Evaluating a management and organization development effort in mental health agencies.

Although the use of management and organization development techniques in health and human service settings is increasing, there are few systematic studies of their effects. Those which do exist are problematic in many respects. An 18-month program incorporating both management and organization development is described along with the results of its evaluation, which were positive and well-utilized. A discussion of the methods employed, the problems encountered, and the outcomes obtained illustrates that these evaluation efforts are needed and can be useful to program evaluators involved in planned-change efforts.     

A principles-focused evaluation of community mental health short-term case management

Principles-focused evaluations allow evaluators to appraise each principle that guides an organization or program. This study completed a principles-focused evaluation of a new community mental health intervention called Short Term Case Management (STCM) in Toronto, Canada. STCM is a time limited intervention for clients to address unmet needs and personalized goals over 3 months. Findings showcase that a principles-focused evaluation, assessing whether program principles are guiding, useful, inspiring, developmental and/or evaluable (GUIDE), is a practical formative evaluation approach. Specifically, offering an understanding of a novel intervention, including its key components of assessment and planning, support plan implementation and evaluation and care transitions. Findings also highlight that STCM may work best for those clients ready to participate in achieving their own goals. Future research should explore how best to apply the GUIDE framework to complex interventions, including multiple principles, to increase evaluation feasibility and focus.     

Building relational possibilities: theoretical roots of infant mental health practice in the case of Alycia

The practice of infant mental health (IMH) has evolved from a combination of theoretical frameworks focused upon early relationships and the complex interplay between individuals and their internal and external worlds. The main components of IMH practice: developmental guidance; emotional support; parent–infant psychotherapy; concrete support; and advocacy, demonstrate a connection between psychoanalytic theoretical frameworks and social work values and forms the basis of practice for IMH therapeutic programmes. This paper will trace the theoretical roots of IMH practice and utilise a clinical case example to illustrate the ways in which insights from object relational, self psychological and attachment theories are integrated into IMH home visiting practices.     

Effectiveness of brief intervention and case management for children and adolescents with mental health difficulties

ObjectiveTo compare the effectiveness of a Brief Intervention (BI) and Treatment As Usual (TAU) in a sample of children and adolescents seeking mental health treatment from a Child and Youth Mental Health Service (CYMHS). BI comprised up to six sessions of psychological therapy from trainee psychologists, and TAU involves case management incorporating assessment and psychological treatment (e.g., individual, parent, family therapy), plus linkage to other services.MethodA matched subjects design was used to evaluate the BI (n = 79) and TAU (n = 79) treatment conditions. Participants were matched according to age, gender, and baseline symptom scores on the Health of the Nations Outcome Scale for Children and Adolescents (HoNOSCA), which was completed at pre- and post-treatment. The HoNOSCA is a clinician-rated measure of symptoms experienced in the previous two weeks.ResultsBI and TAU both significantly reduced mental health symptoms, with no significant difference between treatments overall, on Externalising or Emotional problems subscales, or on the percentage of most problematic items for participants.ConclusionsBI was as effective as TAU in reducing mental health symptoms in some children and adolescents. BI however is briefer, and could form part of a Stepped Care model for CYMHS. Further research is required to establish the most effective elements of BI in reducing mental health symptoms.     

A survey of mental health district structure and effectiveness

A national survey using a mailed questionnaire was undertaken to clarify issues of mental health district governance. CMHC, state hospital and district management and governance staff from 49 identified districts classified their districts on 20 types of decision authority and 14 measures of district effectiveness. Each respondent type thought their districts: (1) dealt with state money issues, seeking regional money, and coordinating/changing programs and services, and (2) effectively enhanced planning capabilities. Service providers did not find planning capabilities to be systematically related to specific decision authorities. CMHC management perceived less district control than district officials and, with state hospital management, perceived less effectiveness. District and CMHC officials see a direct relationship between district control and effectiveness. In a subsample of 11 districts each described by multiple respondent types, no item of authority or effectiveness was rated universally positive by all groups. District management subjectivity and legislative implications are discussed.     

Access barriers to mental health services for older adults from diverse populations: perspectives of leaders in mental health and aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

An intensive mental health home visiting model for two at-risk early childhood populations

This study examined proximal outcomes of a mental health home visiting model for two populations at risk for child maltreatment: families with young children referred by child protective services (CPS) and at-risk pregnant women (Prenatal) referred by community agencies. Family- and caregiver-level outcomes were measured using the Family Assessment Form (FAF). Families (n = 215) showed significant improvement in all eight family functioning factors over the course of their participation in mental health home visiting services. Initially, CPS-referred families (n = 84) scored higher on the FAF measure of Interactions between Caregivers, indicating greater conflict between caregivers in the family. Prenatal referred families (n = 131) were at greater risk initially on Housing. Prenatal-referred families demonstrated greater risk reduction on measures of Supports to Caregivers, Developmental Stimulation, Caregiver Personal Characteristics and Housing. In addition, all families demonstrated significant improvements in functioning on 11 of 12 items comprising the Caregiver Personal Characteristics factor. Overall, CPS-referred families scored at higher risk on items reflecting externalizing problems, while Prenatal-referred families showed greater improvement on items reflecting internalizing problems. This model was successful in reducing risk factors and promoting protective factors for CPS-referred and Prenatal at-risk families. Implications and future directions are discussed.     

Evaluating the effectiveness of ergonomics application

The effectiveness of ergonomics application is achieved in the course of this research by reviewing ergonomics literature, Internet searches and case studies of a number of work related musculoskeletal disorders (WMSD's) and other ergonomic related workplace incidence rate. The results of ergonomic intervention control measures such as engineering controls, administrative controls and personnel protective equipment were also studied. The findings in this paper may help to development model for analysing and solving ergonomic problems in the workplace. It concludes on the need for management to support ergonomics intervention programme for effective cost saving, litigation avoidance and better productivity.     

Improving physical and mental health in frontline mental health care providers: Yoga-based stress management versus cognitive behavioral stress management

The need for brief, low-cost, easily disseminable, and effective interventions to promote healthy lifestyles is high. This is especially true for mental health providers. The authors developed two studies to compare the impacts of Cognitive Behavioral Stress Management (CBSM) and Yoga-Based Stress Management (YBSM) interventions for health care professionals. Study 1 offered an 8-week YBSM intervention to 37 mental health care participants and collected health data pre- and post. Study 2 offered YBSM and CBSM classes to 40 randomly assigned mental health care providers and collected mental and physical health data at four time points. In Study 1, using t tests, the YBSM intervention affected a number of mental and physical well-being indices pre to post. In Study 2, using linear mixed modeling, YBSM and CBSM groups both improved significantly (p?p?F?=?4.34), physical activity (YBSM increased more, p?F?=?3.47), overall mental health (YBSM increased more, p?F?=?5.32), and secondary traumatic stress (YBSM decreased more, p?F?=?4.89). YBSM and CBSM appear to be useful for health care professionals’ mental and physical health. YBSM demonstrates some benefit above and beyond the extremely well studied and empirically supported CBSM, including increased physical activity, overall mental health, and decreased secondary traumatic stress benefits.     

Evaluating health outcomes of criminal justice populations using record linkage: the importance of aliases

Individuals in contact with the criminal justice system are a key population of concern to public health. Record linkage studies can be useful for studying health outcomes for this group, but the use of aliases complicates the process of linking records across databases. This study was undertaken to determine the impact of aliases on sensitivity and specificity of record linkage and how this affects ascertainment of mortality. Records for a cohort of prisoners were linked to methadone maintenance treatment (MMT) and mortality records. The record linkage was conducted in two stages. First, the linkage was undertaken using the participant's name and date of birth as recorded in a prior study. Then, a second linkage was undertaken using these identifiers, plus all known aliases. Sensitivity was 64%, and specificity 100%, for the first linkage. When aliases were added to the linkage, sensitivity increased to 86% and specificity remained 100%. The standardized mortality ratio was 4.3 for the first linkage, increasing to 6.1 when aliases were used. These results suggest that the potential effects of participant aliases on linkage outcomes, and methods for mitigating these effects should be carefully considered when planning and undertaking record linkage studies with criminal justice populations.     

Simple measures of case mix in mental health services.

The concept of Case Mix in community mental health service program evaluation can be useful in mental health program evaluation if the definition of case mix is expanded beyond Diagnostic Related Groups (DRG), where DRG is solely based upon diagnosis and length of hospitalization stay. A case mix definition based upon two principal characteristics is offered. One characteristic is clinical status defined in terms of diagnostic signs and symptoms, level of functioning, and age. The other characteristic is typical treatment strategy for a given period of time (e.g., 13 weeks). Two cases mixes typical of services designed for the chronically mentally ill are discussed.     

The effectiveness of health care cost management strategies: a review of the evidence

This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care services for their employees, and a health care system that is generally more concentrated and vertically integrated.     

Evaluating the effectiveness of student assistance programs in Pennsylvania

This article presents data from an evaluation of the Pennsylvania Student Assistance Program (SAP). Focusing on both program process and effectiveness, the evaluation was conducted to determine the overall efficacy of SAPs in Pennsylvania and, more specifically, how SAP is currently being implemented. Five data collection strategies were employed: statewide surveys of SAP team members and county administrators, focus groups, site visits, and the Pennsylvania Department of Education SAP Database. A total of 1204 individual team members from 154 school buildings completed the team member survey. Fifty-three county administrators completed the county administrator survey. Focus groups were comprised of SAP coordinators, school board personnel and community agency staff. Site visits were conducted at five schools. The findings of the evaluation indicate that SAP in Pennsylvania is being implemented as designed. Recommended is the development of benchmarks and indicators that focus on the best SAP practices and the extent to which various indicators of the effectiveness of SAP are occurring at appropriate levels.     

Issues in mental health care benefits: the costs of mental health parity

This Issue Brief discusses issues in mental health care benefits. It describes the current state of employment-based mental health benefits and discusses studies and issues regarding full mental health parity. It also includes an analysis of the effect of full mental parity on the uninsured population and the effects of the limited mental health parity provision contained in the VA-HUD appropriations bill. The final section discusses the implications of mental health parity for health plans and health insurers. When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable. The general strategies employers have used to manage their health care costs are cost sharing, utilization review, managed care, and the packaging of provider services. Employers' cost management strategies may be restricted, however. Five states have mental health parity laws, but three of the states--Rhode Island, Maine, and New Hampshire--apply these laws only to the seriously mentally ill. In addition, 31 states mandate that mental health benefits be provided. However, state mandates apply only to insured plans, not to self-insured employer plans, which are exempt from state regulation of health plans under the Employee Retirement Income Security Act of 1974 (ERISA). A number of recent studies have examined the effect of mental health parity on health insurance premiums in a "typical" preferred provider organization and on the uninsured. In general, the studies concluded that mental health parity could increase health insurance premiums, decrease health insurance coverage for non-mental health related illnesses, and increase the number of uninsured individuals. All studies of mental health parity, and mandated benefits in general, assume that there is a strong likelihood that increased health benefit costs would be passed along to workers in the form of higher cost sharing for health insurance, lower wage growth, or lower growth in other employee benefits.     

The mental health of the never-married

Although the interaction between mental health and marital status has been the object of much social scientific research, little is known about the mental health of never-married people. This article reviews research relevant to mental health and marital status as it pertains to never-marrieds. Methodological problems and current gaps in such research are pointed out. The mental health of never-marrieds is examined from three popular models of mental health—the social protection, social reaction, and social selection models. Each model offers competing explanations for differences in rates between married and unmarried people and between unmarried men and women. Suggestions are offered for improvement in researching the mental health of this neglected group.