Chronic care,integrated care,and mental health: Moving the needle now

Healthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts.     

How do we value our children today? as reflected by children's health,health care and policy?

SUMMARY. The importance of children in their own right and of their healthy development for the health of society, have been affirmed at an international level by the United Nations Convention on the Rights of the Child in 1989 and by the Children Act 1989 in the United Kingdom. In the UK fifteen years ago, the report of the Court Committee set out a framework for Child Health Services based on the same recognition of the value of children. This paper describes how in spite of the far-reaching recommendations made by the Court Committee, the health of children in this country is far from satisfactory; how health policy and services have failed to meet their health care needs; and how other recent legislation such as the NHS and Community Care Act may well lead to further difficulties in working for the best interests of the child.     

Championing the interface between mental health and child protection: evaluation of a service initiative to improve joint working in northern Ireland

The importance of establishing effective inter‐agency working between adult mental health services and child care services in order to safeguard children has been repeatedly identified by research, policy, inquiries and inspection reports. This article reports on the evaluation of an initiative in one health and social care trust in Northern Ireland that aimed to facilitate joint working and so improve service provision and protection for children and families. The Champions Initiative involved identifying a Champion in each multidisciplinary community mental health team and in each family and child care team that would have responsibility for providing information, promoting joint working and identifying any obstacles to better cooperation. The evaluation of this Initiative assessed levels of experience, training, confidence, understanding and awareness in the Champions and their team members at baseline. The Champions and their Team Leaders were then followed up after six months to obtain their qualitative views of the impact of the initiative. The results include comparisons between mental health and child care staff, and crucially, views about whether the initiative has had any impact on working together. This study also generated recommendations for further service development in this complex and important area of practice. Copyright © 2010 John Wiley & Sons, Ltd.

‘Identifying a Champion in each multidisciplinary community mental health team and in each family and child care team’

Citing Literature

Number of times cited according to CrossRef: 15

• Kerry McVeigh, The Think Family Social Work Assessment: outcomes of a family-focused initiative using The Family Model, Advances in Mental Health, 10.1080/18387357.2020.1825969, (1-15), (2020). Crossref
• Billie Lever Taylor, Liberty Mosse, Nicky Stanley, Experiences of social work intervention among mothers with perinatal mental health needs, Health & Social Care in the Community, 10.1111/hsc.12832, 27 , 6, (1586-1596), (2019). Wiley Online Library
• Lelia Fitzsimons, The role of champions in promoting family focused practice across adult mental health and children's services, Advances in Mental Health, 10.1080/18387357.2019.1661783, (1-10), (2019). Crossref
• Nicky Stanley, Khatidja Chantler, Rachel Robbins, Children and Domestic Homicide, The British Journal of Social Work, 10.1093/bjsw/bcy024, 49 , 1, (59-76), (2018). Crossref
• Sanne Rumping, Leonieke Boendermaker, Doret J. Ruyter, Stimulating interdisciplinary collaboration among youth social workers: A scoping review, Health & Social Care in the Community, 10.1111/hsc.12589, 27 , 2, (293-305), (2018). Wiley Online Library
• Robin Mason, Janice Du Mont, Maeve Paterson, Ilene Hyman, Experiences of child protection workers in collaborating with adult mental health providers: An exploratory study from Ontario, Canada, Children and Youth Services Review, 10.1016/j.childyouth.2018.02.005, 86 , (271-276), (2018). Crossref
• Andani Thakhathi, Champions of Change and Organizational Development: A Return to Schön and Typology for Future Research and Practice, Research in Organizational Change and Development, 10.1108/S0897-301620180000026007, (265-306), (2018). Crossref
• Phillip Tchernegovski, Andrea E. Reupert, Darryl J. Maybery, How do Australian adult mental health clinicians manage the challenges of working with parental mental illness? A phenomenological study, Child & Family Social Work, 10.1111/cfs.12426, 23 , 3, (381-389), (2017). Wiley Online Library
• Eeva Timonen-Kallio, Juha Hämäläinen, Eila Laukkanen, Interprofessional Collaboration in Finnish Residential Child Care: Challenges in Incorporating and Sharing Expertise Between the Child Protection and Health Care Systems, Child Care in Practice, 10.1080/13575279.2016.1158153, 23 , 4, (389-403), (2016). Crossref
• Barry Luckock, Jane Barlow, Chris Brown, Developing innovative models of practice at the interface between the NHS and child and family social work where children living at home are at risk of abuse and neglect: a scoping review, Child & Family Social Work, 10.1111/cfs.12228, 22 , S4, (62-69), (2015). Wiley Online Library
• Joe Duffy, Gavin Davidson, Damien Kavanagh, Applying the recovery approach to the interface between mental health and child protection services, Child Care in Practice, 10.1080/13575279.2015.1064358, 22 , 1, (35-49), (2015). Crossref
• Estela Arcos, Ximena Sanchez, Maria Cecilia Toffoletto, Margarita Baeza, Patricia Gazmuri, Luz Angélica Muñoz, Antonia Vollrath, Social protection systems in vulnerable families: their importance for the public health, Revista de Saúde Pública, 10.1590/S0034-8910.2014048005131, 48 , 3, (398-405), (2014). Crossref
• Oi Ling Wong, Integrative Family and Systems Treatment with Parental Mental Illness: A Hong Kong Chinese Family, Contemporary Family Therapy, 10.1007/s10591-014-9298-2, 36 , 2, (242-249), (2014). Crossref
• Peter Sidebotham, Rethinking Filicide, Child Abuse Review, 10.1002/car.2303, 22 , 5, (305-310), (2013). Wiley Online Library
• Jane V. Appleton, Peter Sidebotham, Child Protection and Mental Health, Child Abuse Review, 10.1002/car.2220, 21 , 3, (153-156), (2012). Wiley Online Library

Volume 21 , Issue 3 May/June 2012

Pages 157-172     

Home care reimbursement for technology-dependent children: Its impact on parental distress

The distress of 52 parents with a technology-dependent child at home is measured using a standardized psychological inventory. Fifty-eight percent of these parents report enough symptoms to classify them as needing psychiatric intervention. Cost savings to third-party payers are accelerating the trend toward home care (rather than institutionalized care). Yet, these findings point to an underestimated cost to families in terms of parents' psychological well-being. One factor associated with less distress for mothers is having services reimbursed through the Medicaid Model Waiver Program, which provides a comprehensive plan for home care services. In contrast, services reimbursed by private third-party payers are more variable, placing greater financial strain and uncertainty on parents, which is associated with greater psychological distress. These results suggest the need for further study of the long-term impact on parents caring for technology-dependent children at home.Reprint requests to Barbara J. Leonard, R.N., Ph.D., Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, Box 197 UMHC, University of Minnesota, Minneapolis, MN 55455, (612) 625-3660.This study was supported in part by BRSG Number 2-S07-RR05448-25 awarded to the University of Minnesota, School of Public Health by the Biomedical Research Grant Program, Division of Research and Resources, National Institute of Health. Additional support was provided by the Department of Health and Human Services, State of Minnesota, Academic Computing Services and Systems, University of Minnesota and special project funds from the University of Minnesota School of Public Health.Barbara J. Leonard is an Assistant Professor and Chair of the Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, University of Minnesota, MN 55455. Her research interests include children with developmental disabilities, their parents, and siblings. She received her Ph.D. from the University of Minnesota.Janny Dwyer Brust is a Research Fellow in the Maternal and Child Health Major at the University of Minnesota. Her research interests include issues related to the care of chronically ill children and sexually abused children. She received her M.P.H. from the University of Minnesota.Joan Patterson is an Assistant Professor in the Maternal and Child Health Major and Associate Director of the Center for Children with Chronic Illness and Disability at the University of Minnesota. Her research interests include family adaptation to chronic illness and family stress and coping. She received her Ph.D. from the University of Minnesota.     

Connecting child care quality to child outcomes: drawing policy lessons from nonexperimental data

Effective early childhood intervention and child care policies should be based on an understanding of the effects of child care quality and type on child well-being. This article describes methods for securing unbiased estimates of these effects from nonexperimental data. It focuses on longitudinal studies like the one developed by the National Institute of Child Health and Human Development's Early Child Care Research Network. This article first describes bias problems that arise in analyses of nonexperimental data and then explains strategies for controlling for biases arising from parental selection of child care. Next, it comments on attrition in longitudinal studies and outlines some strategies for addressing possible attrition bias. Finally, it discusses the need to translate "effect sizes" derived from these studies into the kinds of cost and benefit information needed by policy makers.     

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.     

Medicaid Managed Care Programs for High-Risk Older People in Massachusetts

The Commonwealth of Massachusetts has undertaken a major initiative in the development of comprehensive managed health care programs for two sets of high-risk older people: those who are frail and homebound and those who reside in nursing homes. This effort has been coordinated by the state's Department of Public Welfare (DPW; Medical Assistance [Medicaid] Program) and Executive Office of Elder Affairs, and expedited ba a set of Health Care Financy Administration (HCFA) waivers and by the state's revised Nurse Practice Act (MGS Chapter 56). Than act allows nurse-practioners and physician assistants expanded roles as primary providers in home care and nursing home settings. The managed care initiatives have supplemented other efforts (1) to coordinate health and social services for older people, (2) to provide as broad a range as possible of community-based services for older people, and (3) to enroll as many older adults as possible in Health Maintenance Organization (HMO) "Senior Plans" and other similar "Competive Medical Plans."

Though there is still no evidence of the managed care programs' effects, this article summarizes some of the possible risks and benefits of managed care programs for those kinds of populations and presents an agenda of questions that evaluations of managed care programs must address.     

Variations in Child Care by Grandparents During the First Three Years

Routine child care by grandparents was examined for 1,229 children who were participants in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care. Four groups were identified: extended full‐time care, extended part‐time care, sporadic care, and no routine care during the first three years. The odds of sporadic child care by grandparents were higher when mothers were relatively young and worked nonstandard hours. The odds of extended full‐time grandparent care versus extended part‐time grandparent care were higher for mothers of color and mothers with more extensive full‐time employment. All types of grandparent care were more likely when a grandparent lived in the household. These findings suggest that grandparent care is heterogeneous and may occur in response to different family circumstances.     

Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self‐Selection Bias?

Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed‐effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent‐quality care is related to more sensitivity for mothers with lower family income. Poor‐quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims.     

New directions in child care

SUMMARY. This article examines through examples of child care services the gaps between research findings, child care policies and good practice. Links are made between research studies and Parliamentary enquiries, and the White Paper on Child Care law, concerning Children's Homes, fostering, education and health in care and leaving care The writer proposes that agencies should consider setting up internal means of keeping up to date with and disseminating research into policy and practice, and monitoring performance in relation to research findings, guidelines, legal requirements and inspectorial findings, Linked with internal training and staff development the article concludes that quality services might thus he more readily achieved than at present This article is based on a presentation to the joint Association of Metropolitan Authorities/Association of County Councils/National Children's bureau Child Care Conference on 26 January 1988     

Welfare Status and Child Care as Obstacles to Full-Time Work for Low-Income Mothers

SUMMARY

In this study, we use new data from the Philadelphia Survey of Child Care and Work to expand on previous analyses: we include child care problems as a work obstacle, and we analyze both current welfare recipients and non-welfare “working poor” mothers. Results show that two main obstacles have a large impact on full-time work: poor mental health and child care problems. Net of other factors, mothers with severe child care problems are 22 percent less likely to work full time. Dividing the sample by welfare status, we find a child care problems effect for both groups. Among welfare recipients, the gap in full-time work between those with severe child care problems and those without is 30 percent. Among the working poor, child care problems reduce the chance of full-time work by about 18 percent. Our findings show that improving mothers' child care situation can significantly improve their ability to support their families.     

A Pilot for Improving Depression Care on College Campuses: Results of the College Breakthrough Series–Depression (CBS-D) Project

Abstract

Objective: To implement a pilot quality improvement project for depression identification and treatment in college health. Participants: Eight college health center teams composed primarily of primary care and counseling service directors and clinicians. Methods: Chronic (Collaborative) Care Model (CCM) used with standardized screening to identify, treat, and track depressed students for 12 weeks to monitor predetermined process and clinical outcomes. Results: Of all students receiving primary medical care services between January 2007 and May 2008, 69% (n = 71,908) were screened for depression. A total of 801 depressed students were treated and tracked; most predetermined treatment process and clinical outcome targets were achieved. Conclusion: The CCM for depression shows promise for improving depression identification and care for college students.     

The Best Laid Plans: Expectations,Preferences, and Stability of Child‐Care Arrangements

This study considers whether an earlier and more extensive search for child care, and a match of the type used to the type preferred, predicts arrangement stability. We used the National Institute of Child Health and Human Development Study of Early Child Care to estimate multinomial logit models of arrangement changes over 3‐month intervals between 3 and 12 months (n= 958 children and 2,223 observations). Use of preferred care predicted greater arrangement stability, and parents who settled early on 1 option were less likely later to switch care types. Those who planned earlier were more likely to use their preferred care type and to use higher quality settings. This study encourages future research on how, when, and with what success parents search for child care.     

Addressing intimate partner violence in primary care: lessons from chronic illness management

Though many studies have documented the high prevalence, morbidity, mortality and costs attributable to intimate partner violence (IPV), it is still unclear how our health care system should address this major public health problem. Many have advocated for routine screening, yet there is still insufficient evidence that routine IPV screening can lead to improved outcomes. Though recognition of IPV is very important, a screening paradigm may not be the optimal way to approach IPV within the health care system. For many patients, exposure to violence is a chronic condition, characterized by long-term abusive relationships, histories of childhood and community violence, multiple associated chronic symptoms, and extra barriers to addressing their other chronic illnesses. Thus, there may be important lessons to be learned from work being done in the area of chronic care. We explore how Wagner's Chronic Care model may guide efforts to improve health care for IPV survivors and may serve as a framework for future research studies.     

Considering child care and parenting needs in Veterans Affairs mental health services

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans’ access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop “family-friendly” mental health services.     

The Safety First Assessment Intervention: A Whole Family Approach for Young People with High Risk Mental Health Presentations

The following article provides a comprehensive guide to the clinical implementation of the Safety First Assessment Intervention (SFAI). The SFAI is a systemised, whole family approach for young people with high‐risk issues presenting in a mental health crisis. It is underpinned by the Safety First Model (Bickerton et al., 2007 ) and promotes community‐based care. The SFAI operationalises the foundation levels of the Safety First Model (SFM) through a highly structured clinical process. It draws on family systems theory, predominantly the work of Bowen ( 1978 ), to conceptualise distress through a multi‐generational systems lens and to prioritise the young person's natural support system (their family, friends, school and community) as their key resource. The SFAI engages this natural support system and facilitates open communication about symptoms, distress, safety and risk. This promotes a shared understanding of the key issues in a relational context and forms the basis of collaborative risk management. Thus, a system of safety emerges prioritising the family's role in optimising the young person's community‐based recovery. The need for pharmacotherapy and hospitalisation is therefore minimised. The article includes background theory, an outline of the structured assessment intervention and clinical techniques, including strategies for complex family situations. Specific strategies are illustrated with fictional vignettes. The work is based on the authors' accumulated experiences of working with young people and their families and carers in an acute Child and Adolescent Mental Health Service (CAMHS) for over a decade.     

Collaborative mental health in rural and isolated Canada: stakeholder feedback

This article presents research findings from the Rural and Isolated Working Group, one of six groups established by the Canadian Collaborative Mental Health Initiative (CCMHI). Funded through Health Canada's Primary Health Care Transition Fund, the goal of the CCMHI is to improve the mental health and well-being of Canadians by increasing collaboration among primary health care and mental health care providers, consumers, families, and caregivers. Qualitative data obtained from mental health care providers and consumers across all regions of Canada are presented in this article. Policy and regulation problems, barriers to mental health care access, service providers' perspectives of the challenges to consumer involvement, and solutions for addressing these issues are discussed. The article concludes by identifying how this research has informed and influenced initial steps toward mental health promotion and treatment of mental illness in rural and isolated Canada.     

Children's Rights and Health Care

SUMMARY. Health and health care are defined as rights in the UN Convention on the Rights of the Child. However, although the National Health Service offers universal coverage, it is hugely expensive with growing costs and growing demands made upon it. Rationing is inevitable and priorities must be set. This paper discusses the part that children's rights can play in influencing equitable provision and the quality of care.     

The Family Team at Boston Healthcare for the Homeless Program: an integrated approach to care in outreach settings

Since 1986, the Family Team at Boston Health Care for the Homeless Program has implemented an integrated, inter-professional, team-based model of care to serve families experiencing homelessness. The Family Team employs key strategies delineated by the well-established Health Care for the Homeless model, which emphasizes the importance of outreach medicine and a case management “one-stop shop approach”. We include an account of a specific case where the Family Team’s unique model helped a refugee family in Massachusetts access medical and social services otherwise more difficult to obtain. The Family Team’s onsite presence in the hotel-shelter and the team-based approach facilitated diagnosis of and successful treatment for cervical cancer in a mother of eight children. This case report suggests that the Health Care for the Homeless model of care should be more widely adopted in order to best serve homeless families.

Abbreviations: Boston Health Care for the Homeless Program (BHCHP); Emergency Assistance (EA); Health Care for the Homeless (HCH); Massachusetts General Hospital (MGH)     

‘Stuck In The Middle With You’: Towards Enabling Social Work with Disabled People

This article explores progress to date in embedding enabling social work understandings and practices with disabled people by reviewing the UK social work curriculum. Based on these observations and the ideas from UK disability studies, it will offer possible solutions or at least better pathways to enabling practice with disabled people. As Meekosha has pointed out in a global context, to date social work has been experienced as an ambivalent practice [Meekosha, H. & Dowse, L. (2007) ‘Integrating critical disability studies into social work education and practice: an Australian perspective’, Practice, vol. 19, no. 3, pp. 59–72], often both enabling and disabling; an intervention that can both lock and unlock resources, and challenge and reaffirm traditional notions of the ‘disability problem’ [Finkelstein, V. (1993) ‘Disability: A Social Challenge or an Administrative Responsibility?’, in Disabiling Barriers ‐ Enabling Environments, eds J. Swain, V. Finkelstein, S. French and M. Oliver, Sage Publications in association with the Open University, London]. Social work also has the potential to both challenge, but also be an (inadvertent) apologist for contemporary social support and welfare systems. Indeed it is clear that social work as a profession and social care as a policy area have been the poor relations of healthcare and health professions [King's Fund (2011) Social Care Funding and the NHS: An Impending Crisis?, King's Fund, London]. Viewed anthropologically, social work remains a largely non-disabled workforce ‘ministering’ to disabled clients (BCODP, 1997). This might reinforce the perception of ‘us and them’ in some social work encounters. As Paul Longmore questioned, can we begin to go ‘beyond affliction’ (2003) in our work with disabled people? Can social work help support the collective struggles of disabled people or is their role inevitably to reinforce that of individual(ised) clients?

The development of the personalisation agenda and self-directed support is clearly welcome in this context [DoH (2006) Our Health, Our Care, Our Say: A New Direction for Community Services, Department of Health, London; DoH (2007) Independence, Choice and Risk: A Guide to Best Practice in Supported Decision-Making, Department of Health, London; DoH (2009) Personalisation of Social Care Services, Department of Health, London]. Such developments reflect the changing service user–professional relationship. The temptation to see these developments as the icing on the social support cake needs, however, to be resisted. Arguably, with the increased rationing of social support, the continued role of social workers in assessment and monitoring of support could be seen to require a yet more reflexive and enabling professional education and training in an age of austerity, one where previously supported disabled people are being told that their needs can no longer be met.