Early intervention services in youth mental health

Mental and substance use disorders are leading contributors to the burden of disease among young people in Australia, but young people experience a range of barriers to accessing appropriate treatment for their mental health concerns. The development of early intervention services that provide accessible and effective mental health care has the potential to reduce the individual and community burden associated with mental health problems. Collaborative care arrangements between general practitioners, psychologists and other service providers are a key component of comprehensive and integrated early intervention services, with evidence-based psychological treatments an important part of these collaborative mental health care models. Recently, the Australian Government funded headspace (the National Youth Mental Health Foundation) to promote and support early intervention in youth mental health by establishing accessible and collaborative models of enhanced primary mental health care for young people with emergent mental and substance use disorders. Clinical psychologists in the headspace Community of Youth Service and other settings will play a key role in providing early and effective interventions within multidisciplinary collaborative care arrangements.     

Reconsidering interactive resilience processes in mental health: Implications for child and youth services

Research consistently demonstrates resilience as an interactive process, drawing on personal assets together with relational and contextual resources, to support improved outcomes in contexts of nonnormative adversity. What remains unclear are the dynamics of this process and what drives it. This article draws on a prior scoping review of the literature to conceptually explore the positioning of the individual within this dynamic interplay of risks, resilience, and sociocultural context as it pertains to child and youth mental health. The paper begins by summarizing findings from this scoping review, highlighting core resilience elements and processes. These are then considered in relational to the global meaning theory, situating meaning-making as a key mechanism that mediates the interaction between individuals and their ecologies. Drawing on the literature, this article considers how this interaction shapes the particular ways in which resilience then manifests itself in the lives of individuals and becomes available as a resource to assist in the promotion of mental health.     

Identifying mental health services in clinical genetic settings

The purpose of this study was to examine the mental health needs of individuals at risk for adult onset hereditary disorder (AOHD) from the perspective of their genetic service providers, as it is unknown to what extent psychosocial services are required and being met. A mail-out survey was sent to 281 providers on the membership lists of the Canadian Association of Genetic Counsellors and the Canadian College of Medical Geneticists. The survey assessed psychosocial issues that were most commonly observed by geneticists, genetic counsellors (GCs), and nurses as well as availability and types of psychosocial services offered. Of the 129 respondents, half of genetic service providers reported observing signs of depression and anxiety, while 44% noted patients' concerns regarding relationships with family and friends. In terms of providing counselling to patients, as the level of psychological risk increased, confidence in dealing with these issues decreased. In addition, significantly more GCs reported that further training in psychosocial issues would be most beneficial to them if resources were available. As a feature of patient care, it is recommended that gene-based predictive testing include an integrative model of psychosocial services as well as training for genetic service providers in specific areas of AOHD mental health.     

Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change

Background

Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic.

Aims

This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner).

Materials and Methods

The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021.

Results

Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender.

Discussion and Conclusion

Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.     

Rape-related services in federally funded community mental health centers.

Amendments to the Community Mental Health Centers Act (Public Law 94-63) required community mental health centers (CMHCs) to provide such rape-related services as rape prevention and control, and to assure service availability to rape victims and their families. A questionnaire designed to assess how rape-related services are delivered was mailed to directors of 107 federally funded comprehensive CMHCs in a seven-state region. Fifty-five responses were received, indicating that rape-related services were offered by approximately two-thirds of the centers, 65% of which considered their rape-related services to be less comprehensive than other services. The budget for rape services was less than $10,000 in 80% of responding centers, representing less than 0.5% of the average CMHC budget. Services provided, primarily clinical, involved crisis intervention, counseling, and psychotherapy with rape victims and their families. Prevention and educational activities accounted for less than 25% of all rape-related services at most CMHCs. The results of the study question the impact of federal mandates on local mental health services.     

Overview of current trends in mental health problems for Australia's youth and adolescents

This paper provides an overview of current trends in the mental health problems of Australia's youth and adolescents. It presents information derived from the most recent and comprehensive Australian surveys of youth mental health, and provides international comparisons and views from professional practice where relevant. An update of trends for the most common and significant mental health problems is required to understand the mental health issues most likely to be encountered when working with young people, and as justification of the focus on intervening early for this age group.     

Ethical challenges in mental health services to children and families

Mental health practitioners working with children and families must attend to several ethical concerns that do not typically come into play with adult clients. The challenges for practitioners usually involve attention to four subsets of concerns that all begin with the letter c: competence, consent, confidentiality, and competing interests. Using the 4-C model, this article focuses on ethical aspects of practitioner competence, consent and assent, confidentiality, and the incongruence of interests that occurs when different people organize and set goals for psychological services. After explicating these issues, I provide recommendations for addressing them in the course of clinical practice.     

Electronic patient records and innovation in health care services.

The approach of today's EPR seems so narrowly focused on automation of the existing paper-based records by means of information technology that it becomes obvious to raise the question: 'Will these automation efforts become an impediment to innovation in products and services in health care?'. This paper discusses how objectives like improvements and innovations in products and services in health care are met by means of information technology (IT), and it argues that a shift of focus from technological innovation to innovation in products and services is necessary in order to obtain maximum benefit from IT.     

Integrating health and mental health services in schools: psychologists collaborating with primary care providers

This article reviews recent trends, developments and empirical support for the expansion of psychological practice to include school-based treatment and management of serious and chronic medical conditions, including somatization, in collaboration with primary health care providers. Trends and developments reviewed include (a) the expansion and integration of health, mental health, social and community services in schools, (b) the rapid growth of school-based health centers (SBHCs), (c) psychology's increased involvement in the collaborative treatment of chronic and serious medical disorders, (d) recent federal and state legislative initiatives, and (e) cost-driven marketplace changes. Lack of empirical data specific to collaborative psychologist-health care provider collaboration in schools and SBHCs, particularly around somatization, is discussed. Ethical and legal, professional, and reimbursement issues that must be addressed if psychologists are to practice in this emergent arena are identified. This article calls for research to document both the clinical effectiveness and cost-efficacy of collaborative psychologist-primary care provider intervention in schools and SBHCs.     

Failure in psychotherapy: an introduction

This article introduces an issue of the Journal of Clinical Psychology:In Session devoted to treatment failures in psychotherapy. In contrast to recent attention from the research perspective and cognitive-behavioral orientation, this issue focuses on clinical material from multiple theoretical perspectives. This article provides an overview of some of the empirical and definitional issues on treatment failure and then outlines the five subsequent articles, each of which offers an interesting case illustration. The article concludes with several transtheoretical recommendations for reducing the incidence of therapeutic failures.     

Practicing attachment in the real world: improving maternal insightfulness and dyadic emotional availability at an outpatient community mental health clinic

The purpose of the study was to examine the efficacy of an attachment-based intervention program practiced at an outpatient clinic. Changes in parental insightfulness and dyadic emotional availability were assessed in 32 mother–child dyads from pre- to post-intervention. At both data collection points, mothers were interviewed with the Insightfulness Assessment and the mother–child dyad was observed in play sessions coded with the Emotional Availability Scales. Findings revealed a strong association between maternal insightfulness and dyadic emotional availability, both before and after treatment. In terms of intervention efficacy, positive gains were observed in both insightfulness and dyadic emotional availability from pre- to post-intervention. Mothers who changed their classifications from non-insightful to insightful following the intervention showed the greatest gains in emotional availability. These findings have important implications for the type of interventions and service delivery model that could work in real world clinical settings.     

Gender differences in adherence and metabolic control in urban youth with poorly controlled type 1 diabetes: the mediating role of mental health symptoms

OBJECTIVE: To examine gender differences in adherence and metabolic control and test the mediating role of mental health symptoms in a sample of predominantly African-American, low-income youth with chronically poor metabolic control. METHODS: Baseline questionnaire data from an intervention study were collected from 119 youth and their primary caregiver. RESULTS: Boys had worse adherence than girls, but there were no gender differences in hemoglobin A1C (HbA1C). Boys had more externalizing symptoms, whereas girls had more anxiety; there were no gender differences in depression. Externalizing symptoms were associated with poor adherence and metabolic control. Although anxiety was correlated with poor adherence, this relationship was not significant in the invariate analysis. Results of structural equation modeling (SEM) suggested that externalizing symptoms mediated the relationship between gender and adherence. CONCLUSIONS: Results suggest that gender differences in adherence may be attributed, in part, to gender differences in externalizing symptoms in urban youth with poor metabolic control. Interventions targeting these symptoms may be necessary to improve adherence and HbA1C in both boys and girls.