Mental Health Services Research Research Articles

Health Reform Gets Its Day In Court—The Supreme One

EntryPoint Health AffairsVol. 31, No. 1: Confronting The Growing Diabetes Crisis Health Reform Gets Its Day In Court—The Supreme OneT.R. Goldman Affiliations T.R. Goldman ( [email protected] ) is a Washington, D.C., journalist who writes about legal affairs and health care. PUBLISHED:January 2012No Accesshttps://doi.org/10.1377/hlthaff.2011.1310AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleAbstractJustices could leave the Affordable Care Act intact, in shambles, or somewhere in between—and just months before the 2012 presidential election.TOPICSAffordable Care ActTaxesIndividual mandateLegal and regulatory issuesPrivate health insuranceMedicaidCosts and spendingLegislationPremiumsMarkets Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 3 History Published online 1 January 2012 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited byMedicaid Reimbursement of Mental Health Peer-Run Organizations: Results of a National Survey29 July 2015 | Administration and Policy in Mental Health and Mental Health Services Research, Vol. 44, No. 4Health care policy and cancer survivorship20 May 2013 | Cancer, Vol. 119The ‘Sleeper’ Issues Before The Supreme Court As It Reviews The Affordable Care ActT.R. Goldman2 August 2017 | Health Affairs, Vol. 31, No. 3

Client-Provider Relationship and Treatment Outcome: A Systematic Review of Substance Abuse, Child Welfare, and Mental Health Services Research

This systematic review reports on the association of the client-provider relationship with service outcomes across 3 service sectors: substance abuse, child welfare, and mental health. The review includes 60 research reports meeting inclusion criteria: 25 in substance abuse, 7 in child welfare, and 28 in mental health. For each social service sector, we analyze the association of the client-provider relationship to intermediate and ultimate outcomes. In addition, we examine potential moderating mechanisms of rater type (i.e., client, provider, and observer) and treatment setting (i.e., inpatient, outpatient, other). Social services research increasingly seeks to identify the active elements that affect outcomes common to all interventions. Results suggest the client-provider relationship is a consistent predictor of client retention in treatment and a somewhat less-consistent predictor of ultimate outcome across the 3 service sectors. These results contrast with recent findings from the psychotherapeutic literature in which the client-provider relationship demonstrated a weaker association with treatment retention (measured as drop out) than with other outcome measures. Findings indicate a clear need to refine the conceptualization and measurement of key service mechanisms and outcomes, particularly in the area of child welfare given that services research is less developed in that sector. The discussion includes recommendations for future research, including the use of selection criteria to enable researchers to conduct formal meta-analyses and expand the moderational framework with additional moderator variables relevant to social service delivery.

Mental Health Research in K–12 Schools: Translating a Systems Approach to University–School Partnerships

The authors discuss the challenges that researchers from university and community systems face in gaining access to and partnering with K–12 school systems to conduct research. Borrowing from Szapocznik, Hervis, and Schwartz's (2003) brief strategic family theory and therapy and Bronfenbrenner's (1979, 1986) ecological systems theory, the authors outline a model for diverse research communities in the United States that can be used by counselors and other mental health services researchers who plan to conduct research in K–12 schools.

Introducing peer support work in Latin American mental health services

In the course of implementing a recently funded network of hubs for building capacities in mental health service development, training, and research (RedeAmericas), the peer support workers are being introduced into the mental health workforce in three Latin American countries for the very first time. They will be part of a team, along with community mental health workers, that provides a modified Critical Time Intervention to individuals with severe psychiatric disorders living in the community. This article reviewed the background of this increasingly widespread development, and discussed its merits, as well as potential obstacles within local contexts.

Implementing a Multidimensional Poverty Measure Using Mixed Methods and a Participatory Framework

Recently, there have been advances in the development of multidimensional poverty measures. Work is needed however on how to implement such measures. This paper deals with the process of selecting dimensions and setting weights in multidimensional poverty measurement using qualitative and quantitative methods in a participatory framework. We estimate the multidimensional poverty measures developed by Alkire and Foster for a particular group: persons with psychiatric diagnoses in the United States. To select relevant dimensions and their relative ordering, two discussion groups are convened: one consisting of persons with lived-experience expertise and the other consisting of people with mental health service provision or research expertise. Several methods are used to convert dimension rankings into weights. The selection and ordering of dimensions differed between the two discussion groups, as did the resulting poverty measures. For instance, the poverty headcount using the dimensions and weights of the ‘lived experience’ group ranged from 20.61 to 26.96% as compared to a range of 18.62–33.19% using those of the ‘provider/researcher’ group. One of the main results of this study is that the Alkire Foster method is sensitive to the selection of dimensions and the methods used to derive rankings and weights. It points toward the limitation of relying exclusively on small scale qualitative methods for the selection and ranking of dimensions. In addition, the participatory framework used in this study was found to be essential in interpreting results, in particular with respect to the limitations of the data set in measuring relevant dimensions.

Mental health service delivery in South Africa from 2000 to 2010: one step forward, one step back.

To identify progress and challenges in mental healthcare in South Africa, as well as future mental health services research priorities. A systematic review of mental health services research. Literature searches were conducted in Medline, PsychInfo and Sabinet databases from January 2000 to October 2010 using key phrases. Hand searches of key local journals were also conducted. Of 215 articles retrieved, 92 were included. Data were extracted onto a spreadsheet and analysed thematically. While progress in epidemiological studies has been good, there is a paucity of intervention and economic evaluation studies. The majority of studies reviewed were on the status of mental healthcare services. They indicate some progress in decentralised care for severe mental disorders, but also insufficient resources to adequately support community-based services, resulting in the classic revolving-door phenomenon. Common mental disorders remain largely undetected and untreated in primary healthcare. Cross-cutting issues included the need for promoting culturally congruent services as well as mental health literacy to assist in improving help-seeking behaviour, stigma reduction, and reducing defaulting and human rights abuses. While there has been some progress in the decentralisation of mental health service provision, substantial gaps in service delivery remain. Intervention research is needed to provide evidence of the organisational and human resource mix requirements, as well as cost-effectiveness of a culturally appropriate, task shifting and stepped care approach for severe and common mental disorders at primary healthcare level.

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Developing preventive mental health interventions for refugee families in resettlement.

In refugee resettlement, positive psychosocial outcomes for youth and adults depend to a great extent on their families. Yet refugee families find few empirically based services geared toward them. Preventive mental health interventions that aim to stop, lessen, or delay possible negative individual mental health and behavioral sequelae through improving family and community protective resources in resettled refugee families are needed. This paper describes 8 characteristics that preventive mental health interventions should address to meet the needs of refugee families, including: Feasibility, Acceptability, Culturally Tailored, Multilevel, Time Focused, Prosaicness, Effectiveness, and Adaptability. To address these 8 characteristics in the complex environment of refugee resettlement requires modifying the process of developmental research through incorporating innovative mental health services research strategies, including: resilience framework, community collaboration, mixed methods with focused ethnography, and the comprehensive dynamic trial. A preventive intervention development cycle for refugee families is proposed based on a program of research on refugees and migrants using these services research strategies. Furthering preventive mental health for refugee families also requires new policy directives, multisystemic partnerships, and research training.

Auswirkungen des Betreuungsgesetzes im wiedervereinigten Deutschland (1992–2009)

The Guardianship Law became effective in the year 1992 with the intention of replacing the paternalistic-restrictive model by a model based on the principles of participation and empowerment. Data from the Federal Ministry of Justice were used to examine the development of 12 legal guardianship parameters over a period of 17 years (1992-2009) at the level of federal states. Due to the completely different practise in both parts of Germany before reunification, the development will be analysed separately for the old and the new federal states. All examined parameters indicate an increase of legal guardianship. The highest increases were found for enlargement of the task scope (+606%) and for approval of contention measures (+868%). With the exception of involuntary commitment rates, in the new federal states the mean values of all variables score higher than in the old federal states. Legal guardianship installation only increased for the old federal states significantly (T(9)=6.64; p=0.007); however, the guardianship expenses were higher, but not significantly, for the new federal states. In spite of the legal changes in the direction of a dynamic instrument in mental health care, the practise of the Legal Guardianship Law indicates a continuous increase of guardianship orders since 1992. It is necessary to recognise that a slowdown of the upward trend is not in sight. Therefore it is pertinent to call those persons in charge of regulating legal guardianship to consider their daily practise carefully. On the other hand it is a task of mental health services research to analyse the driving factors of the presented developments.

Preface

the IXth ENMESH International Conference 2011 (June 23–25, Ulm, Germany) gives an opportunity for mental health services researchers to present their findings and learn from differences, in order to further improve mental health care and research across Europe.

‘What You Do is Important But How You Do it is More Important’

Evidence on the methods followed by non‐Indigenous researchers for conducting research that involves Indigenous people in Australia is sparse. This paper describes the methodology and steps followed by a non‐Indigenous researcher for engaging with men from an Aboriginal community in rural Victoria in conducting mental health services research. It describes the process adopted to initiate research and build research capacity within an Indigenous community where Indigenous researchers were unavailable and the local communities were ill‐equipped to conduct research themselves. The methodology followed was informed by the values and ethics guidelines of the Australian National Health and Medical Research Council, the decolonising methodology of Linda Tuhiwai Smith as well as methods suggested by other authors. Lessons learnt included providing for a long time frame, which is necessary to develop relationships and trust with individuals and their Communities, adopting a flexible approach and engaging cultural advisers who represent different sections of the Community.

Mixed-Methods Designs in Mental Health Services Research: A Review

Despite increased calls for use of mixed-methods designs in mental health services research, how and why such methods are being used and whether there are any consistent patterns that might indicate a consensus about how such methods can and should be used are unclear. Use of mixed methods was examined in 50 peer-reviewed journal articles found by searching PubMed Central and 60 National Institutes of Health (NIH)-funded projects found by searching the CRISP database over five years (2005-2009). Studies were coded for aims and the rationale, structure, function, and process for using mixed methods. A notable increase was observed in articles published and grants funded over the study period. However, most did not provide an explicit rationale for using mixed methods, and 74% gave priority to use of quantitative methods. Mixed methods were used to accomplish five distinct types of study aims (assess needs for services, examine existing services, develop new or adapt existing services, evaluate services in randomized controlled trials, and examine service implementation), with three categories of rationale, seven structural arrangements based on timing and weighting of methods, five functions of mixed methods, and three ways of linking quantitative and qualitative data. Each study aim was associated with a specific pattern of use of mixed methods, and four common patterns were identified. These studies offer guidance for continued progress in integrating qualitative and quantitative methods in mental health services research consistent with efforts by NIH and other funding agencies to promote their use.

Vermont’s Blueprint For Medical Homes, Community Health Teams, And Better Health At Lower Cost

written permission from the Publisher. All rights reserved. mechanical, including photocopying or by information storage or retrieval systems, without prior may be reproduced, displayed, or transmitted in any form or by any means, electronic or Affairs Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of by Project HOPE The People-to-People Health 2011 Bethesda, MD 20814-6133. Copyright © is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Health Affairs

Mixed-Methods Designs in Mental Health Services Research: A Review

Mixed-Methods Designs in Mental Health Services Research: A Review

Trials and tribulations: Conducting research in routine NHS child and adolescent mental health services

The following gives a brief overview of an ongoing randomised control trial (RCT) for childhood obsessive compulsive disorder (OCD). It then discusses some of the practical difficulties involved in doing research in non-research cultures and the impacts of the research.

Questioning heteronormativity: using queer theory to inform research and practice within public mental health services

Queer theory is often maligned as being inadequate for advancing social justice. So, how might queer theory guide research and practice in public mental health services (PMHS)? Within the research on mental health issues for lesbians, gays and bisexuals (LGB) there are calls for making mental health services more LGB affirmative. Mostly this scholarship is from the field of ‘lesbian and gay psychology’. This tends to have an individualistic, positivist and essentialising focus. As such, it is limited in exploring how heteronormative cultural discourses impact on research, mental health systems and clinical practice. For example, common recommendations include separate LGB services and matching clients and clinicians along sexual orientation lines. Utilising a queer perspective on the homo/hetero binary, this article argues that such strategies are minoritising, in that they make homosexuality relevant to only a minority of clients and staff. When applied to mental health practice, minoritising strategies have limited scope to effect change for the wide group of same-sex attracted clients within PMHS. Based on research with same-sex attracted clients and staff of PHMS in Aotearoa/New Zealand, this article explores how a queer theoretical perspective can usefully inform research and clinical practice in ways that affirm queerness by questioning heteronormativity.

School Reform and Mental Health Services for Students with Emotional Disturbances Educated in Urban Schools

Outcomes for students in special education continue to be disappointing and those having emotional disturbances (ED) continue to lag behind the other disability groups. In this study, school reform activities and the effects on students who are educated in special education programs for students who have ED were examined. Demographically similar elementary, middle, and high schools in urban communities were classified as either actively engaged in (HI) or not very engaged in (LO) reform activities. Findings indicated students with ED in the HI schools spent more time in academic general education classes with non-handicapped peers; had significantly higher achievement scores in math; and were more likely to receive mental health services from community agencies compared to students in the LO schools. Implications are discussed in terms of current developments in the school-based mental health services research and provider communities to refocus interventions on learning, the core function of schools.

Towards integrated care in Europe

The split responsibility for in-patient and out-patient care is one of the most serious problems facing mental healthcare in Europe. It is a major obstacle in the continuity of care, particularly with severely mentally ill patients. I have been involved in mental health services research for 30

Health Care Reform and Mental Health Care Delivery

Back to table of contents Next article Taking IssueFull AccessHealth Care Reform and Mental Health Care DeliveryVidhya Alakeson M.Sc.,Richard G. Frank Ph.D.,Vidhya Alakeson M.Sc.Search for more papers by this author,Richard G. Frank Ph.D.Search for more papers by this author,Published Online:1 Nov 2010AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Three articles in this issue of the journal review economic and policy implications for mental health delivery of the Patient Protection and Affordable Care Act, referred to as the ACA. The authors highlight opportunities for great improvement, as well as challenges, in the financing and delivery of mental health care in the United States. The ACA incrementally expands existing insurance, and it also creates and encourages the development and diffusion of important new institutions and organizational forms that will govern insurance markets and service provision. Garfield and colleagues describe these expansions. McGuire and Sinaiko explain the role of health insurance exchanges in restructuring the individual and small-group markets. Druss and Mauer explain the potential of new organizational forms to promote integration of mental health and other medical care, along with improved approaches to specialty care delivery.In each case, important potential gains in social welfare are noted, with an emphasis on key choices that must be made by those implementing the blueprint set out in the ACA. Gains in coverage among people with mental and substance use disorders are intertwined with the problems of poverty, illiteracy, and social isolation. Special efforts will be required to engage and enroll this deprived and frequently costly population. McGuire and Sinaiko explain that competitive insurance markets have functioned especially poorly in providing coverage to people at elevated risk of mental health and substance use problems. They review measures that might be adopted by new health insurance exchanges to mitigate historical failures in private insurance. The analysis presented by Garfield and colleagues highlights that gaps in services will remain despite coverage expansion, particularly for social supports that are not likely to be covered by private health insurance. Funding for wraparound services will continue to be important. Finally, Druss and Mauer suggest improvements in the infrastructure to promote improved mental health care within newly created medical homes and accountable care organizations. They call for development of a broader range of quality measures in mental health and the use of information technology by specialty providers.The ACA reinforces the place of mental health and substance use disorder care in the health care mainstream, building on the 2010 implementation of parity requirements for coverage of behavioral health care in private health insurance. Even though the field may have entered the mainstream of health care reform, it is still important to recognize and address the unique challenges to the health care system posed by individuals with mental and substance use disorders. The government and other stakeholders must redouble their commitments to craft policies that account for the sometimes exceptional circumstances presented by mental health care delivery.Nuffield TrustOffice of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services FiguresReferencesCited byDetailsCited ByNavigating a Complex Health System: the Perceptions of Psychiatric Residents in Addressing Sexual and Reproductive Health of Women with Severe Mental Illness21 February 2020 | Academic Psychiatry, Vol. 44, No. 4Behavioral Health's Integration Within a Care Network and Health Care Utilization30 May 2018 | Health Services Research, Vol. 53, No. 6The Role of Health Plans in Supporting Behavioral Health Integration23 June 2017 | Administration and Policy in Mental Health and Mental Health Services Research, Vol. 44, No. 6How Health Reform is Recasting Public PsychiatryPsychiatric Clinics of North America, Vol. 38, No. 3Administration and Policy in Mental Health and Mental Health Services Research, Vol. 42, No. 3 Volume 61Issue 11 November, 2010Pages 1063-1063PSYCHIATRIC SERVICES November 2010 Volume 61 Number 11 Metrics PDF download History Published online 1 November 2010 Published in print 1 November 2010

Health Care Reform and Mental Health Care Delivery

Back to table of contents Next article Taking IssueFull AccessHealth Care Reform and Mental Health Care DeliveryVidhya Alakeson M.Sc.,Richard G. Frank Ph.D.,Vidhya Alakeson M.Sc.Search for more papers by this author,Richard G. Frank Ph.D.Search for more papers by this author,Published Online:1 Nov 2010AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Three articles in this issue of the journal review economic and policy implications for mental health delivery of the Patient Protection and Affordable Care Act, referred to as the ACA. The authors highlight opportunities for great improvement, as well as challenges, in the financing and delivery of mental health care in the United States. The ACA incrementally expands existing insurance, and it also creates and encourages the development and diffusion of important new institutions and organizational forms that will govern insurance markets and service provision. Garfield and colleagues describe these expansions. McGuire and Sinaiko explain the role of health insurance exchanges in restructuring the individual and small-group markets. Druss and Mauer explain the potential of new organizational forms to promote integration of mental health and other medical care, along with improved approaches to specialty care delivery.In each case, important potential gains in social welfare are noted, with an emphasis on key choices that must be made by those implementing the blueprint set out in the ACA. Gains in coverage among people with mental and substance use disorders are intertwined with the problems of poverty, illiteracy, and social isolation. Special efforts will be required to engage and enroll this deprived and frequently costly population. McGuire and Sinaiko explain that competitive insurance markets have functioned especially poorly in providing coverage to people at elevated risk of mental health and substance use problems. They review measures that might be adopted by new health insurance exchanges to mitigate historical failures in private insurance. The analysis presented by Garfield and colleagues highlights that gaps in services will remain despite coverage expansion, particularly for social supports that are not likely to be covered by private health insurance. Funding for wraparound services will continue to be important. Finally, Druss and Mauer suggest improvements in the infrastructure to promote improved mental health care within newly created medical homes and accountable care organizations. They call for development of a broader range of quality measures in mental health and the use of information technology by specialty providers.The ACA reinforces the place of mental health and substance use disorder care in the health care mainstream, building on the 2010 implementation of parity requirements for coverage of behavioral health care in private health insurance. Even though the field may have entered the mainstream of health care reform, it is still important to recognize and address the unique challenges to the health care system posed by individuals with mental and substance use disorders. The government and other stakeholders must redouble their commitments to craft policies that account for the sometimes exceptional circumstances presented by mental health care delivery.Nuffield TrustOffice of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services FiguresReferencesCited byDetailsCited byNavigating a Complex Health System: the Perceptions of Psychiatric Residents in Addressing Sexual and Reproductive Health of Women with Severe Mental Illness21 February 2020 | Academic Psychiatry, Vol. 44, No. 4Behavioral Health's Integration Within a Care Network and Health Care Utilization30 May 2018 | Health Services Research, Vol. 53, No. 6The Role of Health Plans in Supporting Behavioral Health Integration23 June 2017 | Administration and Policy in Mental Health and Mental Health Services Research, Vol. 44, No. 6How Health Reform is Recasting Public PsychiatryPsychiatric Clinics of North America, Vol. 38, No. 3Administration and Policy in Mental Health and Mental Health Services Research, Vol. 42, No. 3 Volume 61Issue 11 November, 2010Pages 1063-1063PSYCHIATRIC SERVICES November 2010 Volume 61 Number 11 Metrics PDF download History Published online 1 November 2010 Published in print 1 November 2010