Mental Health and Substance Abuse Services to Parents of Children Involved with Child Welfare: A Study of Racial and Ethnic Differences for American Indian Parents

American Indian (AI) parents of children involved with child welfare were compared to White, Black and Hispanic parents on mental health and substance abuse problems and access to treatment. Data came from the National Study of Child and Adolescent Well-Being, a longitudinal study of a nationally representative sample of children aged 0–14 years involved with child welfare. Weighted statistics provided population estimates, and multivariate logistic regression was used to predict the likelihood of caregivers receiving mental health or substance abuse services. There were significant disparities in the likelihood of receiving mental health, but not substance abuse, services. Unmet need for mental health and substance abuse treatment characterized all parents in this study. AI parents fared the worst in obtaining mental health treatment. Parents of children at home and of older children were less likely to access mental health or substance abuse treatment.     

Administrative Barriers to the Adoption of High-Quality Mental Health Services for Children in Foster Care: A National Study

While the need to provide appropriate mental health services to children in foster care is well recognized, there is little information on administrative barriers to assuring that such services are provided. This article presents results from a national survey of mental health agencies to profile their awareness of currently available practice standards, the roles these standards play in guiding practice of mental health agencies, common reimbursement strategies in use for mental health services, and collaborations between mental health and child welfare agencies that enhance children’s access to appropriate mental health care. Implications and recommendations for mental health policymakers are discussed.     

Implementation Research in Mental Health Services: an Emerging Science with Conceptual,Methodological, and Training challenges

One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field. An earlier version of this paper was presented at the NIMH Services Research Conference, July 23, 2007.     

Child Mental Health is Everybody's Business: The Prevalence of Contact with Public Sector Services by Type of Disorder Among British School Children in a Three-Year Period

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed-up over 3 years. Parents provided summary information on service contacts in relation to mental health; selected subgroups provided more detailed information by telephone interview.
Results:  Common overlaps in service use were between health services, between teachers and educational specialists, and between the latter and CAMHS or social services. Services other than primary health care saw more children with externalising disorders, while children with anxiety disorders were less likely than children with other psychiatric disorders to be in contact with any service.
Conclusions:  Child mental health is everybody's business, and professionals need to be alert(ed) to the types of disorders that children using their service may have.     

Selecting Measures for Use in Child Mental Health Services: A Scorecard Approach

The implementation of evidence-based treatments in mental health services requires reliable and valid measurements to guide treatment. This study evaluated the efficiency of three caretaker-report measures of child psychiatric disorders. Data from 211 caregivers were used to assess the CBCL, the OHIO, and the SDQ. A scorecard methodology was implemented to determine the efficiency of each scale as compared to the DISC-IV. Across measures, the OHIO was optimal for assessing services need while the CBCL and SDQ provided better disorder-specific assessment. Results may improve clinical practice by providing an empirical approach to the selection of assessment tools.     

User and Carer Involvement in Child and Adolescent Mental Health Services: A Norwegian Staff Perspective

It has been suggested that user involvement in heath care leads to improved services. The aim of the study was to explore attitudes towards user involvement of staff employed in Norwegian Child and Adolescent Mental Health Services (CAMHS). Most of the investigated mental health service staff expressed the opinion that users should be involved in the planning of their own treatment and generally have a positive attitude towards user involvement. Skepticism was related to some aspects of involvement and does not contradict their generally positive attitude towards user involvement.     

Telepsychiatry and e-Mental Health Services: Potential for Improving Access to Mental Health Care

Reforming mental health care is a focus of many ongoing initiatives in the United States, both at the national and state levels. Access to adequate mental health care services is one of the identified problems. Telepsychiatry and e-mental health services could improve access to mental health care in rural, remote and underserved areas. The authors discuss the required technology, common applications and barriers associated with the implementation of telepsychiatry and e-mental health services.     

Need for Child Mental Health Consultation and Paediatricians' Perception of these Services: A Survey in the West Midlands

Background:  High rates of psychopathology have been noted in children presenting to GP surgeries and paediatricians. However, paediatricians do not always recognise this and when they do the Child and Adolescent Mental Health Service (CAMHS) is often unable to meet their consultation needs.
Method:  This postal survey looked at paediatricians' perception of the need for child psychiatry consultation in the West Midlands.
Results:  The survey confirmed that paediatricians see a significant proportion of children with mental health problems and the findings showed that their need for child psychiatry consultation was not being adequately met. Lack of access to CAMHS was a significant issue.
Conclusions:  This has implications not only for further development of consultation services within CAMHS but also for improving training in child psychiatry for paediatricians in a more formalised way.     

Routine Outcome Measurement: A Survey of UK Child and Adolescent Mental Health Services

Background:  Research suggests that the routine measurement of treatment outcomes is a neglected area of clinical practice within mental health care settings. Still it is not clear to what extent such findings apply to child and adolescent mental health services (CAMHS). A cross-sectional survey of UK CAMHS revealed that although quantitative clinical measures are commonly used within these services, there is little uniformity in the instruments utilised, and they rarely inform a system of routine outcome measurement. However, in general, respondents did not have a philosophical or scientific objection to the practice of routinely measuring outcomes, but rather felt that they lacked the necessary resources to facilitate such initiatives.     

Mixing Oil and Water: Integrating Mental Health and Addiction Services to Treat People with a Co-occurring Disorder

Treatments for people with the co-occurring disorders of mental illness and substance use (abuse or dependence) have been evolving and improving since the mid 1980s. During this period substance abuse treatment programs reported between 50 and 75% of the people they served also had a mental health problem. At the same time, mental health programs reported between 20 and 50% of the people they served had a co-occurring problem of substance use or abuse. The proposed solution is to integrate the two treatment systems so as to treat both disorders at the same time. During the 1990s integrated treatment was proposed and several models of integrated care were evaluated. The fallacy of these conceptualizations is that the authors of these models presume that the numerous treatment interventions from both treatment traditions are compatible. This is a critical assumption. What if the two are not compatible? Rather than integrate the two systems of mental health and addiction treatment in whole, I would argue, a model is needed that selects the best interventions from each field and discard the rest. Suggestions are presented here for a beginning inventory of best practice interventions that could be the foundation for effectively treating people with co-occurring disorders.     

Beyond Criminalization: Toward a Criminologically Informed Framework for Mental Health Policy and Services Research

The problems posed by persons with mental illness involved with the criminal justice system are vexing ones that have received attention at the local, state and national levels. The conceptual model currently guiding research and social action around these problems is shaped by the “criminalization” perspective and the associated belief that reconnecting individuals with mental health services will by itself reduce risk for arrest. This paper argues that such efforts are necessary but possibly not sufficient to achieve that reduction. Arguing for the need to develop a services research framework that identifies a broader range of risk factors for arrest, we describe three potentially useful criminological frameworks—the “life course,” “local life circumstances” and “routine activities” perspectives. Their utility as platforms for research in a population of persons with mental illness is discussed and suggestions are provided with regard to how services research guided by these perspectives might inform the development of community-based services aimed at reducing risk of arrest.     

Collaboration Between the NHS and Social Services in the Provision of Child and Adolescent Mental Health Services: A Personal View

The quality of collaborative links between the NHS and Social Services in the field of child mental health is dependent on the culture of co-operation set at the highest level of government. There needs to be an understanding of the different theoretical models that underpin working practices. The importance of personality factors, power struggles and misperceptions is highlighted. Constructive suggestions are made on how to ensure that collaboration works effectively.     

Assessing Functional Impairment and Social Adaptation for Child Mental Health Services Research: A Review of Measures

The need for assessing impairment in functioning as an integral part of child mental health services research is discussed. Methodologic difficulties related to problems in case definition, the conceptual definition of impairment and social adaptation, and the assessment of the construct across cultures are also addressed. In addition, a critical review of existing child impairment measures with published psychometric properties is presented. The measures are divided into three types: measures of global impairment, domain-specific measures, and symptom-specific measures. The paper concludes that the choice of the measure to use in health services research needs to be determined according to the main goals of the study, the population in which the instrument is going to be used, and the interviewer's knowledge of the child. Other characteristics of the measures of impairment that the researcher should consider are also discussed.     

Persistence of Mental Health Service Use among Latino Children: A Clinical and Community Study

This study examined predictors of treatment persistence (receiving mental health services at two time points one year apart) among children in Puerto Rico who had previously sought care for mental health concerns. Children and their primary caregivers completed interviews one year apart. Treatment persistence was lower among children recruited from community sampling (n = 137) than those children recruited from public and private clinics (N = 381). Persistence was associated with psychological measures of need and co-morbidity only in the clinical sample, while in both samples persistence was associated with measures of family burden and school functioning. In multivariate analyses, persistence was associated in both the clinical and community samples with a measure of school functioning but not with diagnosis, impairment, or parental concerns about the child’s behavior.     

Monitoring Change in Families Receiving Primary Mental Health Specialist Services: A Pragmatic Evaluation Within an Existing Service for the Under‐Fives

Background: Specialist CAMHS‐based services for pre‐school age children are being introduced in the UK using different models of care. The clinical value of these new services requires assessment. Method:  Over 20 months a Primary Mental Health Specialist (Under 5s) service operating in South West UK was evaluated on a variety of themes including effectiveness. Recruited clients completed questionnaires on their own well‐being (on two occasions) and their child’s behaviour (on three occasions) over the intervention period. Results: Of the 67 carers assessed at or shortly after recruitment using the General Health Questionnaire, 55.2% were at high risk of having a clinically significant affective mental condition. Despite a trend towards improvement, neither the GHQ‐12 total score nor the proportion meeting the clinical criterion was statistically significantly reduced. The main index of child behaviour and emotional state demonstrated a statistically significant reduction in the number of disturbance‐indicating behaviours over the service intervention period. The largest changes occurred between recruitment and the 4^th visit. Selection bias cannot be excluded. Conclusions: Significant changes determined over a relatively short period of intervention is consistent with an effect of service, but direct attribution demands care as no control groups were included.     

Unmet Needs for Mental Health Services for Latino Older Adults: Perspectives from Consumers, Family Members, Advocates, and Service Providers

This study qualitatively assessed the need for mental health services among Latino older adults in San Diego, California. The primary mental health issue was depression. Primary organizational barriers to accessing services were language and cultural barriers secondary to a lack of translators, dearth of information on available services, and scarcity of providers representative of the Latino community. Other challenges included a lack of transportation and housing, and the need for socialization and social support. Latino older adults experienced their unmet needs in ways associated with their cultural background and minority status. Age- and culturally-appropriate services are needed to overcome these barriers.     

Innovations in Disaster Mental Health Services and Evaluation: National,State, and Local Responses to Hurricane Katrina (Introduction to the Special Issue)

The severe consequences of Hurricane Katrina on mental health have sparked tremendous interest in improving the quality of mental health care for disaster victims. In this special issue, we seek to illustrate the breadth of work emerging in this area. The five empirical examples each reflect innovation, either in the nature of the services being provided or in the evaluation approach. Most importantly, they portray the variability of post-Katrina mental health programs, which ranged from national to state to local in scope and from educational to clinical in intensity. As a set, these papers address the fundamental question of whether it is useful and feasible to provide different intensities of mental health care to different populations according to presumed need. The issue concludes with recommendations for future disaster mental health service delivery and evaluation.