Outpatient Mental Health Treatment Research Articles

The development of an innovative, theory-driven, psychoeducational HIV/STI prevention intervention for heterosexually active black adolescents with mental illnesses

ABSTRACTSexually transmitted infections (STIs), including human immunodeficiency virus (HIV), continue to disproportionately affect Black adolescents. Those experiencing the psychological sequelae of mental illnesses are at increased risk. Here, we outline the development of an HIV/STI prevention intervention for heterosexually active Black adolescents with mental illnesses. This research was guided by a psychosocial expansion of the Theory of Planned Behavior, nested within a broader social determinants of health framework. A youth community advisory board provided study oversight. Heterosexually active Black adolescents aged 14–17 were recruited from community-based outpatient mental health providers for focus groups, surveys and two ‘dress rehearsals’ of the intervention protocol (N = 68). The qualitative and quantitative findings indicated that knowledge, attitudes and skills related to consistent condom use, reduced number of sexual partners, routine HIV/STI testing, abstinence and emotion regulation were important areas to target. These elicitation data provided insight into the context of HIV/STI risk for the study population, and were used to develop the intervention content. ‘Project GOLD: We are Kings and Queens’ was designed to be delivered over two days (3 hours per day), with eight, 45-min modules. The activities address behaviors, as well as cognitive, emotional, psychological and social processes associated with HIV/STI risk. Alongside evidence-based HIV/STI prevention strategies (e.g. sexual partner communication skills), the intervention activities are rooted in principles of Cognitive Behavioral Therapy. Dress rehearsal participants were in favor of the intervention and provided feedback on activity length, gender and cultural relevance and strategies to sustain attention; this information was used to finalize the curriculum. In partnership with the community, we developed a theoretically driven, gender and culturally relevant, developmentally and psychologically appropriate HIV/STI prevention program. Our ultimate goal is to standardize sexual health assessment and intervention in outpatient mental health treatment settings to meet sexual health needs in this underserved population.

Michigan officials praise new laws to help people with MH issues

Michigan court officials are commending state lawmakers for passing and the governor for signing laws Dec. 28 that should improve mental health care for adults and juveniles, The Macomb Daily reported Dec. 29, 2018. State Court Administrator Milton L. Mack Jr. is pleased with three bills to reform the state mental health code to allow for earlier treatment of individuals who need mental health care services prior to a crisis involving the criminal justice system, state court administrative officials said in a news release. “This legislation is a monumental step forward and makes Michigan a national leader in making it easier to ask for outpatient mental health treatment — before a crisis and before contact with the justice system,” Mack said in the release. Statewide, there are 185 problem‐solving courts that focus on providing treatment and intense supervision to offenders as an alternative to incarceration, including drug, mental health, sobriety and veterans courts. Mack, former chief of Wayne County Probate Court, said the reforms respond to concerns in Michigan and across the nation that jails and prisons have become the primary institutions for people with mental illness. The state has awarded $5.2 million to fund the operation of 31 mental health courts in fiscal year 2019.

Perceptions of Fetal Alcohol Spectrum Disorder (FASD) at a Mental Health Outpatient Treatment Provider in Minnesota.

Resulting from prenatal exposure to alcohol, Fetal Alcohol Spectrum Disorder (FASD) is characterized by deficits in adaptive and cognitive functioning. This disorder is typically accompanied by co-occurring disorders and conditions (e.g., mood, anxiety, psychosis, and substance use disorders). This complicated presentation of diverse symptoms makes the process of screening, assessing, and diagnosing FASD very difficult, limiting the likelihood that clients receive the treatment and services that they need. Although mental health care providers have an opportunity to intervene on behalf of clients with FASD, professionals may not be very familiar or comfortable with this complicated and life-altering disorder. The present study explores the familiarity of 79 mental health outpatient treatment professionals’ personal knowledge and training about FASD. Findings suggest that the majority of respondents had received at least some FASD training, understood the basic symptoms of FASD, and were realistic about FASD’s impact on treatment.

Use of a Web-Based Shared Decision-Making Program: Impact on Ongoing Treatment Engagement and Antipsychotic Adherence.

The authors examined the impact of a Web-based shared decision-making application, MyCHOIS-CommonGround, on ongoing outpatient mental health treatment engagement (all users) and antipsychotic medication adherence (users with schizophrenia). An intervention study was conducted by comparing Medicaid-enrolled MyCHOIS-CommonGround users in 12 participating mental health clinics (N=472) with propensity score-matched adults receiving services in nonparticipating clinics (N=944). Medicaid claims were used to assess ongoing treatment engagement and antipsychotic adherence (among individuals with schizophrenia) one year prior to and after entry into the cohort. Multilevel linear models were conducted to estimate the effects of the MyCHOIS-CommonGround program over time. No differences during the baseline year were found between the MyCHOIS-CommonGround group and the matched control group on demographic, diagnostic, or service use characteristics. At one-year follow-up, engagement in outpatient mental health services was significantly higher for MyCHOIS-CommonGround users than for the control group (months with a service, 8.54±.22 versus 6.95±.15; β=1.40, p<.001). Among individuals with schizophrenia, antipsychotic medication adherence was also higher during the follow-up year among MyCHOIS-CommonGround users compared with the control group (proportion of days covered by medication, .78±.04 versus .69±.03; β=.06, p<.01). These findings provide new evidence that shared decision-making tools may promote ongoing mental health treatment engagement for individuals with serious mental illness and improved antipsychotic medication adherence for those with schizophrenia.

An Examination of Triarchic Psychopathy Constructs in Female Offenders

This study sought to expand scientific knowledge on psychopathic personality traits in female offenders by evaluating the relationship between MMPI–2–RF triarchic scales and self-reported external variables in a sample of 205 female offenders. Results indicated that boldness was inversely related to internalizing dysfunction, including suicidal behavior, psychosis, youth conduct problems, problems stemming from alcohol use, and a history of outpatient mental health treatment. Meanness was positively related to internalizing dysfunction as well as youth conduct problems, anger, prison disciplinary reports, and psychosis. Disinhibition was associated with a history of abuse in childhood, suicidal behavior, internalizing dysfunction, problems associated with alcohol and drug use, family history of mental illness, prison disciplinary reports for violence, number of previous criminal charges, and anger. Consistent with views of psychopathy as a configural condition, interactive effects of boldness with disinhibition and meanness were observed for multiple key external variables (e.g., conduct problems, substance use, nonsuicidal self-injurious behavior). This study provides further evidence for the triarchic conceptualization of psychopathy in female offenders and lends additional support for the validity of MMPI–2–RF triarchic psychopathy scales.

Trends in and Predictors of Long-Term Antipsychotic Polypharmacy Use Among Ohio Medicaid Patients with Schizophrenia, 2008–2014

The study examined trends and patterns in long-term antipsychotic polypharmacy among Ohio Medicaid patients with schizophrenia and predictors of use. A study using a retrospective cohort design and Medicaid claims data was conducted for a cohort of 25,062 adults with a schizophrenic disorder receiving antipsychotic medication between 2008 and 2014. Long-term antipsychotic polypharmacy was defined as simultaneous treatment with two or more antipsychotic medications for ≥90 days. Annual trends in antipsychotic polypharmacy were estimated. Multivariate logistic regression was used to identify patient demographic, clinical, and treatment characteristics associated with antipsychotic polypharmacy. The prevalence of antipsychotic polypharmacy decreased significantly from 29.5% in 2008 (2,715 of 9,211) to 24.9% in 2014 (2,866 of 11,500) (adjusted odds ratio=.98, 99% confidence interval=.97-.99, p<.001). Factors significantly associated with antipsychotic polypharmacy included younger age, male sex, disabled status, rural residence, a schizophrenic disorder other than schizoaffective disorder, a greater number of general medical comorbidities, treatment with more psychotropic medication classes, and more outpatient mental health treatment and emergency department visits. Antipsychotic polypharmacy was significantly less likely for African Americans or those from other racial minority groups compared with whites, for those with substance use disorders compared with others, and for those with a greater number of inpatient psychiatric hospitalizations. Antipsychotic polypharmacy declined for pharmacologically treated individuals with schizophrenia in Ohio Medicaid between 2008 and 2014, but it remained inordinately prevalent given existing treatment guidelines that recommend antipsychotic monotherapy as the standard of care for patients with schizophrenia.

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps.

Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.

Using Photography to Explore Recovery Themes With Veterans

ABSTRACTThis author of this study examined if creating photographs to explore a recovery experience could be therapeutic. Veterans from multiple war periods, who were receiving outpatient mental health treatment, voluntarily enrolled in a six-week photography workshop. During the workshop, 31 veterans learned the basics of photography and discussed recovery challenges with peers. For the final class, participants created a six-image portfolio that visually expressed a personal recovery theme. Pre-and post, 10-item Likert scale questionnaires were completed in order to evaluate the benefits of the photography workshop. There was a statistically significant increase in the post test questionnaire score (+0.47 points, p = 0 .001). The findings support the hypothesis that taking photographs while in recovery can improve personal reflection and organization of thinking, as well as promote recovery discussions, communication, social support, and sense of purpose. Recovery themes included dealing with pain, isolation, growth, transformation, and healing.

Substance Use Disorder Among Current Cancer Patients: Rates and Correlates Nationally in the Department of Veterans Affairs

Substance use disorders (SUDs) are known to cause or complicate treatment of many types of cancers. We sought to systematically assess rates of current SUDs among patients currently in treatment for cancer. The National Veteran Health Administration administrative data from fiscal year 2012 were used to compare veterans with both cancer and comorbid SUDs to veterans with cancer but no SUDs and those with a SUD but no cancer. Bivariate comparisons and multivariate logistic regression were used to compare groups on sociodemographic characteristics, medical and mental health diagnoses, service use, and psychotropic and opioid medication fills. Of 482,688 veterans with cancer diagnoses, 32,037 (6.64%) had a comorbid SUD diagnosis. Veterans with cancer and a SUD had more medical and psychiatric disorders than those with cancer alone, a greater risk of homelessness, and a greater use of both mental and medical health services, with 60% receiving mental health outpatient treatment. These veterans had fewer differences from veterans with SUDs only, although they were older and had more medical illnesses. Notably the cancer SUD group had higher rates of hepatic disease and received a greater number of opioid prescriptions than both veterans with cancer alone and veterans with SUD alone. Veterans with cancer and SUD showed a specific risk for liver disease and a higher use of opioids. Collaborative teams involving oncology, palliative care, and psychiatry may be best able to address the challenge of providing adequate and safe opiate pain control for this vulnerable population.

Rationale, design and pilot feasibility results of a smartphone-assisted, mindfulness-based intervention for smokers with mood disorders: Project mSMART MIND

BackgroundAlthough individuals with psychiatric disorders are disproportionately affected by cigarette smoking, few outpatient mental health treatment facilities offer smoking cessation services. In this paper, we describe the development of a smartphone-assisted mindfulness smoking cessation intervention with contingency management (SMI-CM), as well as the design and methods of an ongoing pilot randomized controlled trial (RCT) targeting smokers receiving outpatient psychiatric treatment. We also report the results of an open-label pilot feasibility study. MethodsIn phase 1, we developed and pilot-tested SMI-CM, which includes a smartphone intervention app that prompts participants to practice mindfulness, complete ecological momentary assessment (EMA) reports 5 times per day, and submit carbon monoxide (CO) videos twice per day. Participants earned incentives if submitted videos showed CO≤6ppm. In phase 2, smokers receiving outpatient treatment for mood disorders are randomized to receive SMI-CM or enhanced standard treatment plus non-contingent CM (EST). ResultsThe results from the pilot feasibility study (N=8) showed that participants practiced mindfulness an average of 3.4times/day (≥3min), completed 72.3% of prompted EMA reports, and submitted 68.0% of requested CO videos. Participants reported that the program was helpful overall (M=4.85/5) and that daily mindfulness practice was helpful for both managing mood and quitting smoking (Ms=4.50/5). ConclusionsThe results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders.

Factors that Affect Choice of Mental Health Provider and Receipt of Outpatient Mental Health Treatment.

According to the US Department of Health and Human Services, 91 million adults live in mental health professional shortage areas and 10 million individuals have serious mental illness (SMI). This study examines how the supply of psychiatrists, severity of mental illness, out-of-pocket costs, and health insurance type influence patients' decisions to receive treatment and the type of provider chosen. Analyses using 2012-2013 MarketScan Commercial Claims data showed that patients residing in an area with few psychiatrists per capita had a higher predicted probability of not receiving follow-up care (46.4%) compared with patients residing in an area with more psychiatrists per capita (42.5%), and those in low-psychiatrist-supply areas had a higher predicted probability of receiving prescription medication only (10.2 vs 7.6%). Patients with SMI were more likely than those without SMI to obtain treatment. A $25 increase in out-of-pocket costs had marginal impact on patients' treatment choices.

To what extent is patient-rated quality of life associated with continuity of care, therapeutic relationships and unmet need for services? A study of outpatient mental health service users in Norway

In addition to attending to patients’ mental and somatic health, mental health services now often offer assistance across many spheres of patients’ lives, such as housing, social activities, and employment. Patient-centered recovery is an aim attempting not only to help patients to control symptoms, but also to help them manage everyday life and live as good lives as possible with their illness. Changes to the delivery of care have resulted in an increased emphasis on the quality of the therapeutic relationship between patients and clinicians, the continuity of care and to meeting as many of patients’ needs as feasible. Both the therapeutic relationship and continuity of care are key to mental health services' interaction with patients in their day-to-day lives, but have not been systematically investigated in relation to patient-rated outcomes including quality of life (QoL). There is scarce evidence of a relationship between the goal of improving patients’ QoL and their assessments of their therapeutic relationships as well as how they perceive continuity of care. In this study, we investigate whether there is an association between how mental health outpatients in Norway experience their therapeutic relationships, continuity of care and unmet needs, and how they assess the quality of their lives. A two stage cross sectional study was performed. Firstly, a national mapping among patients receiving mental health outpatient treatment during a fourteen day period in 2013 (n=23167), and at the same time a service user-generated Continuity of care-measure (n=15258). Secondly, a follow-up survey was performed ten months later among service users who accepted to be contacted again (n=4338). In total, 1327 responded in the follow-up study. Regression analysis was performed to investigate factors associated with QoL (measured by MANSA). The results show that patient-rated QoL-outcome is strongly related to therapeutic relationship with closest provider and to continuity of care. Also unmet need for unmet need for activity center/day center and meeting places for users were significantly associated (negative) with QoL, as were unmet need for social services and individual support contact. Furthermore, the results show that having good contact with family and friends is highly important for QoL. The same applies for living together with spouse or cohabitant as opposed to living alone. As in most other studies QoL associates with socioeconomic status. Also in line with other studies, the results show that QoL is actually higher among patients with a severe diagnosis (smi) compared to non-smi diagnosis. The findings show the importance of including relatively simple actions of everyday life in terms of activity and social life that give people with mental illness a good opportunity to improved QoL. Furthermore, that mental health services have to maintain focus on continuity of care and a good relation between patient and provider, and that support from family and friends should be utilized to the fullest. The study supports the importance of a recovery perspective.

Insurance Coverage and Health Outcomes in Young Adults With Mental Illness Following the Affordable Care Act Dependent Coverage Expansion.

As a provision of the Affordable Care Act, young adults were able to remain on their parents' health insurance plans until age 26. We examined the impact of the 2010 dependent coverage expansion on insurance coverage and health outcomes among young adults with mental illness. Data are from the 2008-2013 National Survey on Drug Use and Health, an annual population-based survey of noninstitutionalized US individuals aged 12 and older. We used a difference-in-differences approach to compare young adults with mental illness subject to the provision (aged 19-25 years, n = 19,051) with an older comparison group (aged 26-34 years, n = 7,958) before (2008-2009) and after (2011-2013) the dependent coverage expansion in their insurance coverage, use of health services, and self-reported health. In adjusted analyses, following the dependent coverage expansion, private insurance coverage increased by 11.7 percentage points (95% CI, 8.4-15.1, P < .001) and uninsurance decreased by 8.9 percentage points (95% CI, -12.1 to -5.7, P < .001) among 19- to 25-year-olds with mental illness, relative to 26- to 34-year-olds. The provision was associated with a modest increase in young adults with mental illness who received outpatient mental health treatment at least monthly on average (+2.0% [95% CI, 0.1% to 4.0%, P = .04]) and a modest decrease in those reporting their overall health as fair or poor (-2.3% [95% CI, -4.6% to -0.0%, P = .05]). Unmet mental health needs due to cost decreased significantly among those with moderate-to-serious mental illness (-12.3% [95% CI, -22.7% to -2.0%, P = .02]), but did not change among those with mild illness. The 2010 dependent coverage expansion was associated with an increase in insurance coverage, several indicators of mental health treatment, and improved self-reported health among young adults with mental illness.

A Randomized Controlled Trial of the Rochester Forensic Assertive Community Treatment Model.

Forensic assertive community treatment (FACT) is an adaptation of the assertive community treatment model and is designed to serve justice-involved adults with serious mental illness. This study compared the effectiveness of a standardized FACT model and enhanced treatment as usual in reducing jail and hospital use and in promoting engagement in outpatient mental health services. Seventy adults with psychotic disorders who were arrested for misdemeanor crimes and who were eligible for conditional discharge were recruited from the Monroe County, New York, court system. Participants were randomly assigned to receive either FACT (N=35) or enhanced treatment as usual (N=35) for one year. Criminal justice and mental health service utilization outcomes were measured by using state and county databases. Forty-nine participants (70%) completed the full one-year intervention period. Nineteen (27%) were removed early by judicial order, one was removed by county health authorities, and one died of a medical illness. Intent-to-treat analysis for all 70 participants showed that those receiving the FACT intervention had fewer mean±SD convictions (.4±.7 versus .9±1.3, p=.023), fewer mean days in jail (21.5±25.9 versus 43.5±59.2, p=.025), fewer mean days in the hospital (4.4±15.1 versus 23.8±64.2, p=.025), and more mean days in outpatient mental health treatment (305.5±92.1 versus 169.4±139.6, p<.001) compared with participants who received treatment as usual. The Rochester FACT model was associated with fewer convictions for new crimes, less time in jail and hospitals, and more time in outpatient treatment among justice-involved adults with psychotic disorders compared with treatment as usual.

Geographic Access to Specialty Mental Health Care Across High- and Low-Income US Communities

ImportanceWith the future of the Affordable Care Act and Medicaid program unclear, it is critical to examine the geographic availability of specialty mental health treatment resources that serve low-income populations across local communities.ObjectivesTo examine the geographic availability of community-based specialty mental health treatment resources and how these resources are distributed by community socioeconomic status.Design, Setting, and ParticipantsMeasures of the availability of specialty mental health treatment resources were derived using national data for 31 836 zip code tabulation areas from 2013 to 2015. Analyses examined the association between community socioeconomic status (assessed by median household income quartiles) and resource availability using logistic regressions. Models controlled for zip code tabulation area–level demographic characteristics and state indicators.Main Outcomes and MeasuresDichotomous indicators for whether a zip code tabulation area had any (1) outpatient mental health treatment facility (more than nine-tenths of which offer payment arrangements for low-income populations), (2) office-based practice of mental health specialist physician(s), (3) office-based practice of nonphysician mental health professionals (eg, therapists), and (4) mental health facility or office-based practice (ie, any community-based resource).ResultsOf the 31 836 zip code tabulation areas in the study, more than four-tenths (3382 of 7959 [42.5%]) of communities in the highest income quartile (mean income, $81 207) had any community-based mental health treatment resource vs 23.1% of communities (1841 of 7959) in the lowest income quartile (mean income, $30 534) (adjusted odds ratio, 1.74; 95% CI, 1.50-2.03). When examining the distribution of mental health professionals, 25.3% of the communities (2014 of 7959) in the highest income quartile had a mental health specialist physician practice vs 8.0% (637 of 7959) of those in the lowest income quartile (adjusted odds ratio, 3.04; 95% CI, 2.53-3.66). Similarly, 35.1% of the communities (2792 of 7959) in the highest income quartile had a nonphysician mental health professional practice vs 12.9% (1029 of 7959) of those in the lowest income quartile (adjusted odds ratio, 2.77; 95%, 2.35-3.26). In contrast, outpatient mental health treatment facilities were less likely to be located in the communities in the highest vs lowest income quartiles (12.9% [1025 of 7959] vs 16.5% [1317 of 7959]; adjusted odds ratio, 0.43; 95% CI, 0.37-0.51). More than seven-tenths of the lowest income communities with any resource (71.5% [1317 of 1841]) had an outpatient mental health treatment facility.Conclusions and RelevanceMental health treatment facilities are more likely to be located in poorer communities, whereas office-based practices of mental health professionals are more likely to be located in higher-income communities. These findings indicate that mental health treatment facilities constitute the backbone of the specialty mental health treatment infrastructure in low-income communities. Policies are needed to support and expand available resources for this critical infrastructure.

Improving Quality Outcomes in Veteran-Centric Care.

The University of Alabama at Birmingham (UAB) School of Nursing and the Birmingham Veterans Affairs Medical Center (BVAMC) created a Psychiatric-Mental Health Nurse Practitioner (PMHNP) Residency Continuity Clinic tasked with providing Veteran-centric mental health outpatient treatment informed by measurement-based care (MBC) to provide quality outcomes. Approved by the BVAMC, the UAB Institutional Review Board also approved and exempted the project as quality improvement. PMHNP residents administered the Patient Stress Questionnaire (PSQ)-an MBC tool that incorporates validated tools for assessing depression, anxiety, posttraumatic stress, alcohol use, and pain-to each Veteran from March to August 2016. Patient outcomes focused on depression and anxiety. PSQ scores were reviewed retrospectively via descriptive statistics, paired t tests, and Wilcoxon signed ranks tests. Analysis showed improvement in depression and anxiety that approached significance, and in several national Veterans Affairs mental health performance measures, reinforcing the importance of using MBC in psychiatric assessment. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 37-44.].

Placental Morphology in Fetal Alcohol Spectrum Disorders.

Aims Maternal alcohol drinking adversely affects pregnancy outcome. Although fetal health and development are highly dependent upon the integrity of placentation, little is known about placental morphology following gestational exposure to alcohol in humans. Methods In this clinical study, subjects were recruited between 2010 and 2013 from an outpatient substance abuse and mental health treatment center for women. Data collected included maternal age, substance abuse history, comorbidities, pregnancy outcomes, gestational age at delivery, birth weight and placental weight. Placental histopathological lesions associated with uteroplacental malperfusion (UPM) were scored under code. Villous cytotrophoblasts reflecting another measure of UPM were immunostained with E-cadherin and quantified using stereology. Inter-group comparisons were made using univariate or multivariate analysis. Results Of the 92 women enrolled in the study, 61 (66%) had histories of alcohol use during the pregnancy while the remaining 31 served as controls. The alcohol-exposed group significantly differed from controls based on (a) higher rates of smoking and polydrug use during pregnancy, (b) lower mean gestational age and birth weight of their infants, (c) elevated UPM scores, (d) increased densities of villous cytotrophoblastic cells and (e) more extensive chorangiosis in placenta. Logistic regression analysis demonstrated alcohol to be the only significant predictor of these outcomes and responses. Conclusions Gestational alcohol exposure is significantly associated with UPM, which could account for the higher rates of preterm delivery and reduced mean birth weights. Since chorangiosis reflects altered placental oxygen dynamics, the greater abundance of this abnormality could represent a compensatory response to UPM. Short Summary In this clinical study, we assessed the effects of maternal alcohol drinking on placental morphology. Applying a cumulative scoring system, we determined that gestational alcohol exposure is significantly associated with uteroplacental malperfusion, which could account for the higher rates of preterm delivery and reduced mean birth weights.

An RCT of Effects of Telephone Care Management on Treatment Adherence and Clinical Outcomes Among Veterans With PTSD.

This study assessed whether adding telephone care management to usual outpatient mental health care improved treatment attendance, medication compliance, and clinical outcomes of veterans with posttraumatic stress disorder (PTSD). In a multisite randomized controlled trial, 358 veterans were assigned to either usual outpatient mental health treatment (N=165) or usual care plus twice-a-month telephone care management (TCM) and support in the first three months of treatment (N=193). Treatment utilization and medication refills were determined from U.S. Department of Veterans Affairs administrative data. PTSD, depression, quality of life, aggressive behavior, and substance use were assessed with self-report questionnaires at intake, four months, and 12 months. Telephone care managers reached 95% of TCM participants (N=182), completing an average 5.1 of 6.0 planned telephone calls. During the three-month intervention period, TCM participants completed 43% more mental health visits (M±SD=5.9±6.8) than did those in usual care (4.1±4.2) (incident rate ratio=1.36, χ2=6.56, df=1, p<.01). Treatment visits in the nine-month follow-up period and medication refills did not differ by condition. Only 9% of participants were scheduled to receive evidence-based psychotherapy. Slopes of improvement in PTSD, depression, alcohol misuse, drug problems, aggressive behavior, and quality of life did not differ by condition or treatment attendance. TCM improved PTSD patients' treatment attendance but not their outcomes. TCM can enhance treatment engagement, but outcomes depend on the effectiveness of the treatments that patients receive.

Relationship Between the Types of Insurance Coverage and Outpatient Mental Health Treatment Use Among Older Adults.

Using the public use data files of the 2008 to 2012 National Survey on Drug Use and Health, this study examined (a) the payment sources for mental health treatment among those aged 50 to 64 years and those aged 65+ years and (b) the relationship between outpatient mental health treatment use and different types of insurance coverage among members of these two age groups. The results show that 16% of the 50 to 64 age group and 10% of the 65+ age group used inpatient or outpatient mental health treatment in the preceding year. Logistic regression analyses showed that mental health problem severity and public insurance programs (Medicare, Medicaid, and Department of Veterans Affairs [VA]/military insurance) significantly increased the odds of receiving outpatient treatment. Private insurance was not a significant factor for either age group. Older adults with mental health problems must be encouraged to seek treatment and need to be informed about mental health coverage included in their insurance(s).

Adolescent Gender Differences in Residential Versus Outpatient Mental Health Treatment: A Meta-Analysis

Level-of-care decisions for adolescents in need of mental health services have been found to be inconsistent. This study sought to establish a research base for more objective and reliable level-of-care decisions related to gender differences in clinical characteristics of male and female patients aged 12–19 years receiving mental health treatment in a residential setting or outpatient mental health services. A meta-analytic approach was used to analyze 20 studies and 49 independent effect sizes across six constructs: internalizing, externalizing, psychosocial stressors, risk to self and others, total pathology, and substance use. The results indicated that male participants had higher levels of externalizing at the outpatient level, and female participants had higher levels of all remaining constructs at both levels of care. This indicated that female patients often presented to both levels of care with greater psychopathology.