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Purpose: Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. Methods: We conducted a cross‐sectional study to evaluate the association between patient‐level factors and a combined outcome variable encompassing multiple aspects of care engagement. Findings: Either online or on paper, 446 participants completed our survey. One‐third of the participants (33%) were from the southern United States; one‐third were women; one‐third were non‐White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. Conclusions: Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH. [ABSTRACT FROM AUTHOR]

Background: More than 20 million children in the United States lack access to primary health care. Practice Learning: Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. Implication For School Health Policy, Practice, And Equity: School‐based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full‐range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non‐insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. Conclusions: This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid‐Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district. [ABSTRACT FROM AUTHOR]

BACKGROUND Mental health services in the United States public schools are an important component of the academic success of a student. Not all schools, however, have the necessary personnel and funding to offer such services. METHODS: In this paper, we provide an analysis of data collected from schools in 3 geographic locations. Comparisons were made of the availability of personnel to assess and treat mental health disorders in students enrolled in city, urban, and suburban schools, with over 10,000 schools represented. The data were part of the 2015 to 2016 School Survey on Crime and Safety. RESULTS: Accessibility of mental health practitioners and reasons that limited efforts of a school to provide the services were assessed. Statistically significant differences were identified by school location, demonstrating that those in rural communities were most challenged providing diagnostic assessment and treatment for students by school mental health professionals, for several reasons. CONCLUSIONS: Increased state and county funding to support mental health practitioners in public high schools is one suggestion to address mental health disorders in students. Other strategies are offered for timely and appropriate diagnoses and treatment for mental health disorders that may impact the quality of life of a student for a lifetime. [ABSTRACT FROM AUTHOR]

Is the failure to implement the lessons of mental health service demonstrations an ethical problem? This paper reviews the experience with evaluating multi-site service demonstration programs in the United States. Some of the lessons have been adopted and others have not. There appears to be a pattern to the adoption of lessons: ideological and inexpensive changes in organization or treatment approach are more likely to be adapted than costly changes in the availability of services or 'transfer' resources (such as disability benefits or rental subsidies) to support independent housing. The paper reviews this experience for demonstrations such as the Community Mental Health Centers program, the Community Support Program, and the Robert Wood Johnson Foundation Program on Chronic Mental Illness, and it discusses prospects for current federal demonstrations. [ABSTRACT FROM AUTHOR]

Managed care and organized systems of care are restructuring the delivery of care in the United States. As care is reorganized, physician practice styles, autonomy, and compensation are undergoing profound changes. To successfully integrate physicians into the new managed systems of care, their organizational relationship to and their compensation within these systems must be carefully considered. This paper first explores physician motivation as it is related to compensation. The paper then describes a variety of emerging organizational designs aimed at aligning the interests of physicians and hospitals. The author considers fully integrated, physician-hospital organizations with target income compensation arrangements to be most suitable to the collective success of professionals and organized systems of care. The paper concludes with a discussion of the many dilemmas and challenges posed by the intertwining of managed care, organized networks of care, and professional compensation. [ABSTRACT FROM AUTHOR]

In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task‐shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task‐shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just‐In‐Time Training (JITT) as one strategy for improving task‐shifting efforts. We define JITT as on‐demand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to pre‐baccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task‐shifting and JITT, including expanding the science of JITT and anticipating how task‐shifting and JITT would work within the context of dynamic mental health service systems. Highlights: Task‐shifting refers to redistributing tasks from professionals to workers who have less training.Task‐shifting may be a key strategy in expanding child services in low resource communities.Just‐in‐Time Training (JITT) refers to efficient, on‐demand training experiences.JITT may strengthen task‐shifting efforts.Task‐shifting and JITT involve unique ethical considerations. [ABSTRACT FROM AUTHOR]

BURRELL B and TRIP H. Nursing Inquiry 2011; : 174-183 In this paper we provide a post structural analysis of the theoretical shifts informing changes to service delivery over the past 150 years in relation to people with intellectual disability. We utilise the New Zealand experience of reform as it reflected global knowledge at any given period. Firstly, we address the historical modes of treatment and care, with reference to the eugenics movement, the concepts informing 'Prisons of protection' and moral treatment. Secondly the paper traces reforms commencing in the 1960s where changes from institutional care to community care were informed by humanistic ideals, a key driver being the concept of normalisation. Theorists offered competing discourses that formed the bases of arguments for the status quo whilst resistant voices advocated change. Covering such significant changes leads us to assess the state of de-institutionalisation' as it stands today and how it may be perceived in the future. We assert that Foucault's genealogical approach provides analytic tools to uncover the dynamics of changing attitudes and approaches to service delivery. In applying a Foucauldian lens to the trajectory of reforms concerning institutionalisation to de-institutionalisation we question whether a form of re-institutionalisation may be occurring. [ABSTRACT FROM AUTHOR]

Created while competent, psychiatric advance directives (PADs) are legal documents that specify treatment preferences and may also include designation of a surrogate decision maker for use during later periods of acute illness in which competent decision making is impaired. The paper begins with an overview of the potentially therapeutic effects of PADs and then addresses four areas in which legislation and methods of implementing PADs need to consider implications of therapeutic jurisprudence: competence to create PADs, when to activate them, whether revocation should be permitted during incapacity and circumstances for overriding PADs. The paper draws on the research carried out in the US by the author and sponsored by the National Institute of Mental Health. The ways in which issues have been resolved in practice in the US point to applications in other jurisdictions. [ABSTRACT FROM AUTHOR]

The American Psychiatric Association, ('APA'), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Position Statement on Firearm Access, Acts of Violence and the Relationship to Mental Illness and Mental Health Services. [ABSTRACT FROM AUTHOR]

Objective: Bipolar disorder is a common and complex condition associated with high rates of disability and high health care costs. The aim of this article is to provide an overview of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)., Method: The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was conceived in response to an NIMH request for proposals to study the effectiveness of treatments for Bipolar Disorder. Aspects of this program have been adapted and enriched for presentation in this paper., Result: Designed for implementation in routine practice across a variety of settings, STEP-BD offers a disease management program in which standardized assessments are linked to critical decision points in clinical management pathways., Conclusion: This paper describes strategies used in STEP-BD to improve the treatment of Bipolar disorder: a simple conceptual model, which integrates assessments and management, and several specialized elements, used in the STEP-BD assessment package.

Unlabelled: RATIONALE, AIMS, AND OBJECTIVES: Evidence-based medicine (EBM) has given rise to evidence-based practice (EBP) in the field of mental health. EBP too is predicated on an evidence hierarchy and has the goal of using the "best evidence" (usually randomized controlled trials) to improve practice. EBP is increasingly influential in mental health care in the U.S. Growing numbers of researchers and public officials endorse its claims and pursue its benefits. The rationale for this paper is to examine the potential of EBP for the field of mental health-and public mental health care specifically. Is it likely to contribute to improved lives for mentally ill people? If so, how?, Methods: This qualitative study relies on archival, and to a much lesser extent, informant interview data. Informants were mostly public mental health officials because they are in a position to implement EBP on a large scale and their policies are a matter of public record. Interviews were semi-structured, held in person and on the telephone, and lasted one to two hours. Archival research included the substantial literature on EBM and EBP plus studies and articles on the practice and policy of U.S. public mental health care., Results: The results of this study were that there exists an extensive, coherent literature critical of EBM and of EBP specifically. Attempts to implement EBP will falter on epistemological and organizational barriers. Still, as a public idea--that more science will bring about better mental health practice--EBP may well serve political purposes, especially in the U.S. public mental health system, where more overtly ideological policies have been inadequate in the past. EBP, as a public idea, has the advantage of ambiguity, accountability, quantifiability, etc., Conclusions: This paper concludes that EBP is growing more influential in public mental health care in the U.S. Its practical strengths, i.e., its improvement of mental health practice, may turn out to be less than its strengths as a public idea in the formulation and dissemination of mental health policy.

This paper explores the provision of disaster-related behavioural and mental health (DBH) services as a problem of institutional collective action in the United States. This study reviews the challenges that providers have in surmounting multi-organizational disconnects, unstable professional legitimacy, ambiguous information, and shifting disaster needs in developing a system for delivering DBH services. Based on the adaptive governance framework, it argues that existing protocols such as the National Incident Management System (NIMS) and Incident Command System (ICS) may be helpful in advancing collective action, but that real progress will depend on a recognition of norms, expectations, and credentials across many spheres-in other words, on the ability of responders to continuously adjust their procedures and administrative boundaries for behavioural health institutions. [ABSTRACT FROM AUTHOR]

A psychometric analysis was conducted to reduce the number of items needed to assess the disability associated with mental disorders using the World Health Organization Disability Assessment Schedule (WHODAS). The WHODAS was to be used in the Substance Abuse and Mental Health Services Administration National Survey on Drug Use and Health (NSDUH), beginning in 2008, as part of a screening algorithm to produce estimates of the prevalence of serious mental illness (SMI) in the US adult population. The goal of the work presented in this paper was to create a parsimonious screening scale from the full 16-item WHODAS that was administered to 24 156 respondents (aged 18?) in the 2002 NSDUH. Exploratory factor analysis showed that WHODAS responses were unidimensional. A two-parameter polytomous Item Response Theory model showed that all 16 WHODAS items had good item discrimination (slopes greater than 1.0) for each response option. Analysis of item difficulties and differential item function across socio-demographic categories was then used to select a subset of eight items to create a short version of the WHODAS. The Pearson correlation between scores in the original 16-item and reduced eight-item WHODAS scales was 0.97, documenting that the vast majority of variation in total scale scores was retained in the reduced scale. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT: Significant growth and improvement of school mental health programs has occurred in recent years. However, evaluation of outcomes for children receiving these services is needed to provide accountability data and ensure the sustainability of these programs. When designing studies, evaluators must overcome several challenges that may threaten the validity of their conclusions. In this paper, threats or challenges to the internal and external validity of results from evaluation studies are reviewed. Suggestions are provided for overcoming these challenges, in order to encourage future evaluation activities in this developing field and to document the impact of services for youth and their families. (J Sch Health. 2000;70(5):206-209) [ABSTRACT FROM AUTHOR]

Aim: Individual Placement and Support (IPS), an evidence‐based supported employment model developed for adults with serious mental illness, has been recently targeted to young adults with mental health conditions, but little is known about its adoption in this age group in the United States. Methods: We recruited a volunteer sample of nine IPS programmes in five states serving young adults with mental health conditions aged 16 to 24. IPS team leaders reported programme and participant characteristics and rated barriers to employment and education. Results: Most IPS programmes were located in community mental health centres, served a small number of young adults, and received most referrals from external sources. The study sample of 111 participants included 53% female, 47% under 21 years old, 60% diagnosed with a depressive disorder; 92% had an employment goal, and 40% had an education goal. IPS specialists reported that managing mental health symptoms was the most common barrier to achieving employment and education goals. Conclusion: Future research should examine how IPS programmes could best provide services to young adults. [ABSTRACT FROM AUTHOR]

The sight of homeless people in U.S. cities and countrysides has entered our national consciousness. Many writers blame the increase in homeless people on the deinstitutionalization movement that occurred in the last 30 years. This paper disputes that conclusion and suggests that solutions to the growing problem of homelessness will not be found in admission wards of state mental hospitals. Relaxing commitment laws, imposing mandatory outpatient commitment, or forcibly transporting homeless people to emergency wards of psychiatric hospitals will not end homelessness, nor will they provide homeless mentally ill people what they need most: a decent home and supportive services. [ABSTRACT FROM AUTHOR]

This article discusses the much-misunderstood Tarasoff decision that requires psychotherapists to protect third parties from patients' violent acts. Through a normative approach, the paper analyzes four important issues: what to do when potential victims are unknown; what to do about the fact that the patients' potential for violence may be incorrectly perceived; the value of warning potential victims; and, the problem of discharging potentially violent patients from the hospital. The author proposes that the courts adopt a more flexible substantial departure test in most cases that involve psychiatric negligence. [ABSTRACT FROM AUTHOR]

Following a 1981 conference on Behavioral Science and the Secret Service, the author and his colleagues worked with the Service in a number of capacities. This paper summarizes their experience, with particular reference to the mentally ill threateners that come to the attention of the Secret Service. This experience offers one model for interaction between the Secret Service and a mental health agency, keeping clear the different roles of each. [ABSTRACT FROM AUTHOR]

The rise in the mental health movement coincides with a decline in prestige and importance of criminal law. While this may, in part, reflect the greater effectiveness of mental health treatment in dealing with overlapping problems, it also reflects certain problems that criminal law has with the individualistic values of modern society and the value-attractiveness of the mental health professions' commitment to helping the individual. However, many of the same value problems inherent in criminal punishment also apply to some aspects of mental health treatment, especially the paternalism of the doctor-patient relationship and involuntary treatment. Informed consent can be seen as a response to these value conflicts as well as part of the general extension of citizenship rights to the less privileged members of the society. This paper analyzes some of the conflicts inherent in the application of informed consent to mental health treatment from the above perspective. [ABSTRACT FROM AUTHOR]

Health care practitioners are encouraged to "know the cultures" of the multicultural client population they are serving in the United States. The premise behind this injunction is that the use of culturally sensitive techniques that are tailored to the cultural background of the client would result in effective therapy and produce positive outcomes. However, as reflected in the plethora of terms used to describe the application of this knowledge, it is not made explicit why culture would make a difference in therapy nor how it makes a difference, ultimately, in the outcome. The intern of this paper is to highlight one of the fundamental sources of variation in cultural beliefs that affect individual mental health. We propose a model that penetrates to the core of why culture makes a difference in how problems are perceived and appropriate responses defined. Humans have three basic needs: safety and security, integrity, and a sense of belonging. Yet each culture uniquely frames each of these needs and prescribes the sanctioned means to achieve them. In our struggle to define culturally competent or culturally based care, this fundamental aspect is often overlooked. Instead, the Western worldview, structure, and definitions are used as the template to assess dysfunction, diagnose a disorder, and prescribe appropriate care. The theoretical underpinnings of indigenous concepts of self and symbolic interactionism are integrated to clarify these cultural misconceptions and to construct a new paradigm for providing effective and acceptable mental health care. [ABSTRACT FROM AUTHOR]

During the past few years there have been important developments in two related fields, i.e., community psychology as it affects the delivery of mental health services and behavior modification as an approach for understanding etiology and treatment of mental disorders. Although behavioral technology has been applied increasingly to community areas, there has been little comprehensive integration of the two approaches. This failure may be due to a lack of clarity both in the definitions and assumptions of the two approaches. This paper presents an integration of community and behavioral psychology, first by delineating their critical concepts and then by presenting illustrations of behavioral community psychology. [ABSTRACT FROM AUTHOR]

This paper discusses the change in services as a suburban community mental health center divided from a central office unit into specific geographical units. Changes were found in the number of requests for service, the extent of consultation efforts, and total caseload. Mental health services in suburbia, it would appear, are significantly more likely to be used if they are close to the client. [ABSTRACT FROM AUTHOR]

Policy PointsLocal governments are increasingly adopting policies that earmark taxes for mental health services, and approximately 30% of the US population lives in a jurisdiction with such a policy.Policies earmarking taxes for mental health services are heterogenous in their design, spending requirements, and oversight.In many jurisdictions, the annual per capita revenue generated by these taxes exceeds that of some major federal funding sources for mental health. Context: State and local governments have been adopting taxes that earmark (i.e., dedicate) revenue for mental health. However, this emergent financing model has not been systematically assessed. We sought to identify all jurisdictions in the United States with policies earmarking taxes for mental health services and characterize attributes of these taxes. Methods: A legal mapping study was conducted. Literature reviews and 11 key informant interviews informed search strings. We then searched legal databases (HeinOnline, Cheetah tax repository) and municipal data sources. We collected information on the year the tax went into effect, passage by ballot initiative (yes/no), tax base, tax rate, and revenue generated annually (gross and per capita). Findings: We identified 207 policies earmarking taxes for mental health services (95.7% local, 4.3% state, 95.7% passed via ballot initiative). Property taxes (73.9%) and sales taxes/fees (25.1%) were most common. There was substantial heterogeneity in tax design, spending requirements, and oversight. Approximately 30% of the US population lives in a jurisdiction with a tax earmarked for mental health, and these taxes generate over $3.57 billion annually. The median per capita annual revenue generated by these taxes was $18.59 (range = $0.04‐$197.09). Per capita annual revenue exceeded $25.00 in 63 jurisdictions (about five times annual per capita spending for mental health provided by the US Substance Abuse and Mental Health Services Administration). Conclusions: Policies earmarking taxes for mental health services are diverse in design and are an increasingly common local financing strategy. The revenue generated by these taxes is substantial in many jurisdictions. [ABSTRACT FROM AUTHOR]

Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The onset of the 2020 COVID‐19 pandemic necessitated a rapid transition of mental health services from in‐person to telehealth counselling. Despite the far‐reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in‐person services delivered (i.e. pre‐pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra‐pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self‐reports would be generally equivalent across in‐person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in‐person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training. [ABSTRACT FROM AUTHOR]

Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This study estimates the rural‐urban differences in outpatient service utilization and expenditures for depression, anxiety disorder, and substance use disorder, and the evolving mental health provider mix for privately insured US adults aged 18‐64 during 2005‐2018. Methods: We used the IBM MarketScan Commercial Claims and Encounters Database for individuals covered by employer‐sponsored health insurance, from 2005 to 2018, with a yearly total number of beneficiaries ranging from 17.5 to 53.1 million. Claims for nonelderly adults with mental health and substance abuse coverage are included. Outcomes include rates of outpatient service utilization for depression, anxiety disorder, and substance use disorder; counts of outpatient visits; expenditure and share of the out‐of‐pocket cost; and the mental health services provider mix. Findings: Rural enrollees were less likely than urban enrollees to use outpatient mental health services for depression by 1.2% (percentage points) in 2005 and 0.6% in 2018. Among those who used outpatient mental health services, rural enrollees had fewer outpatient visits than their urban counterparts (difference: 1.8‐2.4 visits for depression, 1.2‐1.7 visits for anxiety disorder, and 0.7‐2.1 visits for substance use disorder). Rural patients paid less per year for mental health outpatient visits of the 3 conditions but incurred a higher share of out‐of‐pocket expenses. Rural and urban patients differ in the mix of mental health providers, with rural enrollees relying more on primary care providers than urban enrollees. Conclusions: Rural‐urban disparities in access to mental health services persist during 2005‐2018 among a population with private insurance. [ABSTRACT FROM AUTHOR]

Aim: Outcomes for individuals with psychotic disorders can be improved through early intervention services; however, identification continues to be a major problem in connecting individuals with these services. Social workers form a vast majority of the human service and mental health workforce in the United States and therefore have the potential to play a unique role in identifying and referring those who may benefit from specialty early intervention services. Methods: The current article describes the methodological design, implementation, and participant recruitment procedures of a large‐scale, web‐based training program for social workers promoting identification and referral of individuals with emerging symptoms of a mental illness with psychosis in the context of a randomized clinical trial. Results: The web‐based study enrolled 1384 individuals. More than half of study participants enrolled within the first 3 months of the 14‐month recruitment period. Completion of all study components was achieved by 959 individuals (69% of total enrolled), and completion status did not vary significantly by gender, ethnicity, or facility at which the individual was employed. Completion rates varied by race, such that participants identifying as White were more likely to complete the study, while those identifying as Black were less likely. Discussion: The results suggest the feasibility of using a web‐based training program to engage social workers in early psychosis identification practices. Challenges related to encouraging participants to complete the training and lessons learned during the study recruitment are discussed. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) is underdiagnosed and undertreated in medical settings, in part due to a lack of AUD assessment instruments that are reliable and practical for use in routine care. This study evaluates the test‐retest reliability of a patient‐report Alcohol Symptom Checklist questionnaire when it is used in routine care, including primary care and mental health specialty settings. Methods: We performed a pragmatic test‐retest reliability study using electronic health record (EHR) data from Kaiser Permanente Washington, an integrated health system in Washington state. The sample included 454 patients who reported high‐risk drinking on a behavioral health screen and completed two Alcohol Symptom Checklists 1 to 21 days apart. Subgroups of these patients who completed both checklists in primary care (n = 271) or mental health settings (n = 79) were also examined. The primary measure was an Alcohol Symptom Checklist on which patients self‐reported whether they experienced each of the 11 AUD criteria within the past year, as defined by the Diagnostic and Statistical Manual of Mental Disorders‐5th edition (DSM‐5). Results: Alcohol Symptom Checklists completed in routine care and documented in EHRs had excellent test‐retest reliability for measuring AUD criterion counts (ICC = 0.79, 95% CI: 0.76 to 0.82). Test‐retest reliability estimates were also high and not significantly different for the subsamples of patients who completed both checklists in primary care (ICC = 0.82, 95% CI: 0.77 to 0.85) or mental health settings (ICC = 0.74, 95% CI: 0.62 to 0.83). Test‐retest reliability was not moderated by having a past two‐year AUD diagnosis, nor by the age or sex of the patient completing it. Conclusions: Alcohol Symptom Checklists can reliably and pragmatically assess AUD criteria in routine care among patients who screen positive for high‐risk drinking. The Alcohol Symptom Checklist may be a valuable tool in supporting AUD‐related care and monitoring AUD criteria longitudinally in routine primary care and mental health settings. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic and its restrictions have led to a shift in how people connect with others. This study investigated (a) profiles of social contact change across social ties and modes of contact, (b) predictors of these profiles, and (c) the association between these profiles and mental health during the pandemic. Participants (N = 2,098; Age mean = 50.94, range = 18–98; 48.3% female) were surveyed online twice, once prior to the pandemic (January 31–February 10, 2020) and again early in the outbreak (March 18–29, 2020). A latent profile analysis identified profiles of social contact change across social ties and communication methods. Additional analyses identified predictors of group membership and their association with mental health. Three latent groups were identified: (1) the "majority group" (77%) slightly restricted in‐person contact and had a small increase in phone and text use, (2) the "high technology use group" (13%) restricted in‐person contact and increased the use of all technology‐based methods, and (3) the "isolated group" (10%) decreased in both in‐person and technology‐based contact. Compared to the majority group, the high technology use group reported higher depression and anxiety, whereas the isolated group reported higher loneliness. There were three distinct profiles of how adults in the United States changed their communication patterns with others early in the pandemic that were linked to distinct patterns of mental health. The results have implications for the development and the delivery of mental health treatment in times of social (physical) distancing. [ABSTRACT FROM AUTHOR]

This paper reports the findings of investigations into allegations of patient abuse and the implications for policy and practice. These investigations were carried out by a nurse with a background in ethics for the office of Protection and Advocacy for Individuals with Mental Illness (PAIMI), a state agency operating under a United States federal law entitling it to investigate complaints by psychiatric patients. PAIMI uses investigations both to help individuals and to provide an avenue for broader change. There are four steps in the investigation process: (1) definition of the problem; (2) gathering information; (3) synthesis; and (4) addressing the problem. Cases are presented to illustrate the investigation process and identify ethical issues arising in mental health treatment. Among the issues raised are autonomy and forced treatment, deinstitutionalization, bias against the mentally ill, privacy, and surrogate treatment decisions. Resolutions range from providing individual advice to clients or clinicians, to changes in institutional policy and the publication of guidelines for specific situations. The following lessons were learnt from the investigations: (1) tell patients what to expect; (2) pay attention to the process of giving care; (3) allow patients to feel ambivalent about treatment; and (4) work to develop good relationships; underlying every investigation has been a poor relationship. [ABSTRACT FROM AUTHOR]

The emergence of the novel coronavirus disease (COVID‐19) in early 2020 led to the sudden temporary closure of K‐12 schools across the United States. Schools were tasked with providing remote instruction to students, and many of these children continued to require mental and behavioral health services provided by school psychologists. In this study, 675 school psychologists were surveyed across the United States to examine how their roles and responsibilities changed as a result of COVID‐19. Participants reported the perceived impact of COVID‐19 on students' mental health and difficulty serving students and families, as well as their concerns and recommendations pertaining to school reentry. Overall, respondents in this study reported that their roles and responsibilities notably changed because of COVID‐19. Participants noted their belief that children and educators will need increased mental health support upon returning to school. Implications for future practice and research are discussed. [ABSTRACT FROM AUTHOR]

Objective: To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence-based treatment.Data Source: Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) in a major metropolitan area in the United States.Study Design: We tested for equivalence between providers (N = 182) with and without advanced degrees in treatment-related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer-rated competence in AF-CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes.Data Collection: Providers completed measures prior to randomization and at 6-month follow-up, after completion of training and consultation in AF-CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months.Principal Findings: Providers without advanced degrees were largely non-inferior to those with advanced degrees in treatment-related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non-inferior to providers with advanced degrees in consultation attendance (B = -1.42; confidence interval (CI) = -3.01-0.16; margin of equivalence (Δ) = 2), number of case presentations (B = 0.64; CI = -0.49-1.76; Δ = 2), total training hours (B = -4.57; CI = -10.52-1.37; Δ = 3), and trainer-rated competence in AF-CBT (B = -0.04; CI = -3.04-2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10-0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive.Conclusions: Provider-level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence-based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence-based treatments. [ABSTRACT FROM AUTHOR]

The authors present the findings of the research on the delivery of mental health services in community disasters initiated by the Disaster Research Center(DRC) at Ohio State University. The study involved case studies of eight communities where mental health services were delivered after a disaster and three communities without recent experience of a disaster. The results showed that the delivery of organized mental health services in disasters is characterized by a lack of preparedness planning at the local community level and a consistent absence of demands for traditional mental health services.

Pediatric anesthesiologists practice within a culture, a system, and a society. In this article, we provide an overview of the influence these have on the well‐being or the unwellness of pediatric anesthesiologists. The scope of these issues is broad and far‐reaching; thus, our goal has been to highlight those areas which would be likely to have the largest impact on well‐being if addressed fully by society, institutions, and leaders in our field. We discuss the burnout‐promoting aspects of medical education and training. We survey occupational factors, such as the high‐stake pediatric anesthesia environment, occupational health hazards, time pressure, and the reduction in physician autonomy. We then describe societal barriers, such as the marginalization of certain populations, the US system of malpractice litigation, the stigma surrounding psychiatric care, and some of the issues related to physician reimbursement in the United States. We conclude that in order to move forward, improving physician wellness must be a focus of society, of the medical system as a whole, and of individual departments and leaders in pediatric anesthesia. [ABSTRACT FROM AUTHOR]

Objective: To examine the availability and facility‐level predictors of LGBT‐specific mental health and substance abuse treatment in the United States. Data Sources/Study Setting: 2016 National Survey of Substance Abuse Treatment Services, 2016 National Mental Health Service Survey, and 2015‐2016 Gallup Daily tracking survey. Study Design: Logistic regression models and average marginal effects were used to identify characteristics of facilities that offer LGBT‐specific programs. Linear regression models were used to estimate the association between the state‐level proportion of LGBT people and the proportion of facilities that offer LGBT‐specific programs. Data Collection/Extraction Methods: Secondary data analysis. Cases with missing values for any predictor were excluded. Principle Findings: 12.6 percent of mental health and 17.6 percent of substance abuse facilities reported LGBT‐specific programs. Several facility characteristics were statistically associated with the likelihood of mental health and substance abuse facilities providing LGBT‐specific programs, including offering outpatient or residential treatment, private ownership, religious affiliation, and payment type. The proportion of LGBT adults living within each state was statistically associated with state‐level density of LGBT‐specific mental health programs, but not substance abuse programs. Conclusions: Findings suggest limited availability of culturally competent mental health and substance abuse treatment, despite well‐documented need. [ABSTRACT FROM AUTHOR]

Objective: The collaborative care model is effective in delivering evidence‐based psychosocial oncology care. Social workers comprise the largest proportion of psychosocial oncology providers in the United States. This study describes the process and perceptions of clinical oncology social workers at a large comprehensive cancer center who transitioned to practicing as care managers within collaborative care. Methods: We describe the process of engaging clinical oncology social workers as care managers as part of the implementation of collaborative care at the Seattle Cancer Care Alliance. We then present survey results from 2017 and 2020 of participating social workers' perceptions of the collaborative care model's advantages and disadvantages. Results: Since the implementation of collaborative care at our institution, key functions of the social worker as care manager were defined. The majority of social workers surveyed in 2017 and 2020 agreed that collaborative care led to improved clinical outcomes, timely access to care, and greater patient satisfaction. They also reported professional advantages: more interdisciplinary team integration, working at the top of their licensure, and improved job satisfaction. Challenges identified included missing important patient needs and creating extra work burden for social workers. Conclusions: Oncology social workers can be successfully deployed as care managers within a collaborative care model, thus leveraging existing clinical staff to address unmet psychosocial patient needs. This model is feasible and sustainable in a large academic cancer center, requires minimal additional resources, and is favorably viewed by participating social workers in terms of perceived benefits to patients and their own professional roles. [ABSTRACT FROM AUTHOR]

Aim: To describe the characteristics of the pathway to coordinated specialty care for young adults with early psychosis in the United States, to examine how various factors correlate with the duration of untreated psychosis (DUP), and to explore factors associated with time from onset of symptoms to first mental health service contact (help‐seeking DUP). Methods: The sample included 779 individuals ages 16 to 30 with recent‐onset non‐affective psychosis enrolled in OnTrackNY. Domains assessed included demographics, clinical characteristics, mental health service utilization and characteristics of the pathway to care. Primary outcomes included the time from onset of psychotic symptoms to admission to OnTrackNY (DUP) and time from onset of psychotic symptoms to first mental health service contact (help‐seeking DUP). Results: The mean DUP was 231.2 days (SD = 87.7, median = 169) and mean help‐seeking DUP was 73.7 days (SD = 110.8, median = 27). Being in school, better social functioning, and greater number of ER visits or hospitalizations were associated with shorter DUP. Violent ideation or behaviour and having an outpatient mental health visit as the first service contact or hallucinations as the reason for first service contact were significantly associated with longer DUP. Only the type of first service contact (outpatient mental health treatment or other non‐mental health service provider) and having hallucinations as the clinical reason for the first service contact were associated with help‐seeking DUP. Conclusions: Referral delays were longer than help‐seeking delays. Strategies to reduce treatment referral delays through systems‐level interventions may be most likely to reduce the overall DUP in this population. [ABSTRACT FROM AUTHOR]