Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Development of the Mental Illness and Disorder Understanding Scale

Abstract: Although administrative bodies such as community health centers have implemented various awareness campaigns to promote community understanding of mental health and to reduce the stigma associated with mental illness and disorder, there have been few reports that have quantitatively analyzed the effects of these campaigns in Japan. Therefore, this study was conducted for the purpose of developing the evaluative “Mental Illness and Disorder Understanding Scale (MIDUS)” for awareness campaigns and assessing its reliability and validity. A survey was conducted on 1 004 community residents using a self‐administered questionnaire. An assessment of the reliability and validity of the scale was then conducted. The Cronbach a coefficient of the MIDUS was 0.78, thus indicating adequate reliability. Factor analysis of the MIDUS revealed three factors: “Treatability of illness”, “Efficacy of medication” and “Social recognition of illness”. In addition, a significant correlation was observed between the MIDUS and existing scales, and fixed criterion‐based validity was demonstrated. The MIDUS utilizes items worded in the form of affirmative expressions so as to avoid promoting new bias. It was confirmed to be both reliable and valid, thereby suggesting its usefulness as an evaluative scale of awareness campaigns.     

大学生自我表露的比较研究

目的:考察主动到心理咨询中心求助的大学生自我表露和孤独状况并与普通大学生的资料进行比较;考察来访者对咨询员的自我表露与其他目标人的表露之差异。结果发现:求询大学生与普通大学生的自我表露相比显著地低;求询大学生对咨询员的表露比其他目标人的表露显著地高;求询大学生的孤独感明显地高于普通大学生;心理咨询在大学生发展过程中起着重要的作用。     

文化符码与心理符码的合－－鲁迅作品中的看客形象小议

看客是鲁迅作品中的重要形象,它一方面作为一种文化符码出现在作品中,代表着鲁迅对中国封建文化的认识,体现着封建文化的吃人本质;另一方面,它又表现着鲁迅内心世界的恐惧心理,成为创作主体的心理符码.鲁迅对看客形象的塑造,是按照抽象这一艺术原则进行的,他限制看客的活动空间,把看客抽象成无生命的结晶质.这些艺术表现均源于鲁迅摆脱内心恐惧的需要.     

试论心理健康教育是思想政治教育的重要组成部分

心理健康教育定位不当是思想政治教育长期效果较差的重要原因之一.文章分析了心理健康教育和思想政治教育的关系,认为现代思想政治教育应包括思想教育、政治教育、道德教育和心理教育四个方面,其中,心理教育是基础.心理健康教育是最初级、最低起点的教育,同时又是最深层次的教育.因此,心理健康教育是思想政治教育的重要组成部分.     

对班主任工作的思考

本文根据笔者工作中的实践经验,从“全面了解学生情况、培养学生自信心、建立良好班风、建立班集体目标、重视学生心理健康教育、做好学生思想工作、客观公平对待学生、重视素质教育、沟通学校、家庭、社会三方面的教育”九个方面分析论证了班主任工作是一项研究人、影响人、教育人和塑造人的系统工程,它在实现学校办学目的、教育目标、教学功能等方面起着非常重要的作用。     

“生存”还是“生活”——论《邱园记事》中现代人的精神困境

弗吉尼亚·伍尔夫的短篇作品《邱园记事》展现了英国皇家花园的独特美景,但也揭示了现代人的精神困境。在自然风光之“静”的衬托下,以蜗牛行动为线索,四组人物的动态感得以呈现。伍尔夫采用不同叙事技巧,如:象征手法、意识流手法、对话等凸显了现代社会的弊端,即个人的精神压力沉重,漫无目的,畏于行动,注重物质“生存”而非富含思考的“生活”;就人与人之间的关系而言,最亲密的人也形同陌路,无比冷漠。由于战争等因素的影响,现代人“异化”严重。然而,伍尔夫还是对现代人摆脱精神困境寄予希望。     

Differences in white-nonwhite community mental health center service utilization patterns

Routinely collected computerized data were used to study the process of service delivery in terms of admission patterns, type and quantity of services rendered, and status at termination for whites and nonwhites in two community mental health centers. Social area analysis techniques were employed to control for socio-economic status, ethnicity and life style variables, and an epidemiologic model was used to analyze admission and service delivery rate differences. It was found that nonwhite admission rates were at least twice as great as white rates. Service delivery rates to the population at large were considerably greater for nonwhites than for whites. Delivery of direct services within the centers differed for whites and nonwhites, but no consistent trends emerged when types and amounts of services rendered were analyzed, controlling for sex, ethnicity, age, diagnosis and social area. Disruption of care indices were greater for nonwhites than for whites. Highlighted were some of the complexities involved in interpreting results of utilization studies.     

Mental health program evaluation: Where you start?

Seduced by the elegance, sophistication and jargon characteristic of new developments in applied research, practicing evaluators are in danger of becoming distracted from achievement of their evaluative goal: that of providing timely, reliable and useful data to program management to facilitate rational data-based decision-making. To avoid such seduction, the author advocates adaptation of simple, inexpensive and efficient evaluative methods tailored to organizational needs and presentation of findings in language readily understood by constituent groups. Likewise, insistance by evaluators upon maintenance of a strict role boundary — that is, limiting role functioning exclusively to those tasks considered evaluation — may be dysfunctional. Rather than detract from accomplishment of his goals, the author maintains that such participation allows development of skills, insights and staff relationships which enhance the evaluator's effective functioning within the organizational context and contribute to organizational acceptance and use of his evaluative results.     

On the limiting properties of social indicators

Characteristics of the population and economic measures that constitute traditional social indicators are compared with more recent “quality of life” measures to demonstrate that social indicators are always value statements at the policy level. The possibility of alternative perspectives is illustrated. It is suggested that an awareness of the assumptions implicit in any given indicator is as important as the data they provide.