Emergency care avoidance: Ethnic matching and participation in minority-serving programs

Using data from a county level mental health service system, relationships were examined between ethnic matching, program involvement and emergency service use. When clients were matched with an ethnically similar clinician who was also proficient in their preferred language, they had fewer emergency service visits than did clients who were unmatched on the basis of ethnicity and language. Equally if not more significant than ethnicity or language matching was the client's program and the proportion of minority clients it served. Clients in programs serving a relatively large proportion of minority clients had fewer emergency service visits than those in programs serving a smaller proportion of minority clients. More research is needed to document the impact of matching along with greater attention to minority oriented programs.Center for Research on the Organization and Financing of Care for the Severely Mentally Ill. Teh-wei Hu is affiliated with the School of Public Health, University of California, Berkeley and the Center for Research on the Organization and Financing of Care for the Severely Mentally Ill.This research was supported by National Institute of Mental Health Grant # 1 RO1 MH46618-01.     

Evaluation of a Mental Illness Awareness Week program in public schools

The authors evaluated the impact of a Mental Illness Awareness Week program on the attitudes of adolescents attending public school toward seeking help for mental health problems and toward psychiatrists. Most students involved in the program liked it and indicated that they were interested in learning more about mental health topics. Students in the program showed more favorable attitudes toward seeking help and toward psychiatrists than a comparison group of students who did not participate in the program. The authors discuss the evidence for enduring effects of the program. The results support continued development of Mental Illness Awareness Week programs for adolescents in the public schools.     

“Positive Attitude”: A multilevel model analysis of the effectiveness of a Social and Emotional Learning Program for Portuguese middle school students

This study investigated the impact, reported by students and their teachers, of a universal, school-based, social-emotional learning program, implemented in three school years on the social-emotional competencies of middle school students (7th to 9th grade). It also analyzes, at post-test and follow-up, the differential results by gender and among students with lower levels of competence. There were 1091 participants, 855 students received the treatment condition (i.e., Project Attitude) and 236 students the control condition. Self-reports identified positive intervention results in social awareness, self-control, self-esteem, social isolation and social anxiety, teachers reported gains in all dimensions. These positive effects were stably effective along the three cohorts. Self-reports also identified bigger gains for girls in social awareness and for boys in social anxiety, self-esteem and leadership. Students with initial lower levels of competence benefited more from the intervention, especially at follow-up. These results support the effectiveness of social-emotional learning programs.     

Prevention of substance use among adolescents through social and emotional training in school: A latent-class analysis of a five-year intervention in Sweden

The study considers the impact of a program for social and emotional learning in Swedish schools on use of drugs, volatile substances, alcohol and tobacco. The program was evaluated in an effectiveness study. Intervention students were compared longitudinally with non-intervention students using nonparametric latent class analysis to identify subgroups of students with similar use levels and trajectories. Statistically significant intervention-by-duration interactions, with medium to large effect sizes to the advantage of the SET students were found for all substances in one or more, but not all, of the latent classes. Favorable trajectories were found for non-users/light users of drugs, moderate sniffers, non-users/light users of alcohol, and occasional smokers. Only among heavy smokers was there a possible iatrogenic effect of SET. Such programs, given a duration of two years or more, may dampen increases in use with age and discourage early debut, although they are not specifically targeted at use itself.     

Reaching out to high school youth: the effectiveness of a video-based antistigma program.

OBJECTIVE: To evaluate the impact on high school students of a video-based antistigma program portraying real life experiences of individuals with schizophrenia and lesson plans to guide classroom discussions and active learning. METHOD: We used a pre- and posttest design to measure the short-term impact of the program on student's knowledge of schizophrenia and its treatment as well as students' self-reported socially distancing behaviours. Participants (571 students) were from 8 high schools across Canada. RESULTS: Following the Reaching Out antistigma program, high school students were significantly more knowledgeable and less socially distancing. Impact also varied by age group and sex. CONCLUSIONS: Video-based antistigma programs are comparable to programs that deliver educational messages through direct contact with individuals with mental illnesses. Video-based programs are more easily disseminated on a broad scale.     

Effects of learning to ski on the self-concept of mentally retarded children.

Changes in the self-concept of TMR children as a function of experience in a physical activity program were evaluated. The self-concept of a group of students was measured before and after participation in a 5-week ski program. A control group received similar pre- and postmeasures of self-concept but did not participate in the ski program. Significant changes in self-concept occurred among students in the experimental but not the control group. Furthermore, the magnitude of success in learning to ski was shown to be positively and significantly correlated with magnitude of change in self-concept.     

Three-year longitudinal study of school behavior and academic outcomes: results from a comprehensive expanded school mental health program

While there has been encouraging growth in the number of expanded school mental health programs (ESMH) across the country, few programs rigorously evaluate long-term academic outcomes associated with receipt of these services. This study examined the effects of services from an ESMH program on school behavior (number of out-of-school suspensions and attendance rates), and academic outcomes (standardized test scores in reading and math). Participants were 89 students from Kindergarten to 8th grade who received ESMH services and 89 students from a matched comparison group. Results revealed that ESMH services (i.e., treatment) did not have a statistically significant association with any of the school behavior or academic outcome variables. Findings are discussed in the context of theoretical and methodological challenges associated with program evaluations of ESMH. Implications for practitioners and researchers regarding program evaluation and response to stakeholders are addressed.     

The use of multiple sclerosis databases at neurological university hospitals in Germany

The development of easy-to-use, clinically oriented multiple sclerosis (MS) database programs has been started, thus paving the way for MS centers to computerize their patient records and to improve quality management To evaluate the prevalence of such programs at German neurological hospitals, a questionnaire was designed and sent to all clinic directors. With a return of more than 92%, it became evident that MS databases are still being used only by a minority of 22% on a regular basis. We did not recognize the predominance of a single program. A new MS database system that is being presently implemented in Germany is described.     

An ethnographic study of job seeking among people with severe mental illness

An ethnographic study employing intensive participant observation methods identified critical differences in styles of searching for competitive employment among people with severe mental illness and explored the social/cultural correlates of these job-seeking styles. Propensity for active job seeking was strongly associated with younger age, with participants' involvement in interdependent kin networks or households, with ethno-racial minority background, and with capacity for coherent discourse. Active job seekers did particularly well in a supported employment program, but also were able to find employment when assigned to other programs; passive job seekers had little success in any vocational program. The authors discuss several implications of these findings for vocational services.     

Treating university students with social phobia and public speaking fears: Internet delivered self-help with or without live group exposure sessions

Background: This study investigated the efficacy of an Internet‐based self‐help program with minimal therapist contact via e‐mail for Swedish university students with social phobia and public speaking fears. The main objective was to test if the Internet‐based self‐help program would be more effective if five live group exposure sessions were added. Methods: Thirty‐eight students meeting the diagnostic and statistical manual of mental disorders, 4th edition criteria for social phobia were randomized into two different treatment groups: Internet delivered cognitive behavior therapy combined with five group exposure sessions (ICBT+ exp) or the Internet program alone (ICBT). Results: Results were analyzed on an intention‐to‐treat basis. Both treatment groups showed significant improvement from pre‐ to post‐test, and from pre‐test to 1‐year follow‐up, on all measured dimensions (social anxiety, general anxiety, depression levels, and quality of life). For both the groups, the average within‐group effect sizes for the primary social anxiety scales, expressed as Cohen's d, were comparable to those seen in traditionally administered cognitive behavioral therapy both at post‐test and at 1‐ year follow‐up. Conclusions: The results suggest that the Internet‐based self‐help program on its own is efficient in the treatment of university students with social phobia. Adding group exposure sessions did not improve the outcome significantly. Depression and Anxiety 25:708–717, 2008. © 2008 Wiley‐Liss, Inc.     

Minority families, early education, and later life chances

Children from low-income minority families participated in early childhood education programs conducted in the 1960s and 1970s by members of the Consortium for Longitudinal Studies. Data on program impact from early childhood to young adulthood revealed direct, positive effects on standardized tests, school competence, attitudes toward achievement, high school completion, and occupational attitudes. Indirect program effects were found on occupational attainment.     

Enrolment Rates into Parenting Programs using a Clinically Viable Recruitment Strategy

Studies of parenting programs often have enrolment rates of 20% or more of the targeted parents. These rates are usually from funded research projects, and may not equate to enrolment rates in programs using clinically viable recruitment strategies without large specialist funding. Two studies were conducted to explore the enrolment rates of parents in group parenting programs. The first investigated the enrolment rate of parents of 5—12-yearold children in a community parenting program, using a clinically viable recruitment strategy. Flyers were twice sent home with the children advertising the program, which was offered both during the day and evening. Parents from nine Australian schools, with a total of 5,275 students from 3,740 families, were offered the program. Only 0.48% enrolled (N = 18 parents). In the second study, the variables of program cost (free vs $20), pre-enrolment requirements (completion of three questionnaires vs no questionnaires), and program duration/type (four-session general parenting program vs single-session specific problem program) were explored. Results showed that the different levels on each variable had no significant impact on parent enrolment. Discussion concludes that, without specialist funding, the snowball effect of parents enrolling because of word-of-mouth endorsement may be a key factor in ensuring that enough parents attend such programs. This has important planning implications for services wishing to introduce new programs to their community. The clinical implications are that more consideration needs to be given to methods that improve enrolment rates in such programs, and in particular programs training clinicians to conduct such community parenting programs should include a module on recruitment strategies.     

Ethnic identity in college students from four ethnic groups

Research on adolescent identity development within Erikson's (1968) framework has not included ethnicity. This study examined ethnic identity search and commitment, the importance of ethnicity as an identity issue, and relationship of ethnic identity to self-esteem among college students. Questionnaires were given to 196 male and female urban college students from three minority groups (Asian-American, Black, and Mexican-American) and a comparison White group. Exploration of ethnic identity issues was significantly higher among minority group, compared to majority group, college students. Ethnicity was considered to be as important as two other traditionally studied areas of identity and was rated as significantly more important by minorities than by Whites. Self-esteem, especially for minority subjects was related to the extent that subjects had thought about and resolved issues involving their ethnicity.     

Bullying among immigrant and non-immigrant early adolescents: School- and student-level effects

We examined the association between school immigrant concentration and bullying among immigrant and non-immigrant early adolescents, and identified potential explanatory factors. First generation immigrant students had reduced odds of victimization and perpetration in schools with high (20–60%), compared to low, levels of immigrant concentration. Second generation immigrant students had reduced odds of ethnic/racial victimization in moderately concentrated schools; while non-immigrants had increased odds in the same schools. Non-white students had increased odds of ethnic/racial victimization compared to White students. While students' sense of school belonging and perceived teacher cultural sensitivity were negatively associated with bullying, they did not account for the differential associations noted above. Results demonstrate the importance of immigrant density as a protective school characteristic for immigrant and ethnic minority youth. Additional social processes operating in schools that may explain bullying behaviors among immigrant and non-immigrant youth should be explored to inform programs for promoting inclusion in schools.     

Recruitment into psychiatry: increasing the pool of applicants.

OBJECTIVE: To demonstrate that it is possible to identify the cohort of students in their first year of medical school from which future psychiatrists will be recruited. METHOD: During a 3-year period, all first-year medical students at the University of Maryland completed a form indicating their specialty preference. Of those students, 403 pursued the regular psychiatry curriculum, and 34 participated in an enriched behavioural science and psychiatry program. Specialty was chosen after graduation. RESULTS: The higher the first-year student ranked psychiatry as a preferred specialty, the more likely the student was to choose psychiatry as a career after graduation. This was true both for students in the regular psychiatry program and for those in the enriched program. Students in the enriched program were significantly more likely to choose psychiatry as a career than were "regular" psychiatry students who gave psychiatry the same ranking in their first year. Freshman students who ranked psychiatry 4th or lower were not likely to choose psychiatry, no matter how much encouragement they received from their psychiatry departments. CONCLUSIONS: 1) Specialty preferences in the freshman year are predictive of future career choices. 2) An enriched medical school program in psychiatry can increase the number of graduates choosing careers in psychiatry. To help resource-poor medical schools increase the number of American medical graduates choosing psychiatry, the authors propose 2 inexpensive enriched programs.     

Support for Students Exposed to Trauma: A Pilot Study

With high rates of trauma exposure among students, the need for intervention programs is clear. Delivery of such programs in the school setting eliminates key barriers to access, but there are few programs that demonstrate efficacy in this setting. Programs to date have been designed for delivery by clinicians, who are a scarce resource in many schools. This study describes preliminary data from a pilot study of a new program, Support for Students Exposed to Trauma (SSET), adapted from the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program. Because of its “pilot” nature, all results from the study should be viewed as preliminary. Results show that the program can be implemented successfully by teachers and school counselors, with good satisfaction among students and parents. Pilot data show small reductions in symptoms among the students in the SSET program, suggesting that this program shows promise that warrants a full evaluation of effectiveness.

Active vs. passive methods of recruiting ethnic minority women to a health promotion program

Ethnic minority women have been underrepresented in health promotion research. There is a need to develop effective methods of recruiting ethnic minority women to health promotion programs and research studies. This article evaluates several methods for recruiting ethnic minority women to a study of a telephone and mail intervention encouraging participation in a home-based walking program. One hundred twenty-six sedentary ethnic minority women between the ages of 25 and 55 were recruited using two types of approaches. Number of participants screened, number enrolled, and recruitment efficiency (ratio of number recruited/ number screened) were assessed. “Active” recruitment, contacting targeted individuals in person, by phone, or by mail, yielded 236 screened and 29 recruited with a recruitment efficiency of 11%. “Passive” recruitment, informing the community through public notices and waiting for volunteers to call, yielded 151 screened and 97 recruited with a recruitment efficiency of 64%. Those recruited by active or passive methods did not differ by demographic characteristics, baseline psychosocial variables, or dropout rates. Passive recruits walked significantly more at five-month follow-up than active recruits. Passive recruitment may be more economical at the cost of potentially biased samples.     

Autopsy recruitment program for African Americans

A specialized brain autopsy recruitment program was implemented within the context of advance medical directives and end-of-life treatment decisions. The program was implemented within the framework of a larger study. The purpose of the program was to (1) improve the rate of consent for brain autopsy among African Americans diagnosed with stroke and dementia, and (2) obtain more empirical information on the underlying reasons for the low response rate (4%) in this minority group. A convenience sample of 133 patient and family caregiver pairs was selected for participation. Face-to-face, open-ended interviews were conducted to ascertain reasons for autopsy preferences and to identify respondents interested in the postmortem procedure. Preferences for brain autopsy were ascertained and individuals interested in the procedure were subsequently followed through death or over the 2 1/2 year course of the study. Brain necropsies were conducted on patients requesting the examination. Thirty-six (36) patient and family pairs consented to the procedure, 16 were indecisive and 81 refused. Factors influencing decisions included existing attitudes toward autopsy, family agreement regarding the procedure, and assurance that funeral arrangements would not be delayed. Ninety deaths and two autopsies were conducted before implementation of the specialized recruitment program, yielding a 2.22% completion rate, and 34 deaths with 10 postmortems conducted within the time frame of the recruitment study, yielding a 29% autopsy completion rate. Fisher exact test (p < 0.0001) revealed a significant difference in the proportion of autopsies completed before and after implementation of the specialized recruitment program. Findings strongly suggest that culturally sensitive recruitment programs may increase the rate of autopsy request made by African American caregivers for relatives diagnosed with dementia and stroke. To obtain a higher rate of consent than that obtained in the general population, the program must contain ethnically sensitive recruitment strategies.     

A computer-tailored dietary fat intake intervention for adolescents: Results of a randomized controlled trial

BACKGROUND: The positive effects of computer-tailored dietary fat intake interventions have been demonstrated in adults, but few studies have investigated the impact on adolescents. PURPOSE: The purpose is to evaluate the acceptability, feasibility and effectiveness of a computer-tailored dietary fat intake education program for adolescents. METHODS: A random sample of 10 schools, 5 with general and 5 with technical-vocational education programs, were selected to participate. In each of the 10 schools, 2 classes of 7th graders were randomly assigned to the intervention (n = 153) or control (no-intervention, n = 151) condition. Students were exposed once in class to a 50-min theory-based computer-tailored dietary fat intake intervention. Questionnaires were completed 1 week before (food frequency questionnaire for dietary fat intake + psychosocial determinants) and 3 months after (process evaluation + food frequency questionnaire for dietary fat intake + psychosocial determinants) the intervention. RESULTS: About one in three students evaluated the intervention as interesting (34%), novel (38%), personally relevant (26%), credible (34%), and correct (38%). Half of the students evaluated the intervention messages to be too long, and one fourth did not read the intervention messages. A decrease in dietary fat consumption was shown in girls enrolled in technical-vocational schools (F = 3.5, p < or = .05) and in boys and girls undertaking general education who reported to have read the intervention messages (F = 3.6, p < or = .05); however, no intervention effects were detected for the total sample. CONCLUSIONS: Further improvements to the intervention for use in adolescents should be evaluated. Given that a positive impact was shown in most adolescents and that a computer-tailored dietary fat intake education program has the capability of reaching large groups at low cost, this study shows that using such interventions in adolescents has potential.     

Cost Assessment of a School-Based Mental Health Screening and Treatment Program in New York City

Although school-based mental health screening and treatment programs have been proposed as a viable means of reaching youth with unmet mental health needs, no previous reports have attempted to comprehensively document the costs of such programs. The purposes of this report are (1) to estimate the cost of a school-based mental health screening and treatment program in a real-world school setting, and (2) to outline the methods and procedures that should be employed by future investigators to explore the costs of such programs. The program, located in a middle school in a low-income, largely Hispanic neighborhood in New York City, aimed to screen all students in Grades 6-8 for anxiety, depression, and substance use disorders. Most students in need of treatment were referred to the school-based treatment program, where social workers offered individual and group counseling. Economic evaluation methods and a before/after study design were used to assess the costs of the screening and treatment programs for 3 years of operation. Costs were estimated from the societal perspective, which includes all measurable program costs regardless of who bears the costs, and the school perspective, which includes only costs that would be borne directly by a school operating these programs. Data primarily came from administrative records and staff interviews. The total cost ranged from 106,125 dollars to 172,018 dollars for the screening program and from 420,077 dollars to 468,320 dollars for the treatment program. The cost of the screening program ranged from 149 dollars to 234 dollars per student and the cost of the treatment program ranged from 90 dollars to 115 dollars per session. These costs were estimated from the perspective of society. Applying economic cost analysis methods in a real-world school setting is challenging, but the process can generate useful estimates. Cost analyses and cost-effectiveness studies are needed in this area.