Achieving Wellness: Monitoring the Success and Challenges of the Youth Health Indicator Program for Youth Treated in Outpatient Psychiatric Settings.

The youth health indicator (YHI) program was developed to improve health and reduce risk behaviors for youth treated in clinic and day treatment psychiatric settings. This study examined implementation of the YHI program and factors associated with BMI % change for youth participating in the program. Outpatient facilities which implemented the YHI program were surveyed (N = 10) and lessons learned were summarized. Mixed random effects repeated measures analysis was used to examine BMI % trajectory for youth admitted during 2010-2014 with BMI % measured (N = 6403). Treatment settings indicated a variety of strategies to undertake and sustain the YHI program. Factors associated with BMI % change over time were identified. The YHI program resulted in the development of a wide variety of programmatic innovations targeted at improving youth health. Continued work needs to be done to improve the health outcomes for youth in these treatment settings.

Detection and treatment of mental health issues by pediatric PCPs in New York State: an evaluation of Project TEACH.

OBJECTIVE: The authors evaluated Project TEACH (PT), a statewide training and consultation program for pediatric primary care providers (PCPs) on identification and treatment of mental health conditions. METHODS: An intervention group of 176 PCPs who volunteered for PT training was compared with a stratified random sample of 200 PCPs who did not receive PT training. Data on prescription practices, diagnoses, and follow-up care were from New York State Medicaid files (2009-2013) for youths seen by the trained (N=21,784) and untrained (N=46,607) PCPs. RESULTS: The percentage of children prescribed psychotropic medication increased after PT training (9% to 12%, p<.001), a larger increase than in the untrained group (4% to 5%, p<.001) (comparison, p<.001). Fewer differences were noted in diagnoses and in medication use and follow-up care among children with depression. CONCLUSIONS: This intervention may have an impact on providers' behaviors, but further research is needed to clarify its effectiveness.

Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know?

OBJECTIVE: Despite major recent research advances, large gaps exist between accepted mental health knowledge and clinicians' real-world practices. Although hundreds of studies have successfully utilized basic behavioral science theories to understand, predict, and change patients' health behaviors, the extent to which these theories-most notably the theory of reasoned action (TRA) and its extension, the theory of planned behavior (TPB)-have been applied to understand and change clinician behavior is unclear. This article reviews the application of theory-driven approaches to understanding and changing clinician behaviors. METHODS: MEDLINE and PsycINFO databases were searched, along with bibliographies, textbooks on health behavior or public health, and references from experts, to find article titles that describe theory-driven approaches (TRA or TPB) to understanding and modifying health professionals' behavior. RESULTS: A total of 19 articles that detailed 20 studies described the use of TRA or TPB and clinicians' behavior. Eight articles describe the use of TRA or TPB with physicians, four relate to nurses, three relate to pharmacists, and two relate to health workers. Only two articles applied TRA or TPB to mental health clinicians. The body of work shows that different constructs of TRA or TPB predict intentions and behavior among different groups of clinicians and for different behaviors and guidelines. CONCLUSIONS: The number of studies on this topic is extremely limited, but they offer a rationale and a direction for future research as well as a theoretical basis for increasing the specificity and efficiency of clinician-targeted interventions.