Child Welfare Recommendations to Improve Mental Health Services for Children who have Experienced Abuse and Neglect: A National Perspective

This study uses a key informant approach to understand the nature, extent, and quality of outpatient mental health services for children in the child welfare system (CWS) in the United States. We interviewed 89 county child welfare administrators to determine the status of outpatient mental health services and provide recommendations for enhancing care and service delivery. Developed for this study (Caring for Children in Child Welfare), the interview was incorporated in the second formal data collection wave (i.e., 18 months after study baseline assessment) of the National Survey of Child and Adolescent Well-Being. The results highlighted general variability in the degree to which these agencies used evidence-based interventions within outpatient services, demonstrated clinical expertise with this population, and met the needs of their families. Community agency use of evidence-based interventions was found to predict their effectiveness in improving clients’ mental health problems. Proposed suggestions for service improvement varied across domains and reflected the need for more communication/coordination, service access, options and resources, and practice refinements to accommodate families’ needs. We discuss the implications of these recommendations from CWS stakeholders for enhancing the service delivery system. We appreciate the assistance and consultation of Jennifer Rolls-Reutz, Barbara J. Burns, Barbara L. Baumann, Michael Hurlburt, and John Landsverk.     

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.     

Residential treatment following outpatient treatment for children with mild to borderline intellectual disabilities: A study of child and family characteristics

In this study, the question was explored whether children with a mild intellectual disability (MID) who were placed in residential treatment following outpatient treatment differ significantly on child and family characteristics from children with MID and not placed in residential treatment following outpatient treatment. The records of the children were examined with respect to various child and family characteristics. Retrospective case analyses were thus undertaken. The results showed those children placed in residential treatment to have experienced significantly more often a traumatic event than the other children. Those children placed in residential treatment had received significantly fewer months of outpatient treatment than those not placed in residential treatment. Finally, there were significantly more children placed in residential treatment having educationally incapable parents or parents with alcohol/drug problems and/or psychiatric problems than in the other group. The findings are discussed in light of a disturbed balance between the support needs and means of the family which can lead to placement of a child in a residential treatment. The possibilities of a multisystemic model for outpatient treatment are discussed.     

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.     

Predictors of dropout from inpatient treatment for anorexia nervosa: Data from a large French sample

Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).     

NPACT: Enhancing Programs of Assertive Community Treatment for the Seriously Mentally Ill

Morbidity and mortality due to physical illness is extremely high in the population of persons with serious mental illness. The purpose of this study was to examine the impact on psychiatric and physical outcomes through enhancing a standard Program of Assertive Community Treatment (PACT) with Advanced Practice Psychiatric Mental Health Nurses (APNs) and stabilized consumer peer providers (NPACT). In a two-group community comparison design, 38 participants receiving NPACT were compared to 21 participants receiving traditional PACT. Evaluations were conducted at baseline and 6 months. Significant improvements over time were demonstrated for both groups on all summary variables. Treatment effects for NPACT over PACT were demonstrated for psychiatric symptoms, community functioning, and consumer satisfaction. Conclusions: Enhancements for PACT using advanced practice nurses and consumer peer providers have the potential to address both health and mental health problems for the seriously mentally ill.     

Increasing the Attendance Rate for First Appointments at Child and Family Psychiatry Clinics: An Opt-in System

Non-attendance for first outpatient appointments at Child Mental Health Clinics is a common problem affecting efficient use of resources, as well as staff morale. This study demonstrates that requiring families to confirm that they want an appointment, in order to receive one, significantly improves the attendance rate for first appointments, compared to two other commonly used procedures: a reminder letter before the appointment is sent, and a standard appointment letter. Furthermore, this procedure did not appear to reduce accessibility to the service.     

Endovascular Treatment of 429 Anterior Communicating Artery Aneurysms Using Bare-Platinum Coils : Clinical and Radiologic Outcomes at the Long-term Follow-up

ObjectiveWe reviewed the feasibility, safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of the anterior communicating artery (ACoA) aneurysms.MethodsA total of 429 ACoA aneurysms in 426 patients were treated using coil embolization between March 1996 and October 2010 in a single institution. Pretreatment aneurysmal features were checked using angiogram. We had usually used tailored steam shaped microcatheter according to individual angiographic architectures. Immediate postembolization outcomes were evaluated using an angiographic outcome scale and clinical evaluation was performed using the Glasgow Outcome Scale (GOS).ResultsPostembolization angiograms demonstrated total occlusion of aneurysm in 290 of 429 (67.6%) aneurysms, neck remnant in 80 (18.6%) and body filling in 59 (13.8%). Dome direction and aneurysm angle was not associated with initial angiographic outcomes. The procedure-related morbidity rate was 0.9% (4 of 429). Clinical and imaging follow-up more than 6 months were available in 382 (89.0%) patients with a mean of 26.2 months. Overall rate of major recanalization was 7.9% (30 of 382) and all of them were retreated without complications. At the last follow-up, 233 (99.2%) of 235 patients had GOS of 5 in unruptured group, and 152 (79.5%) of 191 patients showed good clinical outcomes (GOS of 4 or 5) in ruptured group.ConclusionTailored steam shaping of the microcatheter is vital to achieve good angiographic outcomes regardless of aneurysmal direction. EVT is feasible and safe for most ACoA aneurysms with acceptable immediate and long-term outcomes.     

Treatment of Fibromyalgia Syndrome Using Low-Intensity Neurofeedback with the Flexyx Neurotherapy System: A Randomized Controlled Clinical Trial

SUMMARY

Background. Treatment of fibromyalgia syndrome (FMS) remains a clinical challenge. Pain, somatic and cognitive symptoms may be due to neurosensitization involving CNS-activated autonomic and musculoskeletal reactions, associated with EEG abnormalities that may respond to brainwave-based stimulation biofeedback. This study's objective was to examine the efficacy and safety of a novel EEG neurobiofeedback treatment, the Flexyx Neurotherapy System® (FNS), and electrophysiological responses in persons with fibromyalgia.

Methods. A randomized, double-blind, placebo-controlled clinical trial was conducted in two private practices: a free-standing neurobiofeedback center and a rheumatologist's office at an academic medical center. Sixty-four participants with FMS (American College of Rheumatology criteria; Wolfe et al., 1990) for at least three years and symptoms for at least 48 months with no recent remission were randomized to treatment. A total of 22 treatment sessions were administered over at least 11 weeks of active (n = 33) or sham (n = 31) FNS therapy. Primary efficacy measures were the Clinical Global Impressions improvement scores, Clinician (CGI-I) and Participant (PGI-I) versions. Secondary outcomes included dolorimetry and tender point count, questionnaires (fibromyalgia symptom scales, CNS Dysfunction Questionnaire, Fibromyalgia Impact Questionnaire, Symptom Checklist-90-R), and EEG activity (delta, alpha, total amplitude).

Results. More participants treated with active FNS than with sham improved partially or fully on the CGI-I at session 22 (p = .01) and follow-up (p = .04). The active FNS group had a higher CGI-I full response rate at session 22 (p < .05) but not at one-week post-treatment (p = .07). Significant active versus sham PGI-I responses were not detected (p>.10). There was no significant treatment effect on any secondary outcome measure and no specific symptom improved preferentially with active compared with sham FNS. The most commonly reported side effect was fatigue/tiredness. Pre-treatment delta/alpha EEG amplitude ratio < 1 was associated with PGI-I (but not CGI-I) response independent of treatment group assignment.

Conclusion. FNS monotherapy is insufficient for treating chronic, nonremitting FMS.     

A Strategy for Assessing Costs of Implementing New Practices in the Child Welfare System: Adapting the English Cost Calculator in the United States

In decisions to adopt and implement new practices or innovations in child welfare, costs are often a bottom-line consideration. The cost calculator, a method developed in England that can be used to calculate unit costs of core case work activities and associated administrative costs, is described as a potentially helpful tool for assisting child welfare administrators to evaluate the costs of current practices relative to their outcomes and could impact decisions about whether to implement new practices. The process by which the cost calculator is being adapted for use in US child welfare systems in two states is described and an illustration of using the method to compare two intervention approaches is provided.     

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.     

The Child Therapy Tracking System (CTTS): A model for an expressive therapy electronic health record (EHR)

The Child Therapy Tracking System (CTTS) is a software model for an expressive therapy electronic health record (EHR). It embeds documentation and design standards derived from EHR informatics, art therapy, and play therapy. This paper outlines how the CTTS incorporates these standards into its construction; describes the features of the CTTS, including database storage, image archiving, graphing, and reporting; and demonstrates the utility of the CTTS through a scenario. The CTTS requires much development to make it more representative of an EHR. Future versions should include expert consultation, increased security measures, and the capability to accommodate other expressive arts. The expressive arts will inevitably convert to paperless practices. The CTTS is a preview of what is to come.     

Evidence-Based Psychotherapy for Children and Adolescents: Data from the Present and a Model for the Future

What is the best way to help children cope with behavioural and emotional problems? This question has been a focus of concern — to children and the adults who care for them — across many centuries and in cultures around the world. In this article we examine the current state of efforts to help children by means of an array of non‐medical interventions designed to alleviate psychological distress, reduce maladaptive behaviour, and/or increase adaptive behaviour. We refer to these interventions, collectively, as ‘psychotherapy’. In the article, we will note some accomplishments of the effort to develop effective interventions through clinical research. Then we will note some concerns about these efforts, and suggest ways to address the concerns through an alternate model of intervention development and testing.     

Investigations of Mental Health of School Teachers for the Mentally Retarded and Staff Members in Social Welfare Facilities for the Mentally Retarded: Using a Japanese Version of the General Health Questionnaire (GHQ)

Abstract: The mental health of 70 school teachers for the mentally retarded, 60 direct care staff in social welfare facilities for the mentally retarded, 124 nurses and 369 general office workers was investigated by means of General Health Questionnaire (GHQ). The results were: 1) The incidence of mental unhealthiness was 44.6% among staff serving the mentally retarded, tending to be higher than among nurses, and significantly higher than among general office workers. 2) Among staff serving the mentally retarded, females tended to be more mentally unhealthy than males; among school teachers for the mentally retarded, the incidence among females was significantly higher than among males. 3) As to the incidence by age and experience, among staff serving the mentally retarded, the younger the age and the shorter the experience, the higher the incidence of mental unhealthiness.