Community‐Based Mental Health and Behavioral Programs for Low‐Income Urban Youth: A Meta‐Analytic Review

A meta‐analytic review of 33 studies and 41 independent samples was conducted of the effectiveness of community‐based mental health and behavioral programs for low‐income urban youth. Findings indicated positive effects, with an overall mean effect of 0.25 at post‐test. While this is comparable to previous meta‐analytic intervention research with more diverse samples, it stands in contrast to findings of the school‐based review (0.08 at post‐test) focused on this population. The current review found type of intervention to significantly moderate effects, with effects highest for programs that were environmentally based. In fact, effect sizes for programs that did not target the environment were not significant. Findings are discussed with an emphasis on environmental influences, including the differing contexts affecting school‐ versus community‐based interventions conducted with low‐income, urban youth.     

RELATIONSHIP OF EVIDENCE‐BASED PRACTICE AND TREATMENTS: A SURVEY OF COMMUNITY MENTAL HEALTH PROVIDERS

Evidence‐based treatments (EBTs) are interventions that have been proven effective through rigorous research methodologies. Evidence‐based practice (EBP), however, refers to a decision‐making process that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service providers’ knowledge of EBP and perceived advantages, disadvantages, reasons for not implementing full EBT protocols, and attitudes toward EBTs. Qualitative examination of mental health service providers’ definitions of EBP reveals confusion between the terms EBP and EBT. Service providers indicated several advantages and disadvantages of using EBTs. Analysis suggests that many perceived EBT disadvantages would be eliminated if EBTs are implemented as part of the EBP approach, thus allowing for clinician expertise and patient characteristics to be combined with EBTs. Alternatively, distinguishing between EBP and EBT may be more confusing than useful for most community mental health practitioners, which indicates new terminology may be needed.     

Effects of personality on self‐rated health in a 1‐year randomized controlled trial of chronic illness self‐management

Objective. Personality factors moderate self‐efficacy enhancing effects of some illness self‐management interventions, but their influence on self‐rated health is unclear. This study examined whether high neuroticism and low conscientiousness, extraversion, and agreeableness (the distressed personality profile) moderated the effects of the homing in on health (HIOH) illness self‐management intervention on mental and physical health status. Design. Analysis of data from 384 subjects completing a randomized controlled trial of HIOH. Methods. Regression analyses examined effects of NEO‐five factor inventory scores on SF‐36 mental component summary (MCS‐36) and physical component summary (PCS‐36) scores (baseline; 2, 4, and 6 weeks; 6 months; 1 year), adjusting for age, gender, and study group. Results. Baseline MCS‐36 scores were worse in those with the distressed personality profile relative to others: high neuroticism (13.3 points worse, 95% confidence interval (CI)=11.0, 15.7) and low conscientiousness (6.6 points worse, 95% CI=4.1, 9.2), extraversion (10.1 points worse, 95% CI=7.7, 12.5) and agreeableness (4.2 points worse, 95% CI=1.6, 6.8). Intervention subjects had better MCS‐36 scores at 4 and 6 weeks, and benefits were confined to participants with low conscientiousness (4 weeks – 3.7 points better, 95% CI=0.2, 71; 6 weeks – 5.0 points better, 95% CI=1.57, 8.4). There were no intervention or personality effects on PCS‐36 scores. Conclusions. Chronically ill self‐management intervention recipients with the distressed personality profile had worse self‐rated mental health, and conscientiousness moderated the short‐term effects of the intervention on self‐rated mental health. Measuring personality may help identify individuals more likely to benefit from self‐management interventions.     

IDENTIFYING MENTAL AND PHYSICAL HEALTH CORRELATES OF HOMELESSNESS AMONG FIRST‐TIME AND CHRONICALLY HOMELESS VETERANS

This study examined four categories of self‐reported health and mental health factors and their association with recurrent or chronic homelessness in a sample of homeless Veterans presenting for care for the first time. These factors and their relationship to housing status were examined in a cross‐sectional analysis comparing first‐time or single episode homeless Veterans to chronic or repeat emergency sheltered or unsheltered homeless Veterans. Results revealed that while Veterans with a history of chronic or recurrent homelessness were more likely to self‐report diagnoses of substance abuse problems, any mental health problems, and bipolar disorder, those who were homeless for the first time in their adult life were more likely to report a variety of physical health conditions, economic causes of homelessness, and some other mental health problem. These findings suggest that further work should be undertaken to determine how clinical interventions for Veteran homelessness address different risk profiles and treatment needs based on lifetime homeless history.     

CLARIFYING THE PHILOSOPHY BEHIND THE COMMUNITY MENTAL HEALTH ACT AND COMMUNITY‐BASED INTERVENTIONS

The passing of the Community Mental Health Act was supposed to signal a change in the treatment of mental disorders. The idea was to embed interventions as much as possible in a community, so that treatment is accessible and appropriately designed. However, many programs that strive to be community‐based never achieve this status. The problem is that becoming community‐based is often treated as merely a methodological or tactical change, rather than a new philosophy. Clinics were built and services offered without a coherent theory to explain why better assessments and treatments should accompany a community‐based strategy. The purpose of this article, therefore, is to clarify the basis for such an approach so that mental health services are not simply placed in communities, but rather are defined and controlled by the persons who reside in these neighborhoods.     

TIED TOGETHER: BUILDING RELATIONAL WELL‐BEING AND REDUCING SOCIAL ISOLATION THROUGH PLACE‐BASED PARENT EDUCATION

Recent research has begun to shed light on the role community organizations can play in fostering relational well‐being, particularly among low‐income parents living high‐poverty neighborhoods. However, less well understood are the organizational, programmatic, and neighborhood factors that contribute to the formation of new social network connections among participants in these settings or the nature of connections developed. This qualitative study examines the efforts of one neighborhood‐based human service organization to counter the effects of social isolation through a place‐based parent education initiative. Findings from 69 interviews suggest that for participants the program served as transformative learning environment that challenged existing narratives about public housing residents and fostered the development of a positive shared identity as parents. Formal structures and informal opportunities in the neighborhood supported the development and maintenance of new social connections and served as the foundation for an ongoing community of practice among participants.     

Reminiscence‐Based Therapies for Depression: Should They Be Used Only With Older Adults?

Reminiscence‐based therapies have been reliably evidenced to be an effective intervention for depression. However, to date, their use has been restricted primarily to older adults. This article reviews empirical findings related to the various functions of reminiscence and their correlates with mental health. Reminiscence‐based interventions and their effectiveness are then reviewed, with a particular focus on recent evaluations of structured reminiscence‐based therapies that utilize preexisting therapeutic frameworks for the treatment for depression. The exclusive use of reminiscence‐based therapies with older adult populations is then challenged, and it is argued that these approaches may be useful for reducing depression symptomatology for young and middle‐aged adults also. Considerations for the use of reminiscence‐based therapies in these populations are discussed, and future directions for research are presented.     

A Longitudinal study of mental health consumer/survivor initiatives: Part 4—Benefits beyond the self? A quantitative and qualitative study of system‐level activities and impacts

The purpose of this article is to report on the system‐level findings of a longitudinal study of four mental health consumerñrun self‐help organizations. Quantitative and qualitative data revealed that staff and members of the four Consumer/Survivor Initiatives (CSIs) participated actively in system‐level activities, including community planning, public education, advocacy, and action research. The qualitative data revealed a number of perceived system‐level outcomes related to these activities: (1) changes in perceptions (changed perceptions of the public and mental health professionals about mental health or mental illness, the lived experience of consumer/survivors, the legitimacy of their opinions, and the perceived value of CSIs) and (2) concrete changes (tangible changes in service delivery practice, service planning, public policy, or funding allocations). These findings are discussed in the context of previous work on system‐level activities and impacts of consumer/survivor organizations. © 2006 Wiley Periodicals, Inc.     

Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students

Sleep problems are a common occurrence in college students. Insomnia, nightmares and impaired sleep quality lead to several mental health issues, as well as impaired academic performance. Although different sleep programmes exist, a systematic overview comparing their effectiveness is still missing. This systematic review aims to provide an overview of psychological interventions to improve sleep in college students. Seven databases were searched from November to December 2016 (MEDLINE, EMBASE, PsycINFO, Cinahl, Cochrane Library, PubMed, OpenSigle). The search string included search terms from three different topics: sleep, intervention and college students. Outcome measures included subjective as well as objective measures and focused on sleep, sleep‐related and mental health variables. Twenty‐seven studies met the inclusion criteria. They were assigned to four intervention categories: (1) sleep hygiene, (2) cognitive–behavioural therapy (CBT), (3) relaxation, mindfulness and hypnotherapy and (4) other psychotherapeutic interventions. Fifteen studies were randomized controlled trials. While sleep hygiene interventions provided small to medium effects, the CBTs showed large effects. The variability of the effect sizes was especially large in the relaxation category, ranging from very small to very large effect sizes. Other psychotherapeutic interventions showed medium effects. CBT approaches provided the best effects for the improvement of different sleep variables in college students. Five studies included insomnia patients. The other three intervention categories also showed promising results with overall medium effects. In the future, CBT should be combined with relaxation techniques, mindfulness and hypnotherapy. Furthermore, the interventions should broaden their target group and include more sleep disorders.     

AN INVESTIGATION OF VOLUNTEER‐STUDENT RELATIONSHIP TRAJECTORIES WITHIN SCHOOL‐BASED YOUTH MENTORING PROGRAMS

This prospective, mixed‐method study investigates the development of school‐based mentoring relationships using direct observations, in‐depth interviews, and questionnaires from the perspective of mentors and students. A pattern‐oriented analysis of qualitative data explores the diversity observed in the life‐course of mentor‐student relationships. Systematic variation in developmental trends across relationships revealed four distinctive groupings. Some relationships showed progressive improvement in strength and quality. Others started well but reached a plateau and did not become particularly close. A third group struggled throughout to make a connection. Finally, some relationships succeeded after a breakthrough to overcome their challenges. These inductively derived categories are corroborated and supplemented with quantitative data regarding relationship quality. The study reveals the heterogeneity of relationship trajectories within school‐based mentoring programs.     

Factors Involved in Clinician Adoption and Nonadoption of Evidence‐Based Interventions in Mental Health

With the development of empirically supported psychological treatments and the growing mandate for evidence‐based practice, the dissemination and implementation of interventions with proven efficacy has assumed a growing sense of urgency. One barrier to the implementation of new procedures involves individual differences in the proclivity to adopt innovations, even in the context of supportive organizational structures. This article reviews the literature on the characteristics of adopters and nonadopters and factors that facilitate adoption of evidence‐based practice in the field of mental health. Information about reasons for adoption and nonadoption of evidence‐based practices in other areas of health‐care delivery is reviewed to inform strategies for improving rates of adoption of evidence‐based treatments by mental health providers.     

Help‐seeking behavior of west African Migrants

In this article, the authors present essential aspects of the help‐seeking behavior with regard to mental health problems of Ghanaian migrants in the Netherlands. Samples of citizens in the general population (n=97) and outpatients treated in mental health care facilities (n=36) were included. Data were acquired by administering a semi‐structured interview. Quantified data were analysed using hierarchical multiple regression analyses and direct (standard) logistic analyses. Help‐seeking pathways are multi‐determined. Being involved in Dutch society may determine an individual's attitude toward health care and the time before taking action. Particularly, socio‐demographic variables (e.g., age, unemployment, urbanicity) and acculturative demands (integrative skills, normative orientation) shape the help‐seeking orientation and service utilization in multiethnic settings. A liaison between mental health services, traditional healers, religious leaders and self‐help groups might therefore benefit patients. By identifying and emphasizing the specific social and acculturation components that facilitate or deter health behaviours, we are better able to implement health care interventions among different ethnic and cultural communities. © 2008 Wiley Periodicals, Inc.     

BRIEF INSTRUMENTAL SCHOOL‐BASED MENTORING FOR FIRST‐ AND SECOND‐YEAR MIDDLE SCHOOL STUDENTS: A RANDOMIZED EVALUATION

A limitation of school‐based mentoring (SBM) is the lack of structured, evidence‐based practices in mentoring sessions that explicitly target school‐relevant outcomes, such as academic performance and school behavior. To address this concern, we developed and experimentally evaluated a brief SBM program based on practices adapted from evidence‐based counseling and academic interventions with the goal of improving the academic and behavioral performance of middle school students. The results indicate that students randomly assigned to instrumental SBM with an average of 8 sessions over a 2.5 month period (N = 74) showed better math grades, reduced school behavioral office referrals, and increased life satisfaction when compared to students randomly assigned to the control group (N = 60). Tentatively, our results suggest that SBM programs may benefit from the incorporation of instrumental elements based on evidence‐based practices.     

A COMPARATIVE STUDY OF MENTAL HEALTH CARE UTILIZATION BETWEEN FOREIGN‐BORN ADULTS AND U.S.‐BORN ADULTS

This secondary data analysis of 4,341 adults examined and compared factors associated with mental health service utilization between U.S.‐born adults and foreign‐born adults. Logistic regression was used to investigate how participants’ mental health care use was associated with (a) predisposing factors, (b) enabling resources, and (c) perceived mental health needs. Two patterns of mental health care utilization were identified based on adults’ nativity statuses in our study. The findings show that the likelihood of foreign‐born adults’ mental health care use associates positively with education, public health insurance coverage, and depression, but such likelihood associated negatively with Asian ethnicity and male gender; compared to the likelihood of U.S.‐born adults’ mental health care use associates positively with education, perceived general mental health condition, depression, and drug abuse, but such likelihood associated negatively with age. Implications for policy and practice are discussed.     

Caring for the carers: Advice for dealing with sleep problems of hospital staff during the COVID‐19 outbreak

Hospital staff are at the frontline in the COVID‐19 outbreak. The stressors they experience may induce sleep problems in a population already at risk. Sleep deprivation, long shifts and insomnia in hospital staff have been associated with individual, organizational and public health hazards. These include increased risk of mental and somatic disorders, altered immune responses, medical errors, misunderstandings, drowsy driving and burnout. In March 2020, the World Health Organization called for providing access to mental health and counselling for health professionals involved in the COVID‐19 outbreak. To answer this call, we propose practical advice for the management of sleep problems (sleep deprivation, insomnia and shift work) that can be included in supportive interventions. The advice is based on psychobiological principles of sleep regulation and on guidelines for the treatment of insomnia and was implemented within an initiative offering psychological support to the staff of three university hospitals in Rome.     

A systematic review of the clinical utility of the concept of self‐disgust

This systematic literature review examined the clinical utility of the construct of self‐disgust in understanding mental distress. Specifically, the review assessed whether there is a shared conceptual definition of self‐disgust, the face and construct validity of the quantitative assessment measures of self‐disgust, and the predictive validity of self‐disgust in formulating the development of a range of psychological difficulties. A systematic database search supplemented by manual searches of references and citations identified 31 relevant papers (27 quantitative, 3 qualitative, and 1 mixed). Analysis of qualitative papers indicated a number of shared features in the definition of self‐disgust, including a visceral sense of self‐elicited nausea accompanied by social withdrawal and attempts at cleansing or suppressing aspects of the self. Quantitative assessment measures appeared to capture these dimensions and evidenced good psychometric properties, although some measures may have only partially captured the full self‐disgust construct. Strong relationships were observed between self‐disgust and a range of mental health presentations, in particular, depression, body‐image difficulties, and trauma‐related difficulties. However, these relationships are smaller when the effects of other negative self‐referential emotions were controlled, and stronger conclusions about the predictive validity of self‐disgust are limited by the cross‐sectional nature of many of the studies.     

Poverty and Mental Health Practice: Within and Beyond the 50‐Minute Hour

Despite the high and increasing prevalence of poverty in the United States, psychologists and allied professionals have done little to develop mental health interventions that are tailored to the specific sociocultural experiences of low‐income families. In this article, we describe the sociocultural stressors that accompany the material deprivations of poverty, and the mental health difficulties to which they often give rise. Next, we outline the psychosocial and class‐related issues surrounding low‐income adults’ access to and use of mental health services and suggest a conceptual framework to guide the modification of mental health practice to better accommodate poor peoples’ complex needs. This framework describes opportunities for practice modification at three levels of intervention, beginning at the individual level of traditional individual psychotherapy and subsequently targeting increasingly broad contextual elements of poverty.     

Eye movement desensitization and reprocessing in the psychological treatment of trauma‐based psychogenic non‐epileptic seizures

Little is known about the types of mental health treatment that are most effective for psychogenic non‐epileptic seizure (PNES) patients who have high rates of comorbid post‐traumatic stress disorder (PTSD) and dissociation. Eye movement desensitization and reprocessing (EMDR) has proved to be effective in the treatment of PTSD, anxiety states, dissociative symptoms and somatoform disorders. This study, which utilized a non‐controlled qualitative multiple revelatory case design, integrates EMDR into the psychological treatment of PNES patients with confirmed trauma experiences. With EMDR targeting trauma and dissociative symptoms in three patients, PNES were extinguished in two. Those patients have remained seizure‐free for 12–18 months. Copyright © 2007 John Wiley & Sons, Ltd.     

School‐Based Mental Health and Behavioral Programs for Low‐Income,Urban Youth: A Systematic and Meta‐Analytic Review

[Clin Psychol Sci Prac 18: 372–390, 2011] A systematic and meta‐analytic review was conducted of the effectiveness of school‐based mental health and behavioral programs for low‐income, urban youth. Applying criteria from an earlier systematic review ( Rones & Hoagwood, 2000 ) of such programs for all populations indicated substantially fewer effective programs for low‐income, urban youth. The meta‐analysis similarly failed to indicate effects of the typical program on primary outcomes. Effectiveness was evident, however, for programs that targeted internalizing problems or had a broader socio‐emotional focus and those delivered to all youth (i.e., universal). In contrast, negative effects were apparent for programs that targeted externalizing problems and were delivered selectively to youth with existing problems. Distinctive characteristics of low‐income, urban schools and nonschool environments are emphasized as potential explanations for the findings.     

Toward Person(ality)‐Centered Treatment: How Consideration of Personality and Individual Differences in Anorexia Nervosa May Improve Treatment Outcome

Anorexia nervosa (AN) is a serious illness that challenges mental health professionals globally. While family‐based treatment is well established for adolescents with parents able to collaborate, little data are available to inform treatment choice for chronic or adult patients. This review proposes that the current high attrition, poor compliance, and suboptimal efficacy of outpatient interventions may reflect inadequate consideration of individual difference variables. Data on certain variables demonstrated to have relevance for AN are briefly summarized, and novel psychotherapeutic interventions that have taken these variables into account are reviewed. These data suggest that identifying subgroups of individuals with AN on the basis of relevant personality or neurocognitive variables may be one way to improve treatment acceptability and effectiveness for this challenging population.