Subject: Studies in the News 07-33 (May 15, 2007)


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Studies in the News for
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California Department of Mental Health

Contents This Week

Introductory Material HEALTH
   Primary Care
   Children and Adolescent Mental Health
   Children and Adolescent Mental Health
   Children and Adolescent Mental Health
   Children and Adolescent Mental Health
   Cultural Competency
   Cultural Competency
   Disparities
   Families under Stress
   First Onset of Psychosis
   Stigma
   Stigma
   Suicide Prevention
   Trauma
   Trauma
   Trauma
   Trauma
Introduction to Studies in the News

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>.
The following studies are currently on hand:

HEALTH

MENTAL HEALTH

Mind and Body Reunited: Improving Care at the Behavioral and Primary Healthcare Interface. By Barbara J. Mauer and Benjamin G. Druss. Prepared for the American College of Mental Health Administration. Summit, March 2007. (National Council for Community Behavioral Healthcare, Rockville, Maryland) 2007. 59 p.

Full Text at: http://www.nccbh.org/TemporaryFiles/Mind-Body-Reunited.pdf

[“Nearly every major policy statement on mental health in the last decade, ranging from the Surgeon General’s Report to the President’s New Freedom Commission on Mental Health, has begun with the tenet that mental health is central to overall health and more recent reports have added a corollary-physical health is central to mental health. Improving the treatment of mental and substance use disorders in primary care settings and improving the medical care of people with serious mental health (MH) and substance use (SU) disorders served in behavioral health (BH) settings has been a growing area of focus over the last decade. The goal of achieving quality of services and outcomes on both sides of the primary care/behavioral health interface is gaining long overdue attention and emphasis. This paper seeks to review the history, structure, and current developments of care at the primary care/behavioral health interface. It focuses on care in the public sector, where high rates of comorbidity, regulatory burdens, and lack of resources create particular challenges in providing care at that interface.”]

[Request #S705063]

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“Childhood Emotional Maltreatment and the Stress Generation Model of Depression.” By Dorothy H. Uhrlass, Binghamton University. IN: Journal of Social and Clinical Psychology, vol. 26, no. 1 (January 2007) pp. 119-130.

[“Despite consistent support for Hammen's (1991, 1992) stress generation model of depression and support for the adverse effects of childhood emotional maltreatment on later functioning and vulnerability to depression, the relation between the two is unclear. Therefore, the primary aim of the current study of young adults was to examine whether changes in recent negative life events would mediate versus moderate the relation between childhood emotional maltreatment and prospective changes in depressive symptoms. We also examined whether the stress generation effect was specific to depressive symptoms. Changes in recent negative events mediated the relation between childhood emotional maltreatment and changes in depressive symptoms. Additionally, initial depressive symptoms, but not anxiety symptoms, contributed to prospective changes in negative life events.”]

[Request #S705064]

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“Mental Health of Young People: A Global Public-Health Challenge.” By Vikram Patel, London School of Hygiene and Tropical Medicine, and others. IN: The Lancet, vol. 369, no. 9569 (April 2007) pp. 1302-1313.

[“Mental disorders account for a large proportion of the disease burden in young people in all societies. Most mental disorders begin during youth (12-24 years of age), although they are often first detected later in life. Poor mental health is strongly related to other health and development concerns in young people notably lower educational achievements, substance abuse, violence, and poor reproductive and sexual health. The effectiveness of some interventions for some mental disorders in this age-group have been established, although more research is urgently needed to improve the range of affordable and feasible interventions, since most mental-health needs in young people are unmet, even in high-income countries. Key challenges to addressing mental-health needs include the shortage of mental-health professionals, the fairly low capacity and motivation of non-specialist health workers to provide quality mental-health services to young people, and the stigma associated with mental disorder. We propose a population-based youth focused model, explicitly integrating mental health with other youth health and welfare expertise. Addressing young people’s mental-health needs is crucial if they are to fulfill their potential and contribute fully to the development of their communities.” NOTE: The Lancet is available for loan. ]

[Request #S705065]

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Forum for State Health Policy Leadership. Responding to Mental Health Needs of Juveniles. Presented by Bruce Kamrodt, Wraparound Milwaukee and Margaret Jefferson, Families United of Milwaukee. Presented at the National Council of State Legislatures, Spring Forum on Adolescent Development and Mental Health. (National Conference of State Legislatures, Washington, DC) April 19, 2007. 20 p.

Full Text at: http://www.ncsl.org/print/health/forum/Wraparound.pdf

[“This meeting at the Spring Forum on Adolescent Development and Mental Health addressed ways state legislators can promote children's healthy mental development, and what programs work to treat children with emotional disturbances. Wraparound Milwaukee is a System of Care for families with children with serious emotional and mental health needs that are referred through the Child Welfare or Juvenile Justice System and who are at immediate risk of placement in a: Residential Treatment Center; Juvenile Correctional Facility; or, Long-Term Psychiatric Inpatient Setting. Operated by the Milwaukee County Behavioral Health Division, it functions as its own managed care entity polling and administering funding across Child Welfare, Juvenile Justice, Medicaid and Mental Health.”]

[Request #S705066]

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“Successful Transitions for Young Children with Disabilities and Their Families: Roles of School Social Workers.” By Sharon E. Rosenkoetter, Oregon State University, and others. IN: Children and Schools, vol. 29, no. 1 (January 2007) pp. 25-34.

[“Three early transitions are significant for young children with disabilities and their families: (1) into Early Intervention, (2) between that program and preschool services, and (3) from Early Childhood Special Education into kindergarten special education. Each of these transitions is significant for families in terms of obtaining appropriate intervention services, involving Families in their children's development, and building foundations for the children's later learning. This article details responsibilities for social workers at each transition. Roles are synthesized into nine important social work contributions that will help to ease the stress of transition for all participants, bridge people and programs, support families, and foster shared efforts to launch young children on a lifetime of learning.”]

[Request #S705067]

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Resident Physicians’ Preparedness to Provide Cross-Cultural Care: Implications for Clinical Care and Medical Education Policy. By Joseph R. Betancourt, Harvard Medical School, and others. (The Commonwealth Fund, New York, New York) May 2007. 24 p.

Full Text at: http://www.commonwealthfund.org/usr_doc/1026_Betancourt_resident_MDs_preparedness_provide_cross-cultural_care.pdf

[“In a national study of resident physicians in their final year of training, few residents reported feeling unprepared in a general sense to care for patients from racial and ethnic minorities and from diverse cultures. Yet far more felt unprepared to care for patients with specific cultural characteristics, including those who mistrust the U. S. health care system or who have health beliefs or practices at odds with western medicine. This gap in perceived levels of preparedness indicates shortcomings in graduate medical education that need to be addressed. Recommended reforms include integration of cross-cultural training into curricula (both during and after medical school) in accordance with standard principles, the appropriate training of faculty (to ensure useful instruction, as well as mentors and role models), and the mandatory and formal evaluation of residents’ cross-cultural communication skills.”]

[Request #S705068]

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Taking Cultural Competency from Theory to Action. By Ellen Wu and Martin Martinez, California Pan-Ethnic Health Network. (The Commonwealth Fund, New York, New York) October 2006. 28 p.

Full Text at: http://www.commonwealthfund.org/usr_doc/Wu_takingcultcomptheoryaction_964.pdf

[“This paper provides principles and recommendations for implementing cultural competency in the field. The following six principles are key to a successful cultural competency effort: 1) community representation and feedback at all stages of implementation; 2) cultural competency integrated into all systems of the health care organization, particularly quality improvement efforts; 3) ensuring that changes made are manageable, measurable, and sustainable; 4) making the business case for implementation of cultural competency polices; 5) commitment from leadership; and 6) staff training on an ongoing basis. Based on interviews with leaders in the field of cultural competency, the authors discuss best practices and important lessons in the implementation of cultural competency initiatives.”]

[Request #S705069]

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"Immigration-Related Factors and Mental Disorders among Asian Americans." By David T. Takeuchi, University of Washington, Seattle, and others. IN: American Journal of Public Health, vol. 97, no. 1 (January 2007) pp. 84-90.

[" The purpose of our study was to examine the lifetime and 12-month rates of any depressive, anxiety, and substance abuse disorders among US-born and immigrant Asian Americans. We examined the bivariate associations among different immigration-related factors, including nativity, length of residency, and age at arrival, generational status, and English language proficiency, to assess how they are associated with mental disorders. These analyses were made in coordination with Collaborative Psychiatric Epidemiology Studies (CPES), which provided the unprecedented opportunity to compare how immigration-related factors are associated with psychiatric disorders across 3 major racial/ethnic categories (Asian, Black, and Latino). For each factor considered in these analyses, we assessed whether immigrants had lower rates of different mental disorders than did their US-born counterparts." NOTE: The American Journal of Public Health is available for loan.]

[Request #S705070]

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“Alcohol, Drug, and Mental Health Specialty Treatment Services and Race/Ethnicity: A National Study of Children and Families Involved with Child Welfare.” By A. M. Libby and others. IN: American Journal of Public Health, vol. 96, no. 4, (April 1, 2006) pp. 628-631.

[“According to the authors, unmanaged alcohol, drug, and mental health problems among caregivers can be a risk factor for their children. Thus, this study compared American Indian caregivers with White, Black, and Hispanic caregivers with regard to whether they received services for alcohol, drug, and mental health problems. Results indicate Hispanic, Black, and White caregivers were more likely to receive services for these problems than were American Indians. “American Indian caregivers were [statistically] significantly less likely to receive services than were Hispanic caregivers, but not significantly less likely than were White or Black caregivers.’ (p. 628)…

At baseline, 22% of all caregivers had alcohol, drug, and mental health problems. Yet only 15% of American Indian caregivers with these risk factors received a formal assessment: of this group, about 25% were referred for services and only 12% received any type of specialty services for alcohol, drug, or mental health problems. In general, caregivers of children ages 3-5 received more services than caregivers of older children, and comorbidity problems ‘more than doubled’ (p. 630) a caregiver’s probability of receiving services when compared with substance abuse problems only.” NOTE: The American Journal of Public Health is available for loan.]

[Request #S705071]

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“Twelve-Month Outcome of Adolescents with Bipolar Disorder Following First Hospitalization for a Manic or Mixed Episode.” By Melissa P. Delbello, University of Cincinnati School of Medicine, and others. IN: The American Journal of Psychiatry, vol. 164, no. 4 (April 2007) pp. 582-590.

Full Text at: http://ajp.psychiatryonline.org/cgi/content/full/164/4/582

[“Although adolescent-onset bipolar disorder is associated with significant morbidity, there have been few prospective outcome studies of this population. The aim of this study was to examine the 12-month outcome of bipolar adolescents following an initial hospitalization for a manic or mixed episode. Bipolar adolescents (N=71) were recruited during their first hospitalization for a manic or mixed episode and were evaluated using diagnostic, symptomatic, and functional assessments. Patients were also evaluated at 1, 4, 8, and 12 months after hospitalization to assess syndromic, symptomatic, and functional outcomes. Predictors of each type of outcome were identified….

Conclusions: Most bipolar adolescents experienced syndromic recovery following their first hospitalization. However, rates of symptomatic and functional recoveries were much lower. Future studies examining effective pharmacological and nonpharmacological treatment strategies for bipolar youth with co-occurring disorders and investigating factors that contribute to the development of substance use disorders and treatment adherence in bipolar youth are necessary to improve outcome.”]

[Request #S705072]

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“Dimensions of Mental Illness Stigma: What about Mental Illness Causes Social Rejection?” By David B. Feldman, Santa Clara University, and Christian S. Crandell, University of Kansas. IN: Journal of Social & Clinical Psychology, vol. 26, no. 2 (February 2007) pp. 137-154.

[“The stigma of mental illness can be as harmful as the symptoms, leading to family discord, job discrimination, and social rejection. The existence of mental illness stigma has been well established, but stigma theory must go beyond demonstrations and mere descriptions. This article addresses which characteristics across mental disorders lead to stigmatization and social rejection. Participants (N = 270) read case histories depicting individuals with 40 mental disorders, rated those individuals on 17 dimensions (e.g., dangerousness to others, treatability, social disruptiveness), and indicated how willing they were to reject these individuals on a social distance scale. This yielded a ranking of mental disorders by degree of stigmatization; most importantly it reveals the structure of mental illness stigmatization. Only three dimensions were essential in accounting for rejection: personal responsibility for the illness, dangerousness, and rarity of the illness. These dimensions provide an efficient and effective account of the causes of social rejection in mental illness.”]

[Request #S705073]

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Unraveling the Contexts of Stigma: From Internalization to Resistance to Change. [Issue Theme.] By Catherine Campbell, London School of Economics, and Harriet Deacon, Human Sciences Research Council Cape town, South Africa. IN: Journal of Community & Applied Social Psychology, vol. 16, no. 6 (November/December 2006) pp. 411-417.

[“This special edition on Understanding and Challenging Stigma; seeks to further our understandings of the types of representations and practices through which stigma is perpetuated, the social contexts within which they are produced and reproduced, and the possibilities for agency, resistance and intervention. In this introductory piece, we outline three broad approaches to stigma in the existing literature; individual, macro-social and multi-level. Aligning ourselves with the latter, we discuss how social effects become sedimented in the individual psyche in ways that often make it difficult for stigmatised group members to resist their devalued social status. This insight frames our discussion of the papers in this volume, which cover various types of stigma, drawing on research in six countries. We focus on the ways in which the papers contribute to our understandings of (i) the material, political, institutional and symbolic contexts of stigma; (ii) the possibility of resistance to stigma; and (iii) the types of interventions most likely to facilitate such resistance. We conclude that the fields of social and community psychology have a central role to play in advancing the types of understandings that are so urgently needed to inform effective multi-level stigma-reduction interventions.”]

[Request #S705074]

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“Assessing Suicide Risk in Children: Guidelines for Developmentally Appropriate Interviewing.” By Casey A. Barrio, University of North Texas. IN: Journal of Mental Health Counseling, vol. 29, no. 1 (January 2007) pp. 50-66.

[“Although suicide is considered a leading cause of death for all age groups, resources and recommendations regarding methods of assessment of suicide risk in children appears to be scattered across related disciplines. Most risk assessment measures for ‘youth’ are intended for use with adolescents, and the nature of children's developmental functioning presents particular challenges for accurate assessment. This article includes a brief review of risk factors and recommendations for preparing to conduct suicide risk assessments with children. Guidelines for mental health counselors who conduct developmentally appropriate risk assessments with children are detailed, and suggestions for consulting with caregivers are provided.”]

[Request #S705075]

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“The Long-Term Consequences of Early Childhood Trauma: A Case Study and Discussion.” By Julie B. Kaplow, John Jay School of Criminal Justice, and others. IN: Psychiatry: Interpersonal & Biological Processes, vol. 69, no. 4 (Winter 2006) pp. 362-375.

[“There is a great need to better understand the impact of traumatic events very early in life on the course of children's future development. This report focuses on the intriguing case of a girl who witnessed the murder of her mother by her father at the age of 19 months and seemed to have no recollection of this incident until the age of 11, when she began to exhibit severe symptoms of posttraumatic stress disorder (PTSD) in response to a traumatic reminder. The case presentation serves as the basis for a discussion regarding pertinent issues involved in early childhood trauma. This case and accompanying discussion were originally presented at the 19th Annual Meeting of the International Society for Traumatic Stress Studies and were transcribed and revised for use in this article. Specific topics include early childhood memory and trauma, learning and the appraisal of danger, and PTSD and traumatic grief in early childhood. Clinical and public health implications are also discussed. This case illustrates the dramatic impact that "preverbal" traumatic memories can have on children's later functioning and speaks to the importance of assisting very young children in the immediate aftermath of traumatic events.”]

[Request #S705076]

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“Post-Traumatic Stress Disorder and Service Utilization in a Sample of Service Members from Iraq and Afghanistan.” By Christopher Erbes, Department of Veteran’s Affairs Medical Center, and others. IN: Military Medicine, vol. 172, no. 4 (April 2007) pp. 359-363.

[“The purpose of this study was to evaluate levels of post-traumatic stress disorder (PTSD), depression, alcohol abuse, quality of life, and mental health service utilization among returnees from Operation Enduring Freedom and Operation Iraqi Freedom. Methods: One hundred twenty returnees, enrolled for health care at a Midwestern Veterans Affairs medical center, completed questionnaires approximately 6 months after their return from deployment. Results: PTSD levels (12%) were consistent with previous research while problematic drinking levels were also elevated (33%), PTSD and, to a lesser degree, alcohol abuse were associated with lower quality of life in multiple domains, even when controlling for the influence of depression.

Of those screening positive for PTSD. 56% reported using mental health services. Only 18% of those screening positive for alcohol abuse reported using such services. Conclusions: PTSD and alcohol problems are prevalent in Operation Enduring Freedom/Operation Iraqi Freedom returnees and associated with lower quality of life. Mental health service utilization is limited, even among returnees enrolled for Veterans Affairs health care.”]

[Request #S705077]

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“Posttraumatic Stress Disorder Needs to Be Recognized in Primary Care.” By Jennifer Fisher Wilson. IN: Annals of Internal Medicine, vol. 146, no. 8 (April 2007) pp. 617-620.

[“This article stresses the need to recognize the diagnosis and treatment of posttraumatic stress disorder (PTSD) in primary care in the U.S. PTSD refers to the certain severe psychological consequences of exposure to, or confrontation with stressful events. According to the author, the disorder should not be ignored for its harmful effects like increased risk for suicide, social isolation and illness. The disorder can be treated using selective serotonin reuptake inhibitor and psychotherapy.”]

[Request #S705078]

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Traumatic Stress/Child Welfare [Issue Theme.] Focal Point. Vol. 21, No. 1. (Research and Training Center on Family Support and Children’s Mental Health, Portland State University, Portland, Oregon) Winter 2007. 32 p.

Full Text at: http://www.rtc.pdx.edu/PDF/fpW07.pdf

[“Traumatic events cause overwhelming feelings of terror, horror, or hopelessness. These kinds of feelings often occur when a person experiences or witnesses a serious injury, or witnesses a death. A person may also be traumatized by threats of injury or death, or by experiencing other forms of attack or violation. Child traumatic stress occurs when exposure to traumatic events overwhelms the child’s ability to cope.

This issue of Focal Point focuses on child traumatic stress, particularly the kinds of stress most commonly found among children and adolescents who are involved with the child welfare system. We (the RTC on Family Support and Children’s Mental Health at Portland State University) and the National Traumatic Stress Network (NCTSN) have worked together to provide this summary of what is currently known about the effects of child traumatic stress and the most effective treatments.”]

[Request #S705079]

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There are no studies in the current issue