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Objective: The authors quantified the impact of the use of telehealth services on patient-level clinical outcomes among children with complex behavioral and emotional needs in Idaho during the COVID-19 pandemic by comparing data collected in 2020 with data for the same months in 2019., Methods: Longitudinal statewide data of Child and Adolescent Needs and Strengths (CANS) assessments were extracted from Idaho's mental and behavioral health system. Prepandemic assessments were matched to midpandemic assessments. A linear mixed-effect model was used to explore four child-level outcomes: psychosocial strengths-building rate, rate of need resolution within a life-functioning domain, rate of need resolution within a behavior-emotional domain, and rate of need resolution within a high-risk behaviors domain., Results: The number of new patients admitted to Idaho's state-funded mental and behavioral health program decreased almost twofold from April-December 2019 to April-December 2020 (N=4,458 vs. 2,794). For most children with complex needs, the use of telehealth was as effective in terms of strengths building and needs resolution as in-person services; for children whose caregivers had issues with access to transportation, availability of telehealth services improved outcomes for the children., Conclusions: The COVID-19 pandemic in 2020 was associated with a dramatic drop in the number of children served by Idaho's mental health program. Telehealth may effectively bridge mental health service delivery while patients and providers work toward the resolution of transportation issues or may serve as a more acceptable permanent format of service delivery for some populations.

Objectives: The goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed., Methods: A 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher's exact test to compare sites., Results: The cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed., Conclusions: Children and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.

The current article proposes that further specification of the system of care concept is required. Based on the assertions that the system of care concept (a) refers to an ideal as opposed to an observable phenomenon, and (b) is engaged in offering transformational experiences, the authors propose that the system of care definition must be expanded to include measurement and outcomes monitoring strategies that extend beyond current quality improvement initiatives. The authors propose that communication across multiple levels is essential if the goal of offering transformational experiences to children and families is to be realized.

Objective: This study was undertaken to improve understanding of the admission decision process by distinguishing between the clinically indicated level of care and actual level-of-care decisions in emergency psychiatry., Methods: Clinicians in emergency psychiatric services in Rotterdam, The Netherlands, prospectively rated 720 patients by using the Severity of Psychiatric Illness Scale and collected information on demographic, clinical, and contextual parameters. The clinically indicated level of care and actual level-of-care decisions were studied independently, by using multivariate logistic regression analyses. The decision-making process was divided into three consecutive steps: evaluation of clinically indicated inpatient or outpatient level of care (step 1), voluntary or involuntary admission (step 2), and actual admission of patients for whom voluntary admission was indicated (step 3)., Results: Each step was determined by separate factors. Specifically, clinically indicated admission (step 1) was associated with family or friends' desire for admission (odds ratio [OR]=3.7), previous admissions (OR=2.9), symptom severity (OR=2.7), and personality disorder (OR=.4). Involuntary admission (step 2) was associated with lack of motivation (OR=5.7), symptom severity (OR=3.7), time of referral (OR=3.5) and danger to self or others (OR=2.7). Actual voluntary admission (step 3) was associated mainly with bed availability (OR=8.7). The overall percentage of correctly predicted cases was 82 percent for all steps in the decision process., Conclusions: This study showed that each step in the admission decision process is determined by a unique set of variables and provided evidence that contextual factors influence decision making. Guidelines for voluntary admission and civil commitment need to be based on the results of studies that distinguish between the clinical needs of patients and contextual factors.

Mental health placement rates by the juvenile justice system differ by race. However, it is unknown whether mental health needs differ by race. This study attempted to investigate potential differences in mental health needs and service utilization among Caucasian, African American, and Hispanic juvenile justice involved youth. A stratified random sample of 473 youth petitioned, adjudicated, and incarcerated from 1995-1996 was examined using a standard chart review protocol and the Childhood Severity of Psychiatric Illness measure for mental health needs. Significant and unique mental health needs were demonstrated for all racial groups. African American youth demonstrated the greatest level of needs. Minority status indicated significantly lower rates of mental health service utilization. Minority youth in the juvenile justice system are most at risk for underserved mental health needs. Based on the current data, it can be inferred that the first contact with the state's child and adolescent serving system, which includes the juvenile justice and mental health sectors, appears to be through the juvenile justice sector for many minority youth with delinquency problems.

Objective: Employers can influence treatment decisions by adjusting characteristics of the structure of the benefits they offer, such as copayments. The authors estimated the relationship between copayment levels for substance abuse treatment and both the insurers' expenditures for treatment and the reoccurrence of treatment., Methods: Retrospective data from a Midwestern behavioral health insurer were used to identify persons with a diagnosis of a substance use disorder. The claims data were used to construct episodes of treatment. Using the variation in copayment levels across 211 different employer groups, the authors used multiple regression models to estimate the effect of copayment levels on treatment expenditures and the likelihood of a treatment reoccurrence., Results: Copayment levels had a significant effect on the reoccurrence of substance abuse treatment. Each 10 percent increase in copayment was associated with a 1 percent increase in the probability of reoccurrence. Copayment levels had a significant effect on current-episode treatment expenditures. Each 10 percent increase in copayment was associated with an 8.7 percent decrease in total per-episode expenditures. From the plan's perspective, a $1 increase in copayment for outpatient substance abuse treatment reduced per-episode spending by $110; however, roughly $13 is lost from that saving because of the increased likelihood of treatment reoccurrence., Conclusions: The longer a person is retained in substance abuse treatment, the greater the likelihood of recovery. Copayments may represent a barrier to retention in treatment. Higher copayments for substance abuse treatment make treatment reoccurrence more likely.

Background: The aim of this study was to determine the relationship between personality factors and the use of mental health services (past 12 months) among adults in the community., Method: Data were drawn from the Midlife Development in the United States Survey (MIDUS), a representative sample of 3,032 adults aged 25-74 in the United States population. Analyses of variance and logistic regression analyses were used to determine the relationship between personality factors and mental health service utilization, in the presence and absence of mental disorders, during the past 12 months., Results: Neuroticism [OR = 1.5 (1.2, 1.9)] was associated with significantly increased likelihood of mental health service utilization among adults in the community. Conscientiousness [OR = 0.7 (0.5, 0.9)] and extraversion [OR = 0.7 (0.5, 0.98)], in contrast, were associated with decreased likelihood of use of mental health services. Among adults with mental disorders, conscientiousness [OR = 0.5 (0.3, 0.8)] was associated with decreased odds of mental health service utilization. Neuroticism [OR = 1.8 (1.3, 2.4)] was associated with increased likelihood of service use among those who did not meet criteria for common mental disorders., Conclusions: These findings are the first to document a significant association between personality factors and the use of mental health services among adults in the general population. Our results highlight new ways in which personality may influence mental health in the community. This information may be useful in identifying those with unmet need for mental health treatment and developing more effective interventions for those at risk for common mental disorders. Replication of these findings is needed.

With the growing emphasis on accountability in mental health services, outcomes management strategies are gaining popularity. However, for these techniques to be credible, it is necessary to ensure the reliability of clinical data. In other words, outcomes measures must accurately reflect the actual status of service recipients. This article presents the use of the measurement audit as one means of monitoring and improving the reliability of outcomes measurements. The methods and findings from an audit of crisis assessment workers for children in state custody are presented. Clinical assessments completed at the time of service were compared with assessments using the same measure completed via retrospective file review. Findings suggest generally good reliability, 0.72 overall, with some variation by provider and type of information.

The evidence-base services literature is continually growing, providing the field with rich and important sets of information regarding what works for treating different types of youth and families. Given this burgeoning of information, the PracticeWise Evidence-Based Services (PWEBS) Literature Database has been developed to aid in summarizing and delivering aggregated evidence-based treatment information to providers in the field. Meanwhile, the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) Scale is a youth mental health assessment tool that was developed by a separate team to assist with treatment planning. In the present study, we developed and tested a system for linking these two related ontological systems so that scientific knowledge can be more widely aggregated and made available to a wider set of audiences for enhanced mental health service delivery. Results revealed the following. First, a construct mapping comparison revealed that the CANS-MH and PWEBS ontologies share a strong core of overlapping content, particularly in the areas of Youth Behavioral/Emotional Needs, Youth Risk Behaviors, and Life Domain Functioning. Second, the CANS-MH areas were able to be used to reliably code the following components of published randomized treatment studies: (a) population sample characteristics (e.g., did the characteristics of the treatment study participant population relate to each CANS-MH area?), and (b) outcome measure targets (e.g., did the treatment study outcome measure target areas relate to each CANS-MH area?). The reliability achieved from this coding process supported the linkage between the CANS-MH areas and the PWEBS Literature Database information. Lastly, high agreement was achieved between an automated translation algorithm and the final ratings from the manual coding of published treatment studies using the CANS-MH scale. The importance of such linkages for the communication of ideas, information, and evidence across differing subfields is discussed, as well as examples of achieving enhanced quality of mental health services by linking system ontologies. [ABSTRACT FROM AUTHOR]

Several epidemiological studies have reported that large numbers of children and adolescents suffer from diagnosable psychiatric conditions, however most of them do not receive treatment. The schools are a key setting where youth with mental health problems are identified and linked to treatment. In this study we examine the demographic and clinical characteristics of youth referred to a school-based mental health intervention, the youth characteristics associated with continued participation in the intervention at 6-month follow up, and the youth characteristics that are associated with intensity of service use at 6-month follow up. The data were analyzed using descriptive frequencies, Chi-square tests and t tests, and bivariate and multivariable Poisson regressions. Demographic and clinical characteristics were not found to be significantly associated with discontinuing services before 6-months; however, several youth who discontinued services before 6-months had clinical characteristics suggesting a possible need for services. Youth demographic (sex, race) and clinical (diagnosis, suicidal ideation, alcohol/drug use, psychiatric medication use, and physical health) characteristics were significantly associated with intensity of service use in the multivariable analysis. This study underscores the importance of monitoring program participation, after the referral has been made and services have been accessed, to assure that youth participate in treatment long enough to obtain clinical benefits. [ABSTRACT FROM AUTHOR]

We studied 1492 children in state custody over a 6-month period to investigate the relationship between children''s hospital admissions and the crisis workers'' clinical assessment. A 27-item standardized decision-support tool [the Childhood Severity of Psychiatric Illness (CSPI)] was used to evaluate the symptoms, risk factors, functioning, comorbidity, and system characteristics. The CSPI has been shown to have a reliability range from 0.70 to 0.80 using intraclass correlations. Logistic regression was used to calculate age-adjusted odds ratios (AOR) of hospitalization, their 95% confidence intervals, and corresponding P values. The results showed that risk factors, symptoms, functioning, comorbidities, and system characteristics were all associated with hospital admissions. Children with a recent suicide attempt, severe danger to others, or history of running away from home/treatment settings were more likely to be hospitalized (respective AOR=12.7, P<.0001; AOR=32.3, P<.0001; AOR=3.0, P=.001). In addition, hospitalization was inversely associated with caregiver knowledge of children (AOR=0.2, P=.01) and multisystem needs (AOR=0.3, P=.04). The decision to hospitalize children psychiatrically appears to be complex. As predicted, risk behaviors and severe symptoms were independent predictors of children''s hospital admissions. Interestingly, the capacity of the caregiver and the children''s involvement in multiple systems also predict children''s hospital admissions. [Copyright &y& Elsevier]

Addresses the mental health needs of youths who arrested and detained in Illinois. Link between youths with psychotic or affective disorders and community services; Comparison of average Child and Adolescent Needs and Strengths-Mental Health Care dimension scores at enrollment and program completion.

Objective: To determine the association between panic attacks and comorbid mental disorders, psychiatric symptomotology, service utilization, and suicidality among individuals with schizophrenia in the community. Method: Data were drawn from the Epidemiologic Catchment Area (ECA) Study (n=20, 291). Differences in comorbid mental disorders, symptomotology, service use, and suicidality were determined between individuals with schizophrenia, with and without panic attacks. Results: Panic attacks (lifetime) were common among almost half (45%) of those with schizophrenia. Individuals with schizophrenia and panic attacks had significantly elevated rates of co-occurring mental disorders, psychotic symptoms, suicidality, and mental health service utilization compared with individuals with schizophrenia who did not suffer from panic attacks. Conclusions: Panic attacks are common among individuals with schizophrenia in the community and are associated with higher rates of other co-occurring mental disorders, service utilization and suicidality. These results suggest that concurrent treatment for both panic and schizophrenia may be indicated for optimal outcomes. Future research is needed to determine the direct and indirect cost benefit in providing mental health treatment for panic among individuals with schizophrenia in the community. [Copyright &y& Elsevier]

This study examined the association of clinical status to mental health service use among persons with mental illness living in residential care. Two hundred residents with a chart diagnosis of schizophrenia were randomly selected from four intermediate care facilities. The severity of psychiatric illness-community mental health (SPI-CMH) scale was used to assess clinical status and symptom severity according to three dimensions: symptoms and functioning, risk behaviors, and complication to illness. Lower levels of severity of psychiatric illness were associated with participation in workshops, family contact, and admitting to mental health problems. Results suggest that residents of the intermediate care facilities have clinical needs consistent with habilitation and rehabilitation services. While residents infrequently engage in high-risk behavior such as suicide and violence, they have considerable living skills and vocational needs. Future research should consider the relationship over time of mental health service utilization, severity of psychiatric illness, and psychosocial factors. [ABSTRACT FROM AUTHOR]

Presents information on a study which assessed the prevalence of strengths in a population of children and adolescents in residential placements in Florida and its relationship to psychopathology. Methodology; Results and discussion; Limitations and clinical implications of the study.

Compares clinical trials and mental health services research. Efficacy of mental health interventions; Conceptual features of clinical trials and mental health services research; Treatment-focused versus patient-focused clinical trials.

Investigates consumer service delivery in a mobile assessment program designed to assist homeless people with severe psychiatric disorders. Consumer staff as a valuable addition to a mobile assessment program; Tendency of consumer staff to certify clients for involuntary hospitalization.

Primary care practitioners are significant providers of mental health services to older Americans. The most common mental health service provided by primary care practitioners to this segment of the population is psychotropic drugs. A US national data base was analyzed to compare the psychotropic prescribing patterns of primary care practitioners with psychiatrists and other office-based specialists in both the early and mid 1980s. Prescribing patterns for six different classes of psychotropics were contrasted for patients 55 years of age and older and those 15–54. Results indicate that primary care practitioners were by far the largest prescribers of psychotropics for patients 55 and over at both time periods. This pattern held for most of the individual psychotropic drug classes. In contrast to psychiatrists, primary care practitioners infrequently included a mental disorder diagnosis when they prescribed a psychotropic drug. In addition, primary care practitioners included a mental disorder diagnosis less frequently when they prescribed for the older group than when they prescribed for the younger group. These findings may b¢ used to benefit the training of non-psychiatrist physicians in the diagnosing and treating of mental health disorders found among older adults. [ABSTRACT FROM AUTHOR]

Examines predictors of hospital readmission to determine whether readmission can serve as a quality indicator for an inpatient psychiatric service. Observations of subjects in regional managed care programs; Effect of success of hospital intervention on readmission; Non-recommendation of readmission rates as quality indicators.

In the 30 years prior to this decade, most negotiations regarding the nature and duration of mental health care occurred between the consumer and the provider. In many situations, where consumers were unsophisticated about their options, the provider had near carte blanche for directing treatment. In contrast, during this same period, negotiations about payment for services generally occurred between the provider and a third party payor. Age was the only predictor of who these children who were placed in residential treatment without significant need. Older adolescents were particularly likely to receive in appropriate residential placement. The results of this study suggested an opportunity to step down a significant number of children who were not at risk into community placements. Consistent with the reform plan, savings from this stepdown process could be sufficient to be reinvested in community-based services with some rapid impact. In the evolving world of managed mental health care, outcomes have the potential of playing a very important role in ensuring that consumers with mental health needs receive effective, efficient, and high quality care. By no means do outcomes represent a panacea for the problems and challenges that mental health service providers face during the coming decades.

Since the rapid expansion of managed care coupled with dramatic reductions in lengths of inpatient stay, there is widespread concern that the emphasis on cost containment is eclipsing attention to patient care. The present study was undertaken to evaluate speculations that the majority of short-stay (less than 48 hours) admissions to a psychiatric inpatient service at a large teaching hospital in the midwestern United States consisted of public pay patients who were rapidly transferred to area state hospitals. Using two cases mix measures, severity of illness and changes in acuity and clinical outcomes of a sample of short-stay (n = 77) and longer stay (n = 145) admissions were compared. Short-stay admissions, although similar to longer stay patients in terms of demographics, Axis I diagnosis, payer status, and appropriateness of admission, are clinically distinct. The use of nonhospital alternatives in treating a subsample of suicidal patients and the implications for improved mental health services delivery are discussed. [ABSTRACT FROM AUTHOR]

Objective: Psychotropic medications have seldom been included in estimates of the costs of mental health services. In the infrequent case that these costs have been assessed, they have been estimated by using national surveys of consumers of health services. The objective of this study was to estimate the costs of prescriptions for psychotropic medications in the United States in 1985 and to assess the difference with the most recent cost estimate from a health services survey (1977). Method: Study data were based on retail costs of psychotropic medications reported to the Pharmaceutical Data Service Alpha National Prescription and Sales Audit. The data come from a computerized survey panel of 2,250 pharmacies representative of the more than 14,000 pharmacies nationwide. The database includes all medication prescriptions filled, whether paid with cash or Medicaid or reimbursed by third-party payment. Analyses were limited to psychotropic medication prescriptions. Results: In 1985, $1.45 billion was spent on outpatient psychotropic medications. Nearly $868 million (60% of the total) was spent on antianxiety and sedative-hypnotic medications, while approximately $263 million (18%) was spent on antipsychotic medications, $240 million (17%) on antidepressants, and $84 million (5%) on combination psychotropic medications. These expenditures were much higher than would have been expected given the most recent health services estimate of $513 million. Conclusions: These results demonstrate the substantial cost of psychotropic medications in 1985. The finding that the cost of psychotropic medications Was so high, in contrast to the lower estimate from the 1977 survey, demonstrates the importance of obtaining more frequent cost estimates and basing future estimates on medication databases. [ABSTRACT FROM AUTHOR]

The amount of time consultation psychiatrists in a large metropolitan teaching hospital spent providing direct services was studied over 1,104 consecutive consultation cases. Although the majority of cases required less than 5 hours of psychiatric time apiece, more than 10% of these cases each received more than 10 hours of direct services. This finding has important implications for understanding the types of psychiatric services provided to hospitalized medical/surgical patients. [ABSTRACT FROM AUTHOR]