance use.     

Appropriate Therapeutic Care for Families with Pre-Pubescent Transgender/Gender-Dissonant Children

In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families, schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize, viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization is the path they would prefer.     

Why do children placed out-of-home because of parental substance abuse have less mental health problems than children placed for other reasons?

The purpose of this paper was to compare children placed out-of-home because of parental substance abuse (PSA) with children placed for other reasons (NPSA), and to explore the association between PSA and mental health problems in a Norwegian sample of 6- to 12-year-old children in out-of-home care (N = 109). Several group differences were found related to the children themselves, their families and the Child Welfare case. The PSA children had less total difficulties, conduct problems and emotional problems than the NPSA children assessed by the teachers on the Revised Rutter Scale. However, both groups had far more mental health problems than children in general. The most important variable explaining the group difference in all subgroups of mental health problems was the extent of prosocial behavior in the children, but being placed for behavioral problems also explained a significant part of total difficulties and conduct problems. Variables like gender, discipline problems and socioeconomic conditions did not have a significant effect. The conclusion of the study was that prosocial behavior might be regarded as an important protective factor against mental health problems, which is an argument for investing in programs focusing on enhancing the placed children's mastering strategies.     

‘The Bad People Go and Speak to Her’: Young People’s Choice and Agency when Accessing Mental Health Support in School

Concerns about the mental health and well‐being of children and young people have been articulated in health and education policy fields as a call for closer working between schools and providers of mental health support services. Drawing from a Scottish study, this article explores issues of access, when mental health initiatives are sited in formal educational settings. In particular, it focuses on the implications for the agency of children and young people seeking support from those services when and how they choose. The study argues that over‐reliance on teachers as the main referral route to service influences what is deemed to be a problem, who is thought to need support and how the interventions are viewed by the children and young people. Alternative approaches are discussed, which offer opportunities for children and young people to explore the available services and make their own choices about their level of engagement.     

Young Fathers: An Analysis of Risk Behaviors and Service Needs

One hundred and twenty eight young fathers participated in an assessment of risk behaviors and service needs prior to entering a program for young fathers. Of this group, 73% were unemployed, 69% were school drop-outs, almost 40% had substance abuse problems, close to 30% had committed a felony, and less than half had declared paternity for their children. The majority of these young fathers desired employment services and educational/vocational training. Despite their risk behaviors, young fathers did not want substance abuse counseling, child support services, or help in obtaining a GED. There appears to be a discrepancy between the problems and needs, and the services which these young fathers requested. Many young fathers believed employment would be a panacea to all their problems. These findings suggest that more attention should be given to examining these issues in programs targeting young fathers. Services such as preventive health and mental health should be considered prior to the final goals of employment and establishment of paternity.     

The impact of climate change and natural disasters on vulnerable populations: A systematic review of literature

ABSTRACT

Climate change is acknowledged as being a crucial determinant of public health. The United States is experiencing an increase in the frequency and intensity of natural disasters as a result of climate change activity, influencing the ways federal, state, and local governments are addressing the growing issue. Individuals who are vulnerable to the effects of extreme weather, namely the poor, the elderly/disabled, children, prisoners, and substance abusers have experienced heightened levels of mental, emotional, and bodily stress due to natural disaster exposure. Researchers from a variety of disciplines, public health, social science, and environmental studies, in particular, are examining how natural disasters are impacting mental and physical health functioning while noting the demographic factors leaving certain groups more susceptible to harm. A systematic literature review was conducted on the past 12 years of research that examined natural disaster-related experiences and psychological and physiological health outcomes on populations who are more vulnerable to adverse weather impacts. It was found that the mental and physical health of marginalized populations during and after a natural disaster were elevated and/or exacerbated by circumstances pertaining to the weather event and the lack of disaster-response actions. It was also found that fostering social capital is a way to combat stressors in disadvantaged communities. It is imperative that clinicians and policy makers confront the issue of climate change and natural disasters, developing relief efforts and preventative measures to secure the well-being of underserved groups who may not have many resources at their disposal.     

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 IMPACT OF PERCEIVED BACKGROUND RISK ON BEHAVIORAL HEALTH: EVIDENCE FROM HURRICANE KATRINA

I explore the hypothesis that Hurricane Katrina in August 2005 raised perceived background risks, which had spillover effects on behavioral health outcomes of mental health and substance use. I estimate the effect that Katrina had in the nondamaged storm surge region, in time intervals leading up to and after the hurricane, compared to areas impervious to hurricanes. I find causal evidence that Katrina increased poor mental health days by 18.8% for the first month after Katrina, and increased smoking among lifetime smokers until 2007. Effects were larger in counties with disproportionate risk to storm surge and for low‐educated individuals. (JEL D81, I12, Q54)     

Life Course Heterogeneity in the Transition from Adolescence to Adulthood Among Adolescent Mothers

Longitudinal data were used to examine pathways taken by 227 adolescent mothers during the transition from adolescence into adulthood. Latent profile analysis identified three sub‐groups of adolescent mothers from 6 months to 6 years postpartum: a problem‐prone profile (15%), a psychologically vulnerable profile (42%), and a normative profile (43%). Group membership was related to long‐term adult outcomes (adult status markers, health‐risk and deviant behaviors, substance use, mental health, and intimate relationships) when respondents were nearing age 30. The psychologically vulnerable group reported greater health and mental health problems, relational problems, and substance use than the normative profile group. Only the problem‐prone profile group, taken together, reported serious problems in all domains of adult outcomes examined including financial, relational, behavioral, and health and mental health problems. Results confirm the existence of different pathways through adolescent parenthood that are associated with adult functioning 12 years postpartum.     

Online meetings for 12‐Step and other support groups

The study showing that Alcoholics Anonymous as as effective, or more effective, than psychotherapy (see “Research: AA is better pathway to abstinence than psychotherapy,” ADAW March 16, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32655 ) was published a few days before COVID‐19 federal and state restrictions on group gatherings (“social distancing”) took effect, making AA and other meetings untenable. This seems like cruel timing. But John Kelly, Ph.D., one of the authors of the study, provided the below infographic to ADAW on other meetings. And Keith Humphreys, Ph.D., co‐author, was quoted recently on ABC News saying that he is concerned about patients with extreme mental health issues such as addiction, for whom face‐to‐face contact is key.     

Editorial

In this paper I shall provide a self‐reflective account of the development of a psychoanalytic psychotherapy service for the parents and carers of children considered to be at risk of abuse or neglect by social workers or child mental health professionals. I will discuss some of my thinking in setting up such a service and the difficulties, both clinical and operational, that I have encountered. I will draw tentative conclusions about the effectiveness of once‐weekly psychotherapy for parents in protecting their children from harm and promoting their development. I will illustrate the difficulties and my conclusions with clinical material.     

Access to Mental Health Services: The Struggle of Poverty Affected Urban Children of Color

It is estimated that, in the United States, one in ten children and adolescents suffer from illness severe enough to cause some level of psychosocial dysfunction. Urban children, and in particular low-income children of color, are at greater risk of developing mental health problems, and are less likely to receive effective child mental health services. Prompt and effective access to mental health services by urban children of color is a critical direct practice and social policy concern. This article provides an overview of significant barriers to mental health care experienced by poverty affected urban children of color and their families. It also addresses a broad range of practice and policy issues that need to be raised in order to ensure competent delivery of mental health services for children living in urban environments. The role of social work in assisting poor urban children of color to access and benefit from mental health services is stressed. Manny John González, D.S.W., is an Assistant Professor of Social Work at Fordham University Graduate School of Social Service.     

Latina and African‐American Girls in the Juvenile Justice System: Needs,Problems, and Solutions

This review focuses on Latina and African‐American girls in the juvenile justice system with a special emphasis on their mental health, substance abuse, and treatment needs. Like many young women in the juvenile justice system, Latina and African‐American girls often have histories of neglect, abuse, and trauma, which contribute to later mental health and substance abuse issues. Despite these histories, juvenile justice professionals sometimes rely on stereotypes rooted in cultural deficit thinking to explain Latina and African‐American girls' delinquency. Relying on gendered, racialized, and classed stereotypes and assumptions can result in decisions that negatively impact Latina and African‐American girls' access to mental health, substance abuse, and other types of treatment. Policy and practice implications for better addressing the needs of Latina and African‐American girls are discussed.     

Predictors of Substance Use and Mental Health of Children of Divorce

Abstract

This short-term longitudinal study examined psycho-social influences on substance use and mental health among children of divorced parents. The sample consisted of ethnically diverse fifth and sixth grade students, and compared children of divorced parents (CODPs; N = 176), who were an average of four years post-divorce, with children of married parents (COMPs; N = 213) who had never divorced. CODPs reported more life stress, less problem-focused coping, and more substance-using friends and family members than COMPs. Further, these variables were significantly related to CODPs' greater reported substance use, aggressive behavior, and depression than COMPs cross-sectionally, and longitudinally, four months later. The results suggest the importance of including both substance use and mental health outcomes in preventive interventions for CODPs.