Models Of Mental Health Service Delivery Research Articles

ADDRESSING THE MENTAL HEALTH NEEDS OF HOMEBOUND OLDER ADULTS IN AGING SERVICE SETTINGS

Abstract Despite significant and urgent mental health needs among low-income homebound older adults, the existing mental health service systems’ reach for these older adults is almost nonexistent. Given the current and projected geriatric mental health workforce shortages, innovative approaches are needed to better serve these underserved older adults. This presentation will focus on a series of randomized clinical trials that tested acceptable and feasible mental health service delivery models for homebound older adults who are served by aging service network agencies that provide hot meals and case management. Findings from the real-world effectiveness trials of tele-delivered behavioral activation treatment for depression and loneliness by bachelor’s-level lay counselors who are embedded in aging service agencies will be shared. Ways to promote a wider adoption of scalable and sustainable mental health service delivery models for homebound older adults will be discussed.

The Acceptability and Appropriateness of a Collaborative, Sport-Centered Mental Health Service Delivery Model for Competitive, and High-Performance Athletes.

The purpose of this study was to evaluate the acceptability and appropriateness of a sport-centered, collaborative mental health service delivery model implemented within the Canadian Center for Mental Health and Sport (CCMHS) over a period of 16 months. The study is situated within a larger Participatory Action Research (PAR) project to design, implement and evaluate the CCMHS. Primary data were collected from CCMHS practitioners (n = 10) and service-users (n = 6) through semi-structured interviews, as well as from CCMHS stakeholders (n = 13) during a project meeting, captured via meeting minutes. Secondary data derived from documents (e.g., clinical, policy, procedural; n = 48) created by the CCMHS team (i.e., practitioners, stakeholders, board of directors) during the Implementation Phase of the project were reviewed and analyzed to triangulate the primary data. The Framework Method was used to organize, integrate and interpret the dataset. Overall, results indicate that both practitioners and service-users found the model to be both acceptable and appropriate. In particular, practitioners' knowledge and experience working in sport, a robust intake process carried out by a centralized Care Coordinator, and the ease and flexibility afforded by virtual care delivery significantly contributed to positive perceptions of the model. Some challenges associated with interprofessional collaboration and mental health care costs were highlighted and perceived as potentially hindering the model's acceptability and appropriateness.

Right care, first time: a highly personalised and measurement-based care model to manage youth mental health.

Right care, first time: a highly personalised and measurement-based care model to manage youth mental health.

The experiences of older adults with a diagnosed functional mental illness, their carers and healthcare professionals in relation to mental health service delivery: An integrative review.

To analyse the experiences of older people with a diagnosed functional mental illness and their carers in relation to mental health service delivery and analyse the experiences of health and social care professionals who care for and treat older people who have a diagnosed functional mental illness. The prevalence of functional mental illness in older adults is notable but to date has received less research attention than dementia. Older adults with functional mental illness have life expectancy of up to 20years less than the rest of the population. Therefore, the experiences of older adults with functional mental illness, their carers and healthcare professionals, in relation to mental health services, need further exploration. Integrative literature review. A five-stage process was informed by Whittemore and Knafl. MeSH was used. Keyword searches of MEDLINE, CINAHL, Cochrane Library, PsycINFO, EMBASE and AMED were conducted between January 2000-October 2017. Titles were screened, and data were extracted manually and analysed using narrative synthesis. The PRISMA checklist was used. A total of 342 articles were deemed potentially relevant to this review. Once inclusion and exclusion criteria were applied, 28 articles were included. The literature presented an overarching theme "determinants influencing older people with functional mental illness use of services." The overarching theme is supported by two main themes: inevitable consequences of ageing and variations of the availability of healthcare services for older people with functional mental illness. Several determinants influence use of services by older people with functional mental illness. Older people with functional mental illness often perceived they did not have a mental health need. Within the literature, there was little acknowledgement of the experiences of older people with functional mental illness regarding their support needs. This integrative review has highlighted that some older people with functional mental illness do not seek mental health support because they believe that functional mental illness is an inevitable consequence of ageing; this is mirrored at times by healthcare professionals and carers. In addition to this finding, different views prevail regarding the impact that ageless and age-defined mental health service delivery models have on the needs of older people with functional mental illness. Further research is required to understand these findings.

Adoption of Technology-Enhanced Treatments: Conceptual and Practical Considerations.

As the efficacy of technology-enhanced mental health service delivery models (i.e., supportive or adjunctive technological tools) are examined, we must inform and guide clinician decision-making regarding acceptance and, in turn, uptake. Accordingly, this review aims to move beyond traditional discussions of geographic barriers by integrating, reconciling, and extending literatures on dissemination and implementation, as well as technology uptake, in order to anticipate and address organizational and clinician barriers to adoption of technology-enhancements. Specifically, a five-stage model is proposed to address organizational readiness for and clinician acceptance of technology-enhancements to evidence-based treatments, as well as the relevance of current adoption strategies for technology-enhanced services. Our aim is to provide a guiding framework for future research and practice.

Students with Dual Diagnosis: Can School-Based Mental Health Services Play a Role?

ABSTRACTThis article describes and investigates initial findings from the Esperanza Mental Health Services (EMHS) Program, which is an intensive outpatient program that provides individual and group mental health services for students with “dual diagnosis” or developmental disabilities and co-occurring mental health problems. Previous research substantiates that the mental health needs of this population are significant, yet often go unaddressed in school settings. Preliminary outcomes for a sample of 61 children ages 4–22 suggest improvements in important school indicators, such as suspensions and absences during the year of program implementation, as well as positive changes in parent-reported mental health functioning. Lastly, parent satisfaction regarding these services and supports was high. The implications of these results for a proposed school-based mental health service delivery model within a multi-tiered system of prevention and intervention are discussed.

Self-directed care: participants' service utilization and outcomes.

Self-directed care (SDC) is a mental health service delivery model in which participants budget the state dollars allotted for their care to purchase the goods and services they deem most appropriate for achieving their recovery goals. This study examines the demographic characteristics, service utilization patterns, and outcomes of individuals enrolled in the Florida Self-Directed Care (FloridaSDC) program, which is the oldest and most established SDC program in the United States for individuals diagnosed with a severe and persistent mental illness. This is a naturalistic descriptive study in which demographic, service utilization, and outcome data (i.e., Functional Assessment Rating Scale (FARS) scores, days in the community, days worked, monthly income, discharge status) were collected from the clinical and fiscal records of 136 FloridaSDC participants. Key findings suggest that FloridaSDC participants had very little income and largely utilized their budgets to subsidize their living expenses. Though most participants did not work or earn income and very few left the program due to employment, participants' FARS scores improved modestly and nearly all participants remained in the community throughout the study period. Participants' service purchases were rational given the poverty in which they live, and their outcomes did not suffer when they controlled decisions regarding their service needs. These findings highlight the utility and value of the personalized budgeting and individualized planning components of SDC. Findings also point to the need for practitioners to implement innovative strategies to enhance participants' employment readiness and supported employment opportunities. (PsycINFO Database Record

Mental Health in Schools: Engaging Learners, Preventing Problems, and Improving Schools

Mental Health in Schools: Engaging Learners, Preventing Problems, and Improving Schools By Howard Adelman PhD, & Linda Taylor PhD 22010, Corwin, USA, 310 pp. $41.95, ISBN: 9781412975384 Reviewed by Courtney Matz, M.A. Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by the very institutions and systems that were created to take care of them. -U.S. Department of Health and Human Services (2001) found in Adelman and Taylor (2010) In public schools across the United States school administrators, teachers, psychologists, counselors and other support staff face the challenge of ensuring their students receive needed mental health services despite budget cuts and other significant logistical constraints . For example, with the elimination of AB 3632 funding in 2010, Local Educational Agencies across California are feeling immense pressure to deliver mental health services to students who previously received assistance from the Department of Mental Health. A timely addition to the educational literature, authors Adelman and Taylor comprehensively address this juxtaposition of need and constraint in their most recent book, Mental Health in Schools: Engaging Learners, Preventing Problems, and Improving Schools. Within the text, readers are provided with valuable information regarding the restructure, development, and enhancement of school-based mental health programs. The authors open with a review of the history and current state of mental health in schools and move toward making suggestions for how to better address the mental health needs of students. They advocate persuasively for effective collaboration among stakeholders when providing mental health services in the public school systems. School psychologists, in particular, may find the guidelines provided by the authors useful in paving the way for school-based mental health service delivery models because they will undoubtedly be responsible for creating comprehensive programs to address student needs. PAST School based mental health service providers have historically been tasked with large number of referrals for the provision of mental health services and it is estimated that the ratio of school psychologists to students will continue to rise from 1 to 2,500 to even larger numbers (Ringeisen, Henderson, & Hoagwood, 2003). Adelman and Taylor begin their analysis of mental health services with an historical review. The authors evaluate the proliferation of legislation and public policy, which has sparked various movements in the delivery of school-based mental health services. They argue that these undertakings, including the President's New Freedom Commission on Mental Health (2003) and the 2007 Progress Report on the President's New Freedom Initiative, have created conflicting agendas. These initiatives call for schools to be involved in the provision of mental health services while at the same time demanding that they maximize their focus on instruction in the school setting. As a result, practitioners are often perplexed about how to balance these demands and implement these services in the schools and their surrounding communities. School systems have traditionally operated under a deficit model of mental health service delivery, which consists of the marginalization and compartmentalization of services seen as auxiliary or unnecessary for the betterment of the whole. For example, student support programs and services are often added to the educational curriculum on an ad hoc basis, via student support personnel who are rarely part of the school's overarching organizational structure. Adelman and Taylor assert that this compartmentalization of service, does not effectively address the challenges our students have encountered and will continue to face. Thus, the only way to meet the needs of the students is to develop a comprehensive approach of service delivery. …

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.

A Community Mental Health Service Delivery Model: Integrating the Evidence Base Within Existing Clinical Models

A model of care for community mental health services was developed by reviewing the available literature, surveying ?best practice? and evaluating the performance of existing services in a metropolitan area mental health service servicing a population of approximately 1.1 million people. A review of relevant academic literature and recognized ?good practice? service delivery models was undertaken in conjunction with a review of local activity data and consultation with key stakeholders (not addressed in this paper). A model was developed identifying the core functions of community mental health service delivery. The components of a comprehensive, integrated model of community mental health service (CMHS) are outlined. The essential components of a comprehensive, integrated model of CMHSs include: acute and emergency response, community continuing care services, assertive rehabilitation teams, partnerships with general practitioners and other human services agencies. We propose a comprehensive integrated model of community mental health service. Clarity of role, required outputs and expected outcomes will assist the development of effective and appropriate community mental health services. Outreach to the community is a key success factor for these services and their associated inpatient services. Gap analysis can assist in the planning and costing of community mental health services.

Investigating Parental Acceptability of the Incredible Years Self-Administered Parent Training Program for Children Presenting Externalizing Behavior Problems

This study takes an in-depth look at parental acceptability (i.e., the ability to meet parent needs) of an intervention that has shown strong empirical support for treating and preventing childhood conduct disorder. The authors obtained acceptability data from 30 parents of children ages 5 to 12 years presenting externalizing behavior problems through completion of the Treatment Evaluation Questionnaire-Parent Form and the Incredible Years Parent Program Video Evaluation Form. The Incredible Years Self-Administered Parent Training Program was implemented over 8 weeks with the majority of participants showing improvement. Study results indicated that the Incredible Years Self-Administered Parent Training Program was found to be acceptable with a significant difference in level of acceptability between Video Series 2 and 3. Given the ease of dissemination and acceptable nature of this parent training program, future research on this evidence-based intervention is warranted within a school-based mental health service delivery model.

Aboriginal mental health workers and the improving Indigenous mental health service delivery model in the 'Top End'

This article reviews the changing Aboriginal mental health service delivery model of Top End Mental Health Services, and highlights the importance of Aboriginal mental health workers in improving communication with Aboriginal patients. The Australian Integrated Mental Health Initiative Northern Territory Indigenous stream (AIMHI NT) is introduced.Baseline measures of AIMHI NT in 2003, and findings from two clinical file audits (1996 and 2001) at Royal Darwin Hospital inpatient unit are presented. The files were audited for a range of assessment and treatment interventions.The audits reveal significant improvements in Aboriginal inpatient care between 1995 and 2001.Aboriginal mental health workers provide essential services as cross-cultural brokers in the setting of Aboriginal mental illness. The improvements in care found in this file audit coincide with the commencement of employment of Aboriginal mental health workers in the inpatient unit. The AIMHI consultation reveals broad support for employment of more Aboriginal mental health workers in the Top End.

Aboriginal Mental Health Workers and the Improving Indigenous Mental Health Service Delivery Model in the ‘Top End’

This article reviews the changing Aboriginal mental health service delivery model of Top End Mental Health Services, and highlights the importance of Aboriginal mental health workers in improving communication with Aboriginal patients. The Australian Integrated Mental Health Initiative Northern Territory Indigenous stream (AIMHI NT) is introduced. Baseline measures of AIMHI NT in 2003, and findings from two clinical file audits (1996 and 2001) at Royal Darwin Hospital inpatient unit are presented. The files were audited for a range of assessment and treatment interventions. The audits reveal significant improvements in Aboriginal inpatient care between 1995 and 2001. Aboriginal mental health workers provide essential services as cross-cultural brokers in the setting of Aboriginal mental illness. The improvements in care found in this file audit coincide with the commencement of employment of Aboriginal mental health workers in the inpatient unit. The AIMHI consultation reveals broad support for employment of more Aboriginal mental health workers in the Top End.

Innovative Rural Mental Health Service Delivery for Rural Elders

This paper describes rural mental-health service delivery models identified in a 1995 yearlong search by the National Resource Center for Rural Elderly for innovative programs. Programs are classified into those providing direct service and those with an education and training focus. The leadership role of a single individual, palatibility to a rural elderly clientele, and flexibility are found to be shared characteristics of successful direct service models. Successful educationally oriented models are characterized by ongoing involvement of community leaders, development of specialized rurally specific curricula, and marketing that enabled programs to survive beyond their initial demonstration project funding. It is concluded that successful rural models of mental health care must be based on information that is germane to rural community life, specific training of mental health professionals to work in rural settings, engagement of rural elders as peer counselors in outreach, and strong linkages with existing services and programs.

EDITORIAL

This edition of the Australian Journal of Rural Health is a thematic issue with a special focus on rural mental health. In 1993, the Human Rights and Equal Opportunity Commission’s Human Rights and Mental Illness report (The Burdekin Report) focused public attention on many mental health problems including those in rural areas. 1 Two chapters of that report presented findings regarding people in rural and isolated areas and Aboriginal and Torres Strait Islander people. They highlighted issues including the distribution of services, difficulties for health professionals and historical and cultural issues regarding Aboriginal and Torres Strait Islander people. More recently, The Burden of Disease and Injury in Australia report found that mental illness is a major cause of morbidity and disability. 2 To date, there is little available research evidence detailing mental health morbidity and mortality patterns in rural and remote areas. As everywhere, environmental and cultural factors are likely to be key determinants of mental health in these areas. When asked, people in small rural communities describe a range of positive and negative aspects of the rural lifestyle that affect health and wellbeing. 3 Generally, however, they do not recognise the impact of the rural culture with its combination of close-knit communities emphasising mutual support, together with independence and self reliance. Often mental illness is seen as ‘weakness’ and those suffering more serious mental illnesses are stigmatised by the rural community. Three of the articles in this edition explore conceptual aspects of rural mental health. Wainer and Chesters 4 explore the distinction between mental illness and mental health in the rural context, drawing on historical perspectives and personal experiences of individual case examples. Subsequently, they describe the determinants of positive mental health in a rural context before concluding that there is a need for balanced social and economic developments as well as improved mental health services in rural and remote areas. Fuller et al. explore the ‘definition’ of mental health problems as perceived by people in rural and remote areas. 5 This research report confirms the reluctance of rural people to acknowledge mental health problems and the stigma associated with formal mental health services as well as the influence of rural and remote circumstances. The third conceptual article explores the gender roles and the emotional distress of women in urban, rural and remote areas of Queensland. 6 The study found that positive gender roles are more frequent in rural and remote areas and associated with lower levels of emotional distress. The authors’ conclusion is that an understanding of rural and remote mental health requires more sophisticated analysis than that based only on geographical location. The authors suggest that factors such as gender roles and other aspects of the rural culture may be important. Three of the articles are focused on clinical service delivery in rural and remote areas with a common emphasis on mutual support of rural health-care providers. Allison et al. evaluate a pilot clinical intervention in a rural setting. Their findings suggest that targeted short-term specialist interventions may often bring substantial improvements for mild to moderate mental health problems in rural and remote areas. 7 Malcolm, in her paper entitled A primary mental health-care model for rural Australia: Outcomes for doctors and the community, describes a successful mental health services delivery model with an emphasis on multidisciplinary teamwork in the rural setting. 8 Harvey describes the genesis and development of the rural psychologists’ network, which provides professional support and communication for counselling psychologists in rural and remote areas. 9 A recurring theme through several of the articles is the need for mental health service delivery models that are effective and successful in the context of rural community attitudes, geographically dispersed populations and serious workforce shortages. Local generalist nurses and doctors are the main providers of mental health care in small rural and remote communities. The quality and effectiveness of their services are likely to be enhanced where they are supported by distant specialist services and health-care providers. These specialist services and providers should fulfil a true consultant role, providing support, guidance and training to the on-the-ground practitioners in small communities. The final article in this thematic issue reports an initiative that is expected to assist workforce recruitment in the medium to long term. 10 The placement of nursing students in rural and remote mental health clinical attachments not only improves the students’ knowledge and understanding of rural and remote mental health issues, but is likely, in some cases, to raise the students’ interest in pursuing their careers in a rural setting. All the articles raise challenging questions that should stimulate considerable thought and discussion among readers. As always, letters to the editor responding to and debating issues raised by these articles are most welcome. I look forward to your comments.