A Call for a Mental Health Services Research Agenda for Youth with Serious Emotional Disturbance

This paper proposes a research agenda on clinical interventions for youth with serious emotional disturbances (SED). A National Institute of Mental Health (NIMH) National Advisory Mental Health Council report on adults with severe mental disorders issued in 1991, led to a research plan and a significant expansion of services research for this adult population. A similar strategy is proposed for children, based on three assumptions: (1) there is a real need for effective treatment; (2) the timing is right; and (3) a small cadre of child clinical and clinical services researchers is prepared to pursue such research. Four topics provide the rationale for NIMH or another agency to commission an expert panel to: (1) conduct an evidence-based review of promising interventions; (2) assess quality indicators; (3) evaluate outcome measures; and (4) reach consensus on a research phase model. A research plan for youth with SED could be endorsed before the new millennium.     

Promoting Mental Health: A Call for a Multicultural Human Movement Perspective

In recent years, a culture of evidence-based, natural scientific, bio-medical and bio-mechanically orientated health-promoting physical activity packages has become popular, to promote health and prevent various illnesses associated with the violence and stress of contemporary planet earth, including the sedentary, technocratic lifestyles typical of economically developed countries. However, humanity has always promoted mental health through involvement in human movement in the form of an infinite variety of behaviours such as playing, running and dancing. Although the new evidence-based approach has scientific validity and undoubted value, considerations of health, holism and harmony also suggest the need for additional forms of discourse that represent more essential, original, meaningful experiences, and multicultural forms of human movement that promote mental health and welfare, perhaps more cost-effectively. The aim of this article is an explication of this conception and its public health implications, with special reference to guidelines for multicultural movement counsellors. Supportive evidence, related to the experience of movement, as well as mental health-promoting activities involving rhythmic, breath-co-ordinated, sociocultural exercises such as chi-gung and dance, is presented.     

The Mental Health Services Program for Youth

This paper traces the development of The Robert Wood Johnson Foundation's Mental Health Services Program for Youth, a private initiative designed to improve the organization, financing, and delivery of service to seriously mentally ill youth. The rationale and structure of this five-year initiative are discussed. In July 1989, 12 one-year development grants were awarded under the program's first phase. All of the grantees propose to utilize a number of strategies to restructure their mental health financing systems. Other common features include: the development of central intake units, early identification mechanisms, stronger utilization review protocols, and unified client tracking mechanisms.     

Violent and Aggressive Behaviors in Youth: A Mental Health and Prevention Perspective

Abstract

Aggressive behavior and violence leading to disciplinary and legal difficulties have reached epidemic proportions among our youth. The severity of problems and social and economic costs to society have increased markedly. In this article, the authors review the risk factors, situational concerns, and warning signs that are important in predicting school violence and in designing effective prevention and early intervention efforts. They then describe programs with which they are involved as mental health professionals that appear to be extremely promising and applicable to other communities. The prevention and intervention programs are distinctive in that they involve collaborations with law enforcement, including the police and criminal sheriff, and the juvenile court as well as parents and schools in their efforts to promote positive development. These clinical, educational, and public policy approaches offer mental health professionals increased opportunities to be of help in this critical area.     

A Predictive Model for Estimating Risk of Harm and Aggression in Inpatient Mental Health Clinics

Psychiatric Quarterly - Serious mental illness is a major risk factor for aggression and violence. The present study aimed to develop and test an algorithm to predict inpatient aggressions that...     

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

     

Anxiety and Atopic Disease: Comorbidity in a Youth Mental Health Setting

Anxiety frequently co-occurs with atopic diseases (e.g., allergies) in community samples, although data are limited to community and pediatric medical samples. Little work has examined atopy rates among mental health treatment seeking youth or whether youth with comorbid anxiety and atopy present similarly to non-comorbid youth. Using initial intake data from a University-based specialty youth clinic for anxiety and depressive disorders (n = 189), rates of atopic comorbidity were benchmarked against lifetime prevalence estimates in epidemiological samples. Anxiety severity and parental stress were compared between youth with and without atopy. Results indicated high rates of atopy in the clinical sample (51.3 %) relative to population atopy estimates (34.5 %). Anxious youth with atopy exhibited more overall and generalized anxiety symptoms relative to non-atopic youth (ps < .05); parental stress was comparable between atopic and non-atopic anxious youth. This suggests potentially heightened clinical severity for youth with co-occurring anxiety and atopy.     

Variations in Mental Health Courts: Challenges, Opportunities, and a Call for Caution

Mental health courts have quickly proliferated in the United States and represent an attempt to expand legal leverage and enhanced treatment access to select persons with severe mental illness who are also involved in the criminal justice system. A national survey of mental health courts has begun to elucidate the procedural, clinical, and operational aspects of these courts and the defendants they adjudicate. A secondary analysis of survey data was performed to determine the similarities and differences among these courts. Results revealed large variability among existing mental health courts across multiple domains. The implications of this variability are discussed in terms benefits and limitations.     

Relationships Between Youth and Caregiver Strengths and Mental Health Outcomes in Community Based Public Mental Health Services

To examine relationships between youth and caregiver strengths and behavioral health outcomes for youth in community service settings. Strengths and behavioral health needs of youth (N = 793) receiving Home and Community Based Services Waiver from 2002–2008 were characterized using the child and adolescent needs and strengths mental health assessment. Comparisons of assessment scores at admission and program completion were conducted using Chi-square, repeated measures ANOVA and Cohen’s d effect size. Associations between strengths at admission and having behavioral health needs met were examined using multivariable logistic regression. Youth had high levels of needs on mental health, risk and functioning dimensions at admission. All needs improved significantly over the course of the service episode. Youth and caregiver strengths at admission were associated with significant improvements in youth behavioral needs areas at discharge. The findings support the importance of assessing and incorporating youth and caregiver strengths in planning and delivering public mental health services.