Behavioral Case Management Research Articles

Youth depression alleviation: the Fish Oil Youth Depression Study (YoDA‐F): A randomized, double‐blind, placebo‐controlled treatment trial

US authorities have recommended 'black-box' warnings for antidepressants because of the increased risk of suicidality for individuals up to age 25. There is thus a clinical and ethical imperative to provide effective treatment for youth depression with an acceptable risk-benefit balance. Long-chain omega-3 polyunsaturated fatty acids (PUFAs) play an important role in a range of physiological processes in living organisms. Supplementation with omega-3 PUFAs has been shown to have a range of beneficial effects on both physical and mental health, and results of previous trials suggest that omega-3 PUFAs may be a safe and effective treatment for depression. However, conclusions from these trials have been limited by their relatively small sample sizes. This trial will test the effectiveness of a 12-week parallel group, double-blind, randomized, placebo-controlled trial of 1.4 g day(-1) omega-3 PUFAs in help seeking 15- to 25-year-olds (N = 400) presenting with major depressive disorder. The primary hypothesis is that young people will show greater improvement of depressive symptoms after 12 weeks of treatment with omega-3 PUFAs plus cognitive behavioural case management compared with treatment with placebo plus cognitive behavioural case management. Because of using a large sample, results from this study will provide the strongest evidence to date to inform the use of omega-3 PUFAs as first-line therapy in young people presenting with major depressive disorder. The study also heralds an important step towards indicated prevention of persistent depression, which may reduce the burden, stigmatization, disability and economic consequences of this disorder.

Toward global prevention of sexually transmitted infections (STIs): The need for STI vaccines

An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.

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Taking Integrated Care Management to the Street

Hudson Health Plan, through a Chronic Illness Demonstration Project, is investigating the value that integrated behavioral and medical health case management brings to stakeholders of a comprehensive assessment and patient assistance program. The New York State Department of Health funds the pilot program dubbed the Westchester Cares Action Program. Hudson Health Plan and its behavioral health vendor, Beacon Health Strategies, are engaged in a 3-year study aimed at improving quality of life and health outcomes while reducing costs for 250 of New York State's highest utilizing, most costly "fee-for service" patients. This article describes the program, the team, and the tools that the program uses. It also discusses the challenges, successes, and lessons learned during its first 15 months of operation.

Psychodynamic Psychiatry, Psychotherapy, and Community Psychiatry

Community psychiatry is defined by mixed systems of care for patients with severe and persistent mental disorders, many of whom are indigent. Much of it dates back to the community mental health movement 50 years ago. The emphasis at that time was on deinstitutionalization, prevention, least restrictive options for care, and transformation of large public hospitals into multiservice regional centers. The current focus, in contrast, is on economy, local control and accountability, emphasizing, for example, manualized behavioral health techniques, pharmacotherapy, and case management by allied professionals. Psychodynamic psychiatry, particularly a psychodynamic orientation is uniquely helpful in complex, community-based clinical situations. Applicable psychodynamics include unconscious mental processes, psychological defenses, emotional relationships, a developmental perspective, disciplined use of the self for healing, transference, and communications in all forms as material for therapy. Literature and case reports illustrate the approach taken. These include examples of active listening, interprofessional collaboration, clinical continuity, appropriate boundaries, and thoughtful timing. Psychodynamic applications in community settings have passed the test of time and because of their validity could again become prevalent. Competence depends upon experience with well-supervised psychodynamic psychotherapy and interdisciplinary collaboration, in a variety of cultures and settings.

North Carolina National Guard Integrated Behavioral Health System

The North Carolina National Guard (NCNG) Integrated Behavioral Health System is designed to systematically bring the best internal and external military resources together to function collaboratively for the betterment of behavioral health assessment, crisis intervention, referral, and case management services available to NCNG service members and their families.

In-home behavioral health case management: An integrated model for high-risk populations

The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.

Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders

A 3-year update with 59 new controlled trials is provided for the ongoing Mesa Grande project reviewing clinical trials of treatments for alcohol use disorders. The project summarizes the current evidence for various treatment approaches, weighting findings differentially according to the methodological strength of each study. The review includes 361 controlled studies that (1) evaluated at least one treatment for alcohol use disorders, (2) compared it with an alternative condition (such as a control group, a placebo, a brief intervention or an alternative treatment), (3) used a procedure designed to create equivalent groups before treatment and (4) reported at least one outcome measure of drinking or alcohol-related consequences. Studies were rated by two reviewers on 12 methodological criteria, and outcome logic was analyzed for the specific treatment modalities tested. Methodological quality of studies was significantly but modestly correlated with the reporting of a specific effect of treatment. Among psychosocial treatments, strongest evidence of efficacy was found for brief interventions, social skills training, the community reinforcement approach, behavior contracting, behavioral marital therapy and case management. For the first time, two pharmacotherapies also appeared among the most strongly supported approaches: opiate antagonists (naltrexone, nalmefene) and acamprosate. Least supported were methods designed to educate, confront, shock or foster insight regarding the nature and causes of alcoholism. Treatment methods differ substantially in apparent efficacy. It would be sensible to consider these differences in designing and funding treatment programs.

Immigrant Families Coping with Schizophrenia Behavioural Family Intervention v. Case Management with a Low-Income Spanish-Speaking Population

This investigation compared the effectiveness and cross-cultural applicability of behavioural family management (BFM) and standard case management in preventing exacerbation of symptoms and relapse in schizophrenia. Forty low-income Spanish-speaking people with a diagnosis of schizophrenia were randomly assigned to receive standard case management or behavioural family management after stabilisation with neuroleptic medication. Survival analyses indicated that among the less acculturated patients BFM was significantly related to greater risk of exacerbation of symptoms. Among the more acculturated patients, risk of exacerbation could be predicted by medication compliance but not by type of intervention. In analyses of symptom severity and functional status at 1-year follow-up, the level of patient acculturation was found to be significantly related to various measures of treatment outcome. Sociocultural factors affect responses to different types of intervention. The results did not support earlier findings of a beneficial effect of BFM when applied to a socioculturally diverse population.