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Studies in the News for

California Department of Mental Health

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Studies in the News is a service provided to the Legislature and Governor's Office by the State Library's Research Bureau. Weekly lists of current articles related to legislative issues will be supplemented by monthly lists focusing on a specific area of public policy. Prior lists can be viewed from the California State Library's Web site at www.library.ca.gov/CRB/SITN/.

This service works as before:

• In addition to our regular Studies in the News, you may request any of our five monthly "Supplements" in the following areas by sending a reply to this e-mail (Please mark your choices).

• _____ Education Policy

• _____ Health Care Policy

• _____ Children and Family Policy

• _____ Environment, Growth Management and Transportation Policy

• _____ Employment, Training, Vocational Education, and Welfare to Work

• You may get copies of these studies by e-mailing a request to <chenningfeld@library.ca.gov> (Christie Henningfeld oversees the State Library's Capitol office), by calling 319-2691, or by stopping by room 5210 in the Capitol.

• If you would like us to try to get other studies, please e-mail information about each study you want to <chenningfeld@library.ca.gov>.

• Please use the same avenues if you want to be off the distribution lists.

• The list which follows shows only current additions to the collection. If you would like a cumulative list, or a cumulative list for only selected topics, please e-mail <chenningfeld@library.ca.gov>.

HEALTH

MENTAL HEALTH

“The Effectiveness and Quality of Routine Child and Adolescent Mental Health Care Outreach Clinics.” By Crispin Day and Hilton Davis. IN: British Journal of Clinical Psychology, vol. 45, no. 4 (November 2006) pp. 439-452.

Full Text at: Academic Search Premier

[“Little evidence has been available about the functioning and outcomes of child mental health services operating at the primary care interface. This study investigated the effectiveness and quality of one particular model of outreach clinic. The study used a quasi-experimental design comparing outcomes of children attending the outreach clinics with a waiting list comparison. The intervention group (n = 88) was assessed at referral, four months and twelve months later. The comparison group (n = 99) completed measures at referral and four months. The main care takers of participant children completed self-report measures of problem severity, impact, burden, parental stress and parent satisfaction. Clinicians provided clinical activity information. Results showed that there were significant reductions in children's problem severity, distress and impairment, particularly for behavioral difficulties. In contrast, the results showed no effect upon the outcomes of children's emotional problems or parental stress. High ratings of satisfaction were obtained for many aspects of care. Conclusions reached were that the children receiving care through this system of decentralized, outreach clinics derived clinical benefits that were maintained over time. The outreach clinics received strong consumer support suggesting the service offered a high level of acceptability to parents.”]

[Request #S20724]

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Community Integration for Older Adults with Mental Illnesses: Overcoming Barriers and Seizing Opportunities. By the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. (The Center, Washington, DC) 2005. 68 p.

Full Text at: mentalhealth.samhsa.gov/publications/allpubs/sma05-4018/

[“This report, Community Integration for Older Adults with Mental Illness: Overcoming Barriers and Seizing Opportunities, is the third in a series of reports prepared by the National and Statewide Coalitions to Promote Community-Based Care under the Olmstead project, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U. S. Department of Health and Human Services. It is designed to help State and local Olmstead coalitions understand the barriers that older adults face and learn about the innovative solutions being adopted and adapted across the country. Though progress has been made in the care of older adults with serious mental illnesses, much remains to be done to achieve the fundamental systems transformation envisioned by the New Freedom Commission and to support full community integration. In the past, communities may have wanted to further integrate older adults with mental illnesses into community life. Today, the Olmstead decision and the New Freedom Commission provide specific guidance for accomplishing this goal.”]

[Request #S20725]

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Racial and Ethnic Disparities in Adolescent Health and Access to Care. By Harriette B. Fox and others. Prepared by Incenter Strategies for the Advancement of Adolescent Health. (Incenter Strategies, Washington, DC) 2007. 9 p.

Full Text at: www.incenterstrategies.org/jan07/factsheet1.pdf

[“This fact sheet provides new national information on disparities in health status and access to care among Hispanic, Black, and White adolescents ages 12 through 17. It addresses racial and ethnic disparities for a broad set of indicators and also examines the impact of income, insurance, and mother’s or household education on these indicators… Understanding whether racial and ethnic disparities exist is important not only for federal and state policymakers, but also for clinicians, managed care plans, public health programs and purchasers…. Further, among adolescents reported to have moderate or severe emotional, behavioral or concentration problems, a remarkably large proportion of Hispanic and Black adolescents have not received any mental health treatment of counseling in the past year. About half of Hispanic and Black adolescents are not receiving needed mental health services, compared to less than a third of White adolescents.” The authors go on to state that “ these findings, which indicate mental health access problems for all adolescents, show significant disparities for minority adolescents and are particularly disturbing given that both problems and service utilization with respect to mental health are likely to be underreported.”]

[Request #S20726]

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“First-episode Psychosis, Early Intervention, and Outcome: What Have We Learned?” By Ashok K. Malla, McGill University, and others. IN: Canadian Journal of Psychiatry, vol. 50, no. 14 (December 2005) pp. 881-891.

Full Text at: Academic Search Premier

[“There has been increased interest in the potential of early intervention to positively influence outcome in first-episode psychosis (FEP) and, consequently, to influence mental health policy and practice. This study's objective was to examine the concept of early intervention and the evidence that currently exists to support such a shift in the delivery of care. Method: We examined the evidence for phase-specific treatment of FEP, looking for interventions that attempt to arrest the transition from a putative prodromal state to full psychosis, as well as for interventions that attempt to reduce delay in treatment. Some evidence supports specialized FEP interventions for short-term outcome in terms of symptom reduction, relapse rates, and greater adherence to and retention in treatment. As well, there is modest support for benefits to aspects of social and community functioning and satisfaction with life. Limited evidence supports a positive effect of community-wide case detection in terms of reduced delays in treatment and pharmacologic and psychological interventions in the prodromal phase. Conclusions reached: The field of early intervention in psychosis is young, with encouraging preliminary results, especially for improving outcome in established FEP. It requires further study, especially of longer-term outcome. Further studies need to examine the effects of a specialized approach on longer-term outcome and to explore cost-effective methods to reduce delays in treatment and provide interventions in the prodromal phase.”]

[Request #S20727]

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“A Group Intervention to Promote Healthy Self-Concepts and Guide Recovery in First Episode Schizophrenia: A Pilot Study.” By Elizabeth McCay, Ryerson University, and others. IN: Psychiatric Rehabilitation Journal, vol. 30, no. 2 (Fall 2006) pp. 105-111.

Full Text at: Academic Search Premier

[The authors state that “the stress associated with managing a first episode of schizophrenia and the secondary psychological sequelae may predispose young people to the phenomenon of illness engulfment, whereby personal identity is lost and replaced with a sense of self defined entirely by the illness. The overall objective of this pilot project was to provide an initial evaluation of the impact of a novel group intervention targeting improvement of self-concept (engulfment) and overall quality of life for young adults recovering from a first episode of schizophrenia. Fifty-two young adults diagnosed with a DSM-IV schizophrenia spectrum disorder were sequentially assigned to either a 12-week group intervention that provided members with opportunities to attain healthy self-concepts or a control group that received high quality treatment as usual. The two groups were compared on pretreatment, post-treatment, and 3-month post-treatment measures of engulfment, quality of life, and psychiatric symptoms. Allowing for dropouts, 26 subjects remained in the treatment group and 14 subjects in the control group after the 3-month follow-up. Participants in the treatment group demonstrated significant improvement in engulfment, quality of life (intrapsychic subscale) and symptoms, while the comparison group did not change. These preliminary results provide support for the benefits of a group intervention designed to enhance self-concept and to minimize the engulfing effects of illness.”]

[Request #S20728]

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“Children in Out-of-Home Care: Entry into Intensive or Restrictive Mental Health and Residential Care Placements.” By Sigrid James and others. IN: Journal of Emotional and Behavioral Disorders, vol. 14, no. 4 (Winter 2006) pp. 196-208.

Full Text at: Academic Search Premier

[“Each year close to 300,000 children enter foster care. After the child welfare system assumes custody of the child, decisions have to be made about placement into the available range of family-based and residential out-of-home care settings. Using longitudinal data from the National Survey on Child and Adolescent Well-Being (NSCAW), this study investigates entry into intensive or restrictive settings during a 36-month study period. Specifically, this analysis examines entry into treatment foster care, group homes, residential treatment, and inpatient psychiatric care for youth placed into out-of-home care. It aims to determine at what point in their first out-of-home episodes and for what reasons youth entered such settings. As NSCAW used a national probability sampling design, this analysis provides national estimates about entry into intensive or restrictive settings for youth in out-of-home care. Twenty-five percent of youth experienced an intensive or restrictive setting during their first out-of-home care episode; 70% were in either group homes (33.2%) or residential treatment settings (37.0%). About half of the youth with such placements (48.9%) were placed into intensive or restrictive settings as a first placement during their first out-of-home episode.”]

[Request #S20729]

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“Suicide Risk at Juvenile Justice Intake.” By Gail A. Wasserman and Larkin McReynolds, Columbia University. IN: Suicide and Life-Threatening Behavior, vol. 36, no. 2 (April 2006) pp. 239-249.

Full Text at: www.atypon-link.com/GPI/doi/pdfplus/10.1521/suli.2006.36.2.239

[“Many risks for suicidal behavior, identified in population samples, are elevated in justice youth. The authors examined whether risks operate similarly in a justice sample. They measured suicidal behavior and disorder on the Diagnostic Interview Schedule for Children in 991 randomly selected youths, and examined associations between demographic, offense, and disorder characteristics and past attempts. Their findings showed that recent attempts were more common in girls, in those with depression or substance disorder, and in violent offenders. While more girls reported recent attempts regardless of depression, depressed boys’ attempt risk was as high as girls’. Depression contributed more to attempt history than did substance disorder.” In addition, the authors state that “juvenile justice contact appears to be a marker for suicide risk. Adolescents in a community cohort who reported a lifetime history of suicide attempt were over ten times as likely to have had prior police contact than were non-attempters…. The authors maintain that probation officers, who often function as gatekeepers for mental health service access, should be trained both in screening procedures and in ways to facilitate the linkage of the vulnerable youths they serve to mental health providers.”]

[Request #S20730]

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“National Estimates of Mental Health Insurance Benefits.” By Myles Maxfield and others. IN: The Journal of Behavioral Health Services & Research, vol. 34, no. 1 (January 2007) pp. 83-95.

Full Text at: www.springerlink.com/content/98410140626218q4/fulltext.html

[“This article presents estimates of the proportion of the U.S. population that had mental health benefits in 1999, of the extent of their coverage, and of the proportion that were enrolled in health plans subject to the Mental Health Parity Act of 1996 (MHPA). Findings indicate that over three-quarters (76%) of the U.S. population had mental health benefits as part of their health insurance. Approximately 18% of the population had no mental health benefits, and for the remaining 6%, mental health benefits could not be determined. Of the 18% with no mental health benefits, most (84%) had no health insurance whatsoever, while the remainder (16%) had health insurance that did not cover mental health benefits. Estimates of the generosity of coverage indicate that 44% of the population had benefits that included prescription drugs, and that provided at least 30 inpatient days and 20 outpatient visits for psychiatric care. For 12% of the population, benefit generosity could not be determined. Finally, study results suggest that the MHPA affected only 42% of the U.S. population.’]

[Request #S20731]

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“Setting the Stage for Success: Implementation of Developmental and Behavioral Screening and Surveillance in Primary Care Practice—The North Carolina Assuring Better Child Health and Development (ABCD) Project.” By Marian F. Earls, University of North Carolina, and Sherry Shackelford Hay. IN: Pediatrics, vol. 118, no. 1 (July 2006) pp. 183-188.

Full Text at: pediatrics.aappublications.org/cgi/content/full/118/1/e183

[“Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice. In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations. Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home. Included here (in this article) are lessons learned and a listing of practical tools for implementation.”]

[Request #S20733]

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Effects of a School-Based Early Childhood Intervention on Adult Health and Well Being: A 20-Year Follow Up of Low-Income Families. By Arthur J. Reynolds, University of Minnesota, and others. Early Childhood Research Collaborative Paper Series. (The Collaborative, Minneapolis, Minnesota) August 2006. 35 p.

Full Text at: http://www.earlychildhoodrc.org/papers/reynolds_cpc.pdf

[“Although the benefits of early childhood interventions are well established, few studies have investigated effects into adulthood, especially for large-scale, publicly funded programs. The authors conducted a 20-year follow-up at age 24 of a cohort of 1539 low-income children (93%black, 7% Hispanic) born in 1979 or 1980 who enrolled in the Child-Parent Center (CPC) Program in 20 sites or an alternative early childhood intervention in randomly selected or matched schools in Chicago, Illinois. The program provides educational enrichment, family support services, and health services in the Chicago public school system from preschool to up to third grade. Relative to the comparison group and adjusted for many background factors, CPC preschool participants by age 24 had higher rates of school completion, higher rates of attendance in 4-year colleges, and more years of completed education. They were more likely to have health insurance. They also had lower rates of felony arrests and incarceration as well as criminal convictions; lower rates of depressive symptoms; and lower rates of out-of- home placement. Participation in the school-age program and in the extended intervention also was linked to better health and well-being on some indicators…. Participation in a school-based intervention beginning in preschool was associated with a wide range of positive outcomes in adulthood for children and their parents. Findings provide strong evidence that established early education programs high in quality can have enduring effects on general health and well-being.”]

[Request #S20734]

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“Expanded School Mental Health: A Collaborative Community-School Example.” By Mark D. Weist, University of Maryland, and others. IN: Children & Schools, vol. 28, no. 1 (January 2006) pp. 45-50.

Full Text at: Academic Search Premier

[“School-based mental health programs are becoming increasingly prominent. This article presents an expanded school mental health framework involving school and community staff working together to enhance mental health programs in schools for youths in both general and special education. Success in this new framework requires staff from multiple disciplines to partner in planning and coordinating activities in ways that are consonant with the goals of the school and its many stakeholders. It is in this context that schools and systems of education around the country are joining forces with community mental health and health systems, families, and community stakeholders to promote youth mental health and remove it as a barrier to learning….The goals of expanded school mental health (ESMH) programs include improving school attendance and achievement, and optimizing the health, mental health and overall quality of live for all students…. Challenges to such interdisciplinary collaboration, as well as strategies to overcome them, are presented with a real-world example.”]

[Request #S20735]

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“Panic Disorder and Suicidal Ideation in Primary Care.” By Daniel J. Pilowsky, Columbia University, and others. IN: Depression & Anxiety, vol. 23, no. 1 (2006) pp. 11-16.

Full Text at: Academic Search Premier

[“The purpose of this study was to ascertain whether panic disorder (PD) and suicidal ideation are associated in an inner-city primary care clinic and whether this association remains significant after controlling for commonly co-occurring psychiatric disorders. The authors surveyed 2,043 patients attending a primary care clinic using the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire, a screening instrument that yields provisional diagnoses of selected psychiatric disorders. We estimated the prevalence of current suicidal ideation and of common psychiatric disorders including panic disorder and major depression. A provisional diagnosis of current PD was received by 127 patients (6.2%). After adjusting for potential confounders (age, gender, major depressive disorder [MDD], generalized anxiety disorder, and substance use disorders), patients with PD were about twice as likely to present with current suicidal ideation, as compared to those without PD After adjusting for PD and the above-mentioned potential confounders, patients with MDD had a sevenfold increase in the odds of suicidal ideation, as compared to those without MDD. Primary care patients with PD are at high risk for suicidal ideation, and patients with PD and co-occurring MDD are at especially high risk. PD patients in primary care thus should be assessed routinely for suicidal ideation and depression.”]

[Request #S20736]

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“An Overview of Posttraumatic Stress Disorder in African Americans.” By Tanya N. Alim, Howard University, and others. IN: Journal of Clinical Psychology, vol. 62, no. 7 (July 2006) pp. 801-813.

Full Text at: Academic Search Premier

[“While several studies have found high rates of trauma exposure there is limited information on posttraumatic stress disorder (PTSD) and its relationship to depression in the African American population. The prevalence and/or expression of psychiatric disorders can differ between racial/ethnic groups. The authors review literature addressing trauma exposure, prevalence, and expression of PTSD in the African American population. Risk factors that may be of specific significance to the development of PTSD in African Americans are also reviewed. Additionally, treatment issues and potential directions for future research of PTSD in the African American population are discussed.”]

[Request #S20737]

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[The following studies, reports, and documents have been ordered or requested, but have not yet arrived. Requests may be placed, and copies will be provided when the material arrives..]

“Life Problems and Physical Illness as Risk Factors for Suicide in Older People: A Descriptive and Case-Control Study.” By Michael Daniel, Oxford University, and others. IN: Psychological Medicine, vol. 36, no. 9 (September 2006) pp. 1265-1274.

[“The authors state that the role of physical illness and life problems in contributing to suicide in older people is potentially important with regard to suicide prevention. The aim of the study was to determine the life problems other than psychiatric illness contributing to suicide in older people. Semi-structured psychological autopsy interviews, covering life problems and physical illness prior to death, were conducted with informants for 100 people aged 60 years old and over who died through suicide in five English counties. Interviews were completed with informants for 54 age- and sex-matched control subjects who died through natural causes. The three most frequent life problems associated with suicide were physical illness, interpersonal problems, and bereavement. Physical health problems were present in 82% and felt to be contributory to death in 62%. Pain, breathlessness and functional limitation were the most frequent symptoms. Interpersonal problems were present in 55% of the sample and contributory in 31%. The corresponding figures for bereavement-related problems were 47% and 25%. In the case-control analysis, the problems found to be risk factors for suicide were problems related to bereavement over 1 year before death, and problems with accommodation, finances, and retirement. The conclusion reached was that physical illness, interpersonal problems and bereavement are commonly associated with suicide in older people, but financial, accommodation, retirement and long- term bereavement-related problems may be more specific risk factors.”]

[Request #S20738]

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