No Treatment Day School

At the No Treatment Day School, less than 15% of students used the dormitory during the school week. Located in the heart of a reservation and serving local students, the K-12 school enrolled over 1,000 students. The site received Therapeutic Residential Model funding for the 2001-2002 school year. Initial evaluation of this site found an array of daunting problems throughout the school structure and functioning. There were some successes, including implementation of the Morningside reading program in the elementary school and some response from the community to the comprehensive evaluation report which provided an overview of the situation to policy-makers and community members. However instability in the system and a mid-year change in leadership complicated the process of implementation. By the end of the first year, it was clear that the feasibility of the original proposal was questionable and that an overhaul of the school's system and culture was necessary before a Therapeutic Residential Model could be implemented or significant change could come about. Therapeutic Residential Model funding was terminated at the end of the school year. As there was no substantial implementation of a Therapeutic Residential Model program, data gathered were utilized as representing a naturally occurring control or minimal treatment site.     

Level 2 Therapeutic Model site

L2, one of the original sites first funded under the Therapeutic Residential Model Initiative in 2001-2002, is operated as a peripheral dormitory. This dormitory cares for 185 boys and girls in grades 1-12 who attend local public schools. L2 presented an outstanding proposal which identified gaps in services and presented a reasonable budget to address those gaps by adding additional mental health services and increasing the number of residential and recreation staff. With only minor modifications to this budget, the site efficiently and effectively implemented the strategies it had proposed and utilized evaluation feedback to fine-tune systems and maximize positive outcomes. The Therapeutic Residential Model funds enabled the site to move from a functional dormitory to a therapeutic residential situation where the needs of students are assessed and addressed. Outcome indicators in spring 2002, 2003, 2004, and 2005 showed impacts in a number of areas when compared with the baseline year of 2000-2001: Retention of students steadily increased going from 40.7% in 2000-2001 to 68.4% in 2004-2005; 75 students graduated from high school during the four Therapeutic Residential Model years, compared with 41 in the preceding four years; Academic Proficiency and ACT scores improved significantly; Thirty-day cigarette use dropped from 62% in spring 2001 to 38% in spring 2005 among 7th and 8th graders, from 58% to 33% among 9th and 10th graders, and from 72% to 29% among 11th and 12th graders; Alienation indices showed an increase in feelings of inclusion and a decrease in lack of meaning. This site is an outstanding example of what can be done with a well-designed and responsibly implemented Therapeutic Model Program, and the measurable impacts which can result from such strategic use of resources.     

Level 1 Therapeutic Model site

This site is an intertribal residential grant school annually enrolling over 250 students in grades 1-8 from tribes located in three states on the Northern Great Plains. From its inception in 1890, the boarding school's mission has been to provide services for young children in need of a safe and supportive living and learning environment. For over a decade, this site has used strategies centered on respecting children, structuring students' time, and providing the therapeutic benefits of a well-maintained campus. This site also has a long history of believing in each child's inherent value and potential. When Therapeutic Residential Model funding commenced at the midpoint of the 2002-2003 school year, L1 focused these new resources on strengthening and refining its program. The number of personnel positions increased from 98 to 135, with new positions principally going to dormitory staff and four Masters-level counselor positions. This increase in staff allowed L1 to proactively address the children's developmental needs. The site also adopted and implemented the Applied Humanism caregiving model. In accordance with Applied Humanism, an interview was utilized that allowed the site to identify and hire applicants possessing the attitudes and skills necessary to be good caregivers, existing staff were trained so that they understood the kind of caregiving that would be expected of them, supervision procedures and practices were implemented that supported and encouraged good caregivers and provided time-limited assistance to those who were not, and relevant agency policies and procedures were revised as needed to align with the Applied Humanism philosophy. In addition, the Morningside program was brought in to systematically address the students' academic lags in reading. The results of implementing the Therapeutic Residential Model were a reduction in behavioral incidents, a decrease in the amount of money spent on external mental health services, an increase in the retention rate, an increase in academic skills in selected areas, and higher scores on pre-post measures of adjustment, interpersonal relationships, and adaptability.     

L3 Therapeutic Model site

L3 is an intertribal residential school enrolling approximately 200 students in grades 5-8 from tribes in the northern Midwest. As a result of successful grant-writing which espoused Circle of Courage and Asset-Building, the school built up an impressive configuration of programs funded by a variety of sources, including a cadre of mental health professionals, and began increasingly to rely on their assessments and services. First funded by the Therapeutic Residential Model program in the 2002-2003 school year, L3 used the funding that year primarily to increase professional-level services of a psychiatrist and psychologist, and to maintain or expand programs which would otherwise have been terminated as funding from short-term sources was running out. Evaluation of this project began in January 2003, when the site was assessed and determined to be strongly oriented toward provision of Level Three, or professional-level, psychiatric and medical mental health services. The initial evaluation report identified a low retention rate and raised concerns that the presence of more than 200 staff on campus had resulted in a diffusion of responsibility, lack of consistency, and duplication or redundancy of services; that elements of the environment appeared to be detrimental to social development and emotional stability; and that an unusually high proportion of students were receiving psychiatric diagnoses and medication. The site was asked to address these issues, and additional funding was provided to bolster lower levels of triage by adding paraprofessional case managers to advocate or students and coordinate provision of services for them. Retention remained low at this site throughout the course of funding, and there were a high number of assaults and psychiatric hospitalizations compared with other sites.     

The impact on anxiety and depression of a whole school approach to health promotion: evidence from a Canadian comprehensive school health (CSH) initiative

In this paper, we examine the impact of adopting a comprehensive school health (CSH) approach on reducing anxiety and depression of school-age children. We use the data from 245 schools that received government funding support to adopt a CSH approach in order to build health promoting school environments in Alberta. Using a linear multi-level (hierarchical) model, we compare the average percentage of students with anxiety and depression across the schools that are in three different funding stages: pre-funded, actively-funded, and post-funded. Results show that, all else held constant, the schools that are in the actively-funded stage, relative to pre-funded schools have a lower percentage of students who suffer from anxiety and depression.     

Public funding for residential and nursing home care: projection of the potential impact of proposals to change the residential allowance in services for older people

BACKGROUND: This paper investigates the potential effects of a policy change in the funding of UK residential care. The White Paper Modernising Social Services (Cm 4169, 1998) outlined plans to change the distribution of the Residential Allowance (RA), payable in support of residents in independent residential or nursing home care, from a component of income support paid direct to establishments to a grant to local authorities. This change was intended to remove the perverse incentive in accessing independent residential care more favourably than local authority care. A further objective was to encourage local authorities to use the grant to support home-based alternatives to residential care. The policy rests on a model in which price signals dictate the choice of care for an older person. By, in effect, raising the price of independent residential and nursing home care, the policy provides an incentive for authorities to seek alternatives to institutional care. METHODS: Managers from 16 UK social services departments attended a focus group discussion, completed questionnaires and provided information to assist in calculating the potential diversionary effect of the policy. RESULTS: Managerial estimates indicated a small diversionary effect of the policy; A potential effect of 0.26 and 0.19 per 1000 older people diverted from residential and nursing care respectively. CONCLUSIONS: The study indicated that wider organisational factors other than price are likely to play a greater role in deciding whether an older person is admitted to care. Changes in public funding alone do not reflect the complexities involved in decision-making concerning the residential placement of older people.     

The Ventura Planning Model: a proposal for mental health reform

The Ventura Planning Model is a proposal for public mental health reform. It addresses the decline in mental health funding. It offers a rationale for increased support--and funding--for public mental health services. The Planning Model grew out of the experience of implementing and operating the Ventura Children's Demonstration Project. The model has five characteristics, or planning steps: 1) multi-problem target population; 2) systems goals; 3) interagency coalitions; 4) services and standards; and 5) systems monitoring and evaluation. The Ventura Children's Demonstration Project implemented these planning steps, with an infusion of $1.54 million in funds from the state legislature. The project offset at least 66 percent of its cost by reducing other public agency costs and improved a variety of client-oriented outcomes. The success of the project in offsetting its costs has led the legislature to provide additional funds for three more California counties to implement the model for children and youth, and $4 million a year for four years for Ventura County to test the model for adults and seniors. Emphasizing cost offsets in addition to client-oriented outcomes provides a practical rationale for proposing increases in public mental health funds. This rationale also implies substantial changes in the operations of many public mental health agencies.     

Community mental health centers and the elderly: A time for expansion of planning,research, and demonstration projects

The purpose of this paper is to acquaint persons working in Community Mental Health Centers with federal funding resources which support planning, research, and demonstration projects related to mental health and aging. The significance of exploration by CMHCs into the aging area is suggested by the legislative histories of CMHCs and aging programs, our expanding aging population which requires increasing health and mental health services, and the growing number of resources available for the development of services related to aging. Principal funding sources related to mental health and aging are: Alcohol, Drug Abuse and Mental Health Administration; National Institutes of Health; Administration on Aging; and Health Care Financing Administration. Each funding source is presented through a review of five key items: 1) name of program; 2) objectives; 3) funds awarded; 4) legislative mandate; and 5) contact person and address. Program areas for each funding source are discussed. Knowledge of these funding resources should enable CMHCs to plan services and to expand capabilities to serve the growing over-60 population.Research was sponsored in part by an Administration on Aging IV-B Grant, 90 A-1658.     

Alcohol and marijuana use among adolescents: Long-term outcomes of the class of 1989 study

The Minnesota Heart Health Program (MHHP) is a population-wide research and demonstration project designed to reduce cardiovascular disease in three educated communities (1980–1993) compared to three matched reference communities. The Class of 1989 Study, a substudy of the MHHP, collected self-reported data in one educated and one matched reference community. All sixth graders enrolled in both communities were invited to participate in a baseline survey in 1983, and that grade cohort was surveyed annually throughout junior high and high school until 1989. Students received interventions designed to favorably influence their smoking, physical activity levels, and eating behavior each year from 1983 to 1987. As part of this five-year intervention, a program addressing smoking, alcohol use, drinking and driving behavior, and marijuana use was implemented during the school year of 1985–1986, when students were in ninth grade. Using the school as the unit of analysis, we found that students in the intervention community in 1986 reported fewer occasions on which they had been drinking alcohol in the past 30 days than did students in the reference community. Furthermore, students in the intervention community reported less problem drinking in the previous two weeks and less driving after drinking than did students in the reference community. These positive intervention effects were not maintained through twelfth grade.     

Gender differences in NIH grant funding in neurological surgery

Research productivity is a vital component to an academic neurosurgeon’s career. We sought to evaluate gender differences in NIH funding among faculty in neurological surgery departments. NIH funding awarded to PIs of neurological surgery departments from 2014 to 2019 were obtained and analyzed for gender differences in funding trends, with attention to terminal degree and academic rank, as well as publication range in length of years and h-index. 79.4% of all NIH grants were awarded to male PIs, with the remaining 20.5% given to their female counterparts. Mean of the total NIH grants awarded to men was significantly higher at $1,796,684 (± Standard Error of Mean (SEM) $155,849, IQR: $1,759,250) compared to women at $1,151,968 (± SEM $137,914, IQR: $1,388,538) (P = 0.022). Mean NIH funding per grant for men was $365,760 (± SEM: $39,592, IQR: $189,692) and for women was $292,912 (± SEM: 28,239, IQR: $283,177). Differences in mean NIH funding per grant approached but did not reach statistical significance between men and women (P = 0.122). When stratified for academic rank, there was a significant difference in mean NIH funding per grant between men and women on the associate professor level (p < 0.005), with women exceeding men in funding at this academic level, with other academic ranks remaining non-significant. Overall, male neurosurgeons receive significantly more total NIH grant funding than their female counterparts, except at the level of associate professor where women were found to surpass men.     

Comparing different short-term service delivery methods of visual-motor treatment for first grade students in mainstream schools

To compare the efficacy of three different short-term service delivery methods on first grade children with soft neurological signs who suffer from visual-motor difficulties. One hundred and forty seven first grade students who scored below the 21st percentile on the Visual-Motor Integration Test (VMI) were recruited from schools and randomly divided into three intervention groups and an additional control group. One group received Direct Treatment Model (DT), the second group received Collaborative-Consultation Treatment Model (CC) and the third group received a Combined Treatment Model (CT). The CC included treatment administered by teachers, after Collaborative-Consultation with an occupational therapist (OT). The CT included the two models (DT, CC), administered simultaneously. Pre- and post-intervention tests were administered to both groups. Students in all three intervention groups made significant gains in comparison to the control group suggesting that all three service delivery methods had the same effect on children's visual-motor skills. Therapists in school settings who are obliged to be more efficient are encouraged to use the CC or the CT service delivery methods which would enable them to treat more children during the same time-frame, with full confidence that the treatment goals will be achieved as if using the DT.     

Vocational outcomes among formerly homeless persons with severe mental illness in the access program

OBJECTIVE: This study examined the vocational outcomes of 4,778 formerly homeless individuals with severe mental illness who were enrolled in the Access to Community Care and Effective Services and Support (ACCESS) program, a multisite demonstration project designed to provide services to this population. METHODS: Participants were interviewed at the time of enrollment and again three months and 12 months later by trained researchers who were not part of the treatment team to determine their employment status. At 12 months, participants were also asked about the types of services they had received during the past 60 days. Multiple logistic regression analysis was used to predict employment at 12 months. RESULTS: ACCESS participants reported receiving relatively few job-related services. Nonetheless, modest but significant increases occurred between baseline and three months and between three months and 12 months in the total proportion of participants who were employed and who were employed full-time and in hourly earnings and estimated monthly earnings. The number of hours worked per week increased significantly between three months and 12 months. When the analysis controlled for site, study condition (whether the ACCESS site received or did not receive extra funds to improve service integration), minority status, addiction treatment, and mental health treatment, participants who were employed at 12 months were more likely to have received job training and job placement services. CONCLUSIONS: Programs that work with homeless mentally ill persons may better serve their clients by placing as great an emphasis on providing employment services as on providing housing and clinical treatment.     

Research Compensation and Lottery: An Online Empirical Pilot Study

Recruiting participants for a research project can be challenging. Incentives, particularly monetary incentives, have been shown to increase response rates. Offering a monetary incentive for participation in a research study can become very costly for the investigators. For this reason some researchers, including graduate students involved in under-funded projects, have resorted to lottery compensation to attract participants. From an ethical standpoint, all participants in a research study should be treated equally and fairly. Compensation lotteries, however, undermine equal treatment of all participants (notion of justice) because they prevent equal distribution of rewards. In this pilot study, we were interested in exploring and understanding the prevalence and determinants of the use of lottery compensation method by graduate students from Canadian universities as a way of compensating participants in their research studies. A sample of 50 students from five major Canadian universities participated. Three methods of compensation were identified in this study: cash reimbursement, grade mark and lottery draw for a prize. Results show that the availability of funding is the main determinant of the use of lottery compensation: students with sufficient funds were more likely to use cash incentives, while those without adequate funds were more likely to use lottery draws. Ethical implications are further discussed.     

A preliminary assessment of the impact of block grants on community mental health centers

Federal block grants to states implemented under the Reagan administration were designed to shift governmental responsibility to state and local levels. Focusing on the impact of block grants on community mental health centers, the authors consider whether states have the revenue and managerial capacity to administer block grant programs and whether they are willing to address equity issues related to access to services for low-income citizens. They report data from 36 centers in eight states showing that a majority are now receiving lower levels of federal funding and that many have reduced staffing and services as a result. To counteract the loss of federal funds, centers have increased fees and have taken steps to develop services geared toward the private sector. The authors discuss the effect of such changes on the centers and the implications for the centers' low-income clientele.     

The socialization of adolescent coping behaviours: relationships with families and teachers

A motivational theory of children's coping identified aspects of relationships--involvement, structure and autonomy support--that are expected to determine whether coping will be characterized by approach (active) or avoidance. Associations between adolescents' (N=487, Age M=14) relationships with families and teachers, and coping behaviours were examined. Whether a Family Primacy Model or a Context-Specific Model best explained the findings was also determined. A Family Primacy Model received predominant support; adolescents with more positive family relationships used more active coping with problems at home and school. Positive relationships with teachers predicted more active coping behaviours, especially at school.     

Public mental health funding in California, 1959 to 1989

Actual expenditures for local mental health services in California from 1959 to 1989 are analyzed to determine trends in state funding of services. As the locus of authority for mental health services shifted from state to county governments, the relative share of state budget appropriations devoted to mental health steadily dwindled. Since 1973 the public mental health budget has declined by 11.8 percent, and in most years the percentage of state general funds allocated to mental health has decreased. Programs for the developmentally disabled, which are similar in scope and mission to those for the mentally ill but are both funded and directed by the state, have received consistently higher levels of funding. California's practice of decentralizing operating authority for mental health programs while retaining responsibility for funding is seen as detrimental to the quality of public mental health services.     

A very modest proposal for 1990s C/L psychiatry

The prediction that consultation-liaison psychiatry would play an integral role in the management of all medical/surgical patients in large hospitals has not come to pass. The primary reason is that no adequate funding mechanism has ever been found to support such a large endeavor. The economic climate as we enter the 1990s makes such funding even less likely. The authors suggest that C/L psychiatry accept a lesser role, largely confined to teaching hospitals. That role, which has been successful at a large public teaching hospital for nearly 10 years, encompasses serving as a primary psychiatric teaching site for medical students, a primary teaching site for psychiatry residents and other postgraduate physicians rotating through psychiatry, a source of innovative dispositions for medically ill psychiatric patients, and a source of opportunity for interdisciplinary research.     

Who Gets Care? Mental Health Service Use Following a School-Based Suicide Prevention Program

OBJECTIVE: To examine symptomatology and mental health service use following students' contact with a large urban school district's suicide prevention program. METHOD: In 2001 school district staff conducted telephone interviews with 95 randomly selected parents approximately 5 months following their child's contact with the district's suicide prevention program, a School Gatekeeper Training model. Parents provided information regarding service use, their child's depressive symptoms (using the Diagnostic Interview Schedule for Children Predictive Scale, Depression module), and their perceptions of their child's need for services. Information about the crisis intervention was abstracted from a standardized assessment form. RESULTS: More than two thirds of students received school or community mental health services following contact with the suicide prevention program. Depressive symptoms, but not past year suicide attempt, predicted community mental health service use. Latino students had lower rates of community mental health service use than non-Latinos. School-based service use did not differ by student characteristics including race/ethnicity. CONCLUSIONS: Most students identified by a school-based suicide prevention program received follow-up care, although Latinos were less likely to access services outside the school. School-based mental health services may be an important way in which underserved populations at risk of suicide can receive care.     

Unique contributions of meanings of smoking and outcome expectancies to understanding smoking initiation in middle school

Background: Previous research has shown that meanings of smoking are highly predictive of smoking in middle school children. Three factors of meanings of smoking have been suggested in the literature: personal meanings, functional meanings, and social meanings. These conceptually derived factors of meanings of smoking have not previously been empirically studied.Purpose: This study examined the factor structure of the Meanings of Smoking Index (MSI) to determine the unique contribution of meanings of smoking and positive outcome expectancies to smoking behavior in middle school children.Methods: A multiethnic sample of 2,247 eighth-grade students enrolled in 24 middle schools in greater Los Angeles completed a paper-and-pencil survey in class.Results: Four factors of the MSI emerged (functional, personal, social image, and weight concern). Positive outcome expectancies and each of the four factors of the MSI predicted lifetime smoking in a multivariate model.Conclusions: Meanings of smoking were empirically distinct from positive outcome expectancies. Adolescents who endorsed personal and functional meanings were more likely to smoke. Social image and weight concern meanings were negatively related to smoking after controlling for all other meanings. Meanings of smoking may prove to be important and modifiable mediators of smoking and therefore useful in future prevention studies. This research was supported in part by the California Tobacco-Related Disease Research Program (grant 7PT-7001), The National Institute of Diabetes and Digestive and Kidney Diseases (grant 1-K01 DK 59293-01 DDK-C), and the University of Southern California Transdisciplinary Tobacco Use Research Center, funded by the National Institutes of Health (grant 1 P50 CA84735-01)     

Generalization from school to home with autistic children

This investigation assessed the generalization of verbal behavior from school to home with three autistic boys. The study attempted to expand upon previous research by Handleman (1979) by analyzing the effects of single versus multiple trainers on generalization. By the use of a multiple-baseline design counterbalanced for treatment condition, the three youngsters were taught responses to common questions in two school settings and were probed to determine transfer of learning to their homes. All three children demonstrated greater generalization when they received training at varied locations as opposed to instruction in a single setting. Results of the study suggest that manipulating the school environment to more closely simulate home conditions may facilitate transfer of treatment gains to the natural setting. Support for this research came in part from an NIMH grant (MH 29897-02) to the second author. The authors would like to express their appreciation for the assistance offered by Maria Arnold, Karen Masak, and Michael Powers.