Assessing the training and staff development needs of mental health professionals

The authors report on the development and field testing of a multimethod needs assessment framework to identify the training needs of mental health professionals. The frame-work consisted of three different methods to identify training needs in relation to (a) clinical work, (b) prevention and consultation, and (c) administration.     

Mental and neurological health research priorities setting in developing countries

Introduction

A multi-region consultation process designed to generate locally produced regional and global research priorities on mental and neurological health in low- and middle-income countries.

Methods

Between 2003 and 2005, priority setting exercises on MNH research, using the systematic combined approach matrix (CAM) were held in the six regions of the developing world. One regional meeting per region was convened, and a global meeting was organized before and after the regional exercises.

Results

During regional meetings, regional agendas were created listing both research priorities and local problems in MNH. During global meetings, a global research agenda was established and four crucial areas of research priorities were identified: awareness and advocacy, enhancement of research capacity, training for service delivery, and development of evidence based policy.

Conclusions

The combined matrix approach enabled the development of regional and global MNH research agendas, derived from bottom up consultations within and between low- and middle-income countries. Collaboration between regions with similar priorities was instituted. Such research agendas are designed to assist policy-makers and donors in the allocation of scarce resources, but they require regular review to reflect changing needs.     

Community residents and mental health center staff: Assessment of program and priorities

Mental health professionals have emphasized the importance of establishing priorities and goals and gearing the delivery of mental health services to the needs of area residents. Sound View-Throgs Neck Community Mental Health Center of New York has made such an effort to involve the community residents and the mental health center staff in establishing priorities for development of the new program for services in the community. We have outlined the methods of gathering such information, and implementation of the conclusions derived from the survey which has resulted in developing comprehensive children's services and a geriatric program in our catchment area.     

Teachers' beliefs about mental health needs in inner city elementary schools

OBJECTIVE: To survey teachers' beliefs about mental health service needs in inner city elementary schools. METHOD: A total of 119 teachers from six elementary schools in a major city in the midwestern United States were surveyed to assess their beliefs about the major mental health problems facing their schools, the major barriers to surmounting those problems, their preferences for mental health topics for in-service education, and their education, experience, knowledge, attitudes, and self-efficacy pertaining to mental health issues. RESULTS: Disruptive behavior was endorsed by approximately 50% of teachers as the largest mental health problem facing their schools, and lack of information/training was endorsed as the greatest barrier to surmounting mental health problems. The highest-rated topics for in-service education were disruptive behavior disorders and implementing behavior plans. Although most teachers had taught students with mental health problems, most had had little education in mental health and little consultation with mental health professionals. Correspondingly, teachers' knowledge about mental health issues was limited, and they did not feel confident about their ability to manage mental health problems in their classrooms. CONCLUSIONS: Teachers would benefit from education, training, and consultation from mental health professionals if they serve as effective gatekeepers to mental health services.     

Mental health assessments in juvenile justice: report on the consensus conference

OBJECTIVE: At national, state, and local levels, there is increasing recognition of the importance of identifying and responding to the mental health needs of youths in the juvenile justice system, as policymakers and practitioners struggle to find ways to address causes and correlates of juvenile crime and delinquency. The proposed guidelines for mental health assessment provide explicit information about how, why, and when to obtain mental health information on justice youths at each important juncture in processing. METHOD: A national group of expert researchers and practitioners convened in April 2002. Experts derived six recommendations, following the expert consensus method, for conducting mental health assessments in juvenile justice settings. Experts had broad experience creating collaborations between juvenile justice, mental health, and child welfare systems and understood the policy and health implications of conducting such assessments in juvenile justice settings. RESULTS: Consensus Conference recommendations regarding screening for emergent risk, screening and assessment of mental health service needs, comprehensive mental health assessment components, assessment before community re-entry, need for periodic reassessment, and staff training are presented. CONCLUSION: Deriving specific recommendations that can be implemented systematically is a necessary first step toward policy changes that will optimize the standard of care for this vulnerable population.     

Risk of Future Offense Among Probationers with Co-occurring Substance Use and Mental Health Disorders

The criminal justice system is the primary service delivery system for many adults with drug and alcohol dependence, mental health, and other health service needs. The purpose of this study was to examine the relationship between risk of future offense, mental health status and co-occurring disorders in a large substance abuse diversion probationer population. A purposive sample of 2,077 probationers completed an assessment to screen for mental health disorders, substance use disorders, risk of future crime and violence, and several demographic characteristics. Probationers who screened positive for co-occurring substance use and mental health disorders were significantly more likely to be at higher risk of future crime and violence compared to probationers who screened positive for only substance use, only a mental health disorder, or no substance use or mental health disorder. Implications for substance use and mental health service delivery are discussed, and recommendations are made for further research.     

Organizational cultural competence consultation to a mental health institution

Cultural competence is increasingly recognized as an essential component of effective mental health care delivery to address diversity and equity issues.?Drawing from the literature and our experience in providing cultural competence consultation and training, the paper will discuss our perspective on the foundational concepts of cultural competence and how it applies to a health care organization, including its programs and services. Based on a recent consultation project, we present a methodology for assessing cultural competence in health care organizations, involving mixed quantitative and qualitative methods. Key findings and recommendations from the resulting cultural competence plan are discussed, including core principles, change strategies, and an Organizational Cultural Competence Framework, which may be applicable to other health care institutions seeking such changes. This framework, consisting of eight domains, can be used for organizational assessment and cultural competence planning, ultimately aiming at enhancing mental health care service to the diverse patients, families, and communities.     

User/consumer involvement in mental health service delivery

The involvement of mental health service users in service delivery is a new and growing phenomenon. Such involvement is complex, given the history of paternalism in the mental health system, the power differential between service providers and service users, and the very differing views each group holds on multiple issues. Unless such differences are addressed, there can be no meaningful involvement. Service user involvement needs to apply to all aspects of the service delivery system, including professional training, service design, delivery, evaluation, and research. User/survivors, and their organizations, have developed a body of experience and knowledge that needs to be recognized and respected. Unless there are multiple opportunities for ongoing and open dialogue on these many difficult issues, real user involvement will not occur.     

上海市综合医院精神卫生服务现状调查

目的 了解上海市综合医院精神卫生服务资源等现状。方法 对上海市区15所三级和14所二级综合医院的精神卫生服务现状进行问卷调查。内容包括:医院规模及医疗服务资源;精神卫生服务机构设置及人员配置状况;会诊联络精神病学开展情况以及医院对临床医师进行精神卫生知识培训情况等。结果 (1)在29所综合医院中,17所甲等医院设置精神卫生科室,占59％,显示近年来综合性医院开始重视精神卫生服务工作。(2)已设立精神卫生科室的医院中精神科年会诊率为0.63％;而未设立的医院中精神科会诊率为0.10％,两者间差异具非常显著性(P>0.01)。(3)在被调查医院中仍有55％的医院未开展或仅是偶尔开展会诊联络精神病学工作。(4)精神科医师以不同形式和程度参加各科医疗工作;(5)已设立精神卫生科室的医院其临床医师在接受精神卫生培训方面显著优于未开设精神卫生科室的医院。结论 需要大大提高综合医院精神卫生服务能力,且设立精神卫生机构势在必行。     

Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents

OBJECTIVE: To focus attention on the critical unmet needs of children and adolescents with mood disorders and to make recommendations for future research and allocation of healthcare resources. METHOD: The 36-member Consensus Development Panel consisted of experts in child/adolescent or adult psychiatry and psychology, pediatrics, and mental health advocacy. Reviews of the literature concerning youth mood disorders were performed on the subjects of risk factors, prevention, diagnosis, treatment, and services delivery, and opinions and experiences of mental health advocates were obtained. RESULTS: The Consensus Development Panel listened to presentations and participated in discussions. Independent workgroups of clinicians, scientists, and mental health advocates considered the evidence and prepared preliminary statements. Workgroup leaders presented drafts for discussion by the Consensus Development Panel. The final document was reviewed by the entire group and edited to incorporate input from all participants. CONCLUSIONS: Evidence suggests high rates of unmet needs for children and adolescents with depression or bipolar disorder. Training is largely limited to child mental health specialists; general psychiatrists, pediatricians, and other primary care physicians receive little or no training. As a result, treatment patterns may reflect adult treatment plans that are not validated for youths. Effective treatments have been identified and some preliminary prevention models have been developed, but they are not yet widely applied. Patients experience limited exposure to clinicians adequately trained to address their problems and little information to guide care decisions, particularly concerning bipolar disorder. National efforts are required to restructure healthcare delivery and provider training and to immediately develop more advanced research on pathophysiology, prevention, and services delivery effectiveness.     

The treatment of persons with dual diagnoses in a rural community

Persons with dual diagnoses of psychiatric illness and substance abuse represent a large subpopulation within the mental health system, but mental health service delivery systems typically do not adequately address their special needs. The literature on dual diagnoses is marked by the paucity of information on such persons in rural settings. This paper describes the characteristics of a rural community mental health system, which illustrate the difficulties in treating persons with dual diagnoses in rural communities. These problems include a fragmented system of services, centralized services in a large geographic area, overly restrictive regulations, conceptual differences in treatment approaches, confidentiality and stigma in a rural culture, and the academic and professional isolation of mental health workers, leading to high turnover and a shortage of staff having sufficient training and experience to work with persons with dual diagnoses. Some recommendations to address these problems and to improve the delivery of services to persons with dual diagnoses are suggested.     

Juvenile justice mental health services

As the second century of partnership begins, child psychiatry and juvenile justice face continuing challenges in meeting the mental health needs of delinquents. The modern juvenile justice system is marked by a significantly higher volume of cases, with increasingly complicated multiproblem youths and families with comorbid medical, psychiatric, substance abuse disorders, multiple family and psychosocial adversities, and shrinking community resources and alternatives to confinement. The family court is faced with shrinking financial resources to support court-ordered placement and treatment programs in efforts to treat and rehabilitate youths. The recognition of high rates of mental disorders for incarcerated youth has prompted several recommendations for improvement and calls for reform [56,57]. In their 2000 annual report, the Coalition for Juvenile Justice advocated increased access to mental health services that provide a continuum of care tailored to the specific problems of incarcerated youth [58]. The specific recommendations of the report for mental health providers include the need for wraparound services, improved planning and coordination between agencies, and further research. The Department of Justice, Office of Juvenile Justice and Delinquency Prevention has set three priorities in dealing with the mental health needs of delinquents: further research on the prevalence of mental illness among juvenile offenders, development of mental health screening assessment protocols, and improved mental health services [59]. Other programs have called for earlier detection and diversion of troubled youth from juvenile justice to mental health systems [31,56]. Most recently, many juvenile and family courts have developed innovative programs to address specific problems such as truancy or substance use and diversionary or alternative sentencing programs to deal with first-time or nonviolent delinquents. All youths who come in contact with the juvenile justice system should be screened and, when necessary, assessed for mental health and substance abuse disorders. The screening should occur at the youth's earliest point of contact with the juvenile justice system and should be available at all stages of juvenile justice processing. Whenever possible, youth with serious mental health disorders should be diverted from the juvenile justice system [58]. If delinquent youths do not receive the necessary evaluation, treatment, and rehabilitation, they face the real prospect of further incarceration in adult correctional facilities. Improved screening and treatment require better interagency collaboration, established standards of care, and continuing research on the mental health needs of youth in the juvenile justice system. Better mental health care for youth in the juvenile justice system supports the goal of rehabilitation. Mental health professionals should support these efforts as the appropriate response to meet the challenges of the new century.     

How Mental Health and Developmental Disabilities Staff Prioritize Training and Development Needs

This paper contrasts a staff training needs assessment distributed to three groups: staff serving persons with mental health needs in the community, staff serving persons with mental health needs in state hospitals, and staff serving persons with developmental disabilities in the community. Analyses revealed that all three groups rated team-related training as the area in greatest need of development. Further analyses suggested that community staff serving persons with developmental disabilities reported significantly less need for training on direct client care compared to community and inpatient staff who serve persons with mental health needs. The community staff serving persons with mental health needs did not differ significantly from the inpatient staff on any of the surveyed training areas. Results suggest that future development efforts should begin with team building skills.     

Collaborative needs assessment for child mental health program development

A needs assessment for child mental health program development involving a collaboration between a state university clinical psychology training program and a coalition of publicly funded child-serving agencies is described. The benefits of the joint research effort for all partners are highlighted as well as the lessons learned about the processes of such a partnership. Application of the results included curricular modifications to the university's training program, the addition of new programming and the improvement of existing services to address child mental health needs, and interventions to increase community awareness of available services.     

Geriatric mental health services research: Strategic Plan for an Aging Population: Report of the Health Services Work Group of the American Association for Geriatric Psychiatry.

In November 1999, a working group of the American Association for Geriatric Psychiatry (AAGP) convened to consider strategic recommendations for developing geriatric mental health services research as a scientific discipline. The resulting consensus statement summarizes the principles guiding mental health services research on late-life mental disorders, presents timely and topical priorities for investigation with the potential to benefit the lives of older adults and their families, and articulates a systematic program for expanding the supply of well-trained geriatric mental health services researchers. The agenda presented here is designed to address critical questions in provision of effective mental health care to an aging population and the health policies that govern its delivery.     

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.     

Training programs in school consultation

The need to train psychiatrists in school consultation is important to approach mental health and psychosocial concerns from the broad perspective of addressing barriers to learning and promoting healthy development. There is a major national impetus to improve academic achievement and literacy, which can be amplified by addressing the social, emotional, and mental health needs of children and youth. Training in school consultation allows the psychiatrist to better understand a critical institution in each child's life and also provides technical assistance and training to school personnel, which facilitates networking between programs and individuals involved in or interested in school mental health. Each of the described programs approaches consultation from a specific focus that varies in time commitment, placement options, and frequency and order of didactic presentations. There is no conclusive available evidence as to which program is most effective, since such evaluation depends on the overall goals of the consultation program itself.     

Developing needs led child and adolescent mental health services: issues and prospects

For many years mental health services for children have been developed incrementally with little attention to the needs of the local population. However, over the past decade there have been attempts to develop more rational ways of planning child mental health services. This paper describes the information required to develop a needs-led child mental health service and, within that context, discusses how priorities should be set. It will be suggested that although the assessment of needs for child and adolescent mental health services is still very haphazard, there is now a clear trend for the evaluation of clinical practice to become more systematic. At an individual level we know quite a lot about the efficacy of treatment and the measurement of outcomes. At the service level, several models of good practice are being specified and evaluated. Accepted: 16 September 1998