Impacts of a Medicaid Wraparound Model Demonstration Program on Youth Specialty Mental Health Services Use.

Effective coordination of mental health care is critical in Medicaid wraparound model programs for youth. This study examined participation over time in mental health services for youth diverted or transitioned from residential care to a Medicaid wraparound demonstration program. Youth in wraparound had more sustained use of mental health outpatient clinic services than did propensity score matched youth who were not in wraparound. However, the rate of outpatient clinic follow-up after inpatient discharge was no greater in wraparound. Routine assessment of wraparound programs' impacts on receipt of mental health care may inform the development of Medicaid wraparound program performance standards.

Youth, Caregiver, and Staff Perspectives on an Initiative to Promote Success of Emerging Adults with Emotional and Behavioral Disabilities.

Transitioning to adulthood is more challenging for youth with emotional and behavioral disorders (EBD) as compared to youth with other disability types and typically-developing peers. Outcomes for emerging adults with EBD as a group are particularly concerning in the domains of unemployment, educational dropout rates, and interactions with the judicial system including incarceration, early parenting, homelessness, substance abuse, mental health problems, and suicide. The current study presents qualitative program evaluation data for one of seven grantee states awarded 5-year cooperative agreements by the Substance Abuse Mental Health Services Administration (SAMHSA) to build developmentally-appropriate and effective youth-guided local systems of care for transition age youth, ages 16-25 years, to promote positive transition outcomes. Findings, obtained from focus groups of 25 participating transition age youth, caregivers, staff, and supervisors, include strategies for maintaining and expanding on the strengths of program, as well as for improving specific program areas. Also, consistent with the goals of the program, this process provided an opportunity for the youth and caregivers to voice their opinions and perspectives regarding their services. Implications for research and practice on effectively serving the unique needs of young adults experiencing EBD and their families in areas such as navigating special education, providing emotional and behavioral supports, and leveraging interagency collaboration are discussed.

Connecting Students to Mental Health Care: Pilot Findings from an Engagement Program for School Nurses.

Schools function as the major provider of mental health services (MHS) for youth, but can struggle with engaging them in services. School nurses are well-positioned to facilitate referrals for MHS. This pilot study examined the feasibility, acceptability, and preliminary efficacy of an engagement protocol (EP) designed to enhance school nurses' utilization of evidence-based engagement practices when referring youth to MHS. Participants were six school nurses and twenty-five adolescents in a large, urban school district. School nurses reported positive attitudes towards the EP, suggesting that they found it feasible and acceptable. Though there were small increases in school nurses' use of engagement practices and in adolescents' readiness for services following training, due to limited sample size, differences were not statistically significant. Still, pilot results suggest preliminary efficacy of training school nurses to strategically implement evidence-based engagement practices to increase adolescents' engagement in MHS.

Youth in group home care: youth characteristics and predictors of later functioning.

This paper presents the findings of an exploratory research study of foster care youth residing in group homes in a mid-Atlantic state in the USA. The aims of the present study were to (1) describe youth characteristics, (2) explore whether baseline functioning differed by gender or ethnicity, (3) explore predictors of cross-time differences in psychosocial functioning, and (4) explore predictors of later functioning, specifically age, gender, and length of stay. Psychosocial functioning at two time points (i.e., T1 = admission into group home; T2 = current or discharge) in 180 charts from 29 randomly selected group homes were reviewed. Youth were on average 14.86 years of age, predominantly male (71%; n = 128), and predominantly African American (79%). Findings suggest that group home placement may benefit some youth but not others, particularly girls and younger children with lower initial level of need. Findings underscore the potential complexity of intervention impact in the context of unique youth, family, and environment factors.

The effect of waiting time on youth engagement to evidence based treatments.

Prolonged waiting times to receive mental health services are common and may have negative consequences. This study examines the relationship between waiting time and treatment engagement among 2,054 youth referred to an evidence based treatment (EBT). Findings indicate that families are more likely to refuse services if they face longer waiting times. Families exposed to a prolonged waiting time were also more likely to drop out prematurely from Functional Family Therapy, but this relationship was not significant among youth receiving Multisystemic Therapy. Implications for EBT implementation and strategies for engaging families are discussed.

Providers' perspectives: utilizing telepsychiatry in schools.

BACKGROUND: The field of telepsychiatry has rapidly advanced a focus on decreasing health disparities by improving access to mental healthcare for children and adolescents. However, perfecting the quality and effectiveness of telemental healthcare is an ongoing process in the face of various documented barriers. Although consumer and provider satisfactions have been investigated in the telepsychiatry literature, perspectives of psychiatrists who consult with schools have been relatively understudied. The current study focuses on the utilization of telepsychiatry consultation to school mental health providers, by reporting on the perspectives of psychiatrists who provide consultation services. MATERIALS AND METHODS: Using quantitative and qualitative data, the psychiatrists' perspectives about their consultation experiences were examined and compared with previously obtained data from school mental health providers about their experiences with the telepsychiatry consultation. RESULTS: Results indicate positive provider experiences with telepsychiatry, including reports that students were more likely to disclose clinical information via video compared with face-to-face contact. However, concerns regarding technological difficulties, logistics, and information sharing were endorsed by some of the psychiatrists. Comparison with clinician reports revealed many similarities; however, differences were noted in regard to the psychiatrists' ability to communicate with the students and their level of preparedness for the consultations. CONCLUSIONS: Recommendations for ongoing evaluation and implementation of effective telepsychiatry consultation for schools are provided. Improvements in communication, scheduling, and addressing technological difficulties within the consultation team through training and consultation are recommended. Future directions for including student, caregiver, and other provider perspectives are also discussed.

Children's behavioral health system transformation: one state's context and strategies for sustained change.

The purpose of this paper was to examine the State of Maryland as a case study of sustained change efforts in the service delivery system for children with significant behavioral health needs and their families. A punctuated equilibrium paradigm is introduced to describe Maryland's behavioral health system transformation over the course of three decades. The context and specific strategies that characterized Maryland's execution of its recent Mental Health Transformation State Incentive Grant are highlighted. There is a discussion of one of the pinnacle achievements of Maryland's transformation efforts, the recent statewide establishment of care management entities for children with behavioral health challenges, and its implications for behavioral health in the context of health care reform changes. This case study illustrates how a state can systematically and incrementally develop systems of care for children and families that are values-based, sustainable, and flexible.

Partner violence before and after couples-based alcoholism treatment for male alcoholic patients: the role of treatment involvement and abstinence.

This study examined partner violence before and after behavioral couples therapy (BCT) for 303 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before BCT, 60% of alcoholic patients had been violent toward their female partner, 5 times the comparison sample rate of 12%. In the 1st and 2nd year after BCT, violence decreased significantly from the year before BCT, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after BCT. Structural equation modeling indicated that greater treatment involvement (attending BCT sessions and using BCT-targeted behaviors) was related to lower violence after BCT and that this association was mediated by reduced problem drinking and enhanced relationship functioning.