Service utilization and event reaction patterns among children who received Project Liberty counseling services

OBJECTIVES: This study examined service utilization and event reaction patterns among children who used crisis counseling services provided under Project Liberty for 27 months after the September 11, 2001, terrorist attacks on the World Trade Center. METHODS: The authors analyzed logs of 681,318 service encounters submitted by Project Liberty counselors, paying particular attention to demographic characteristics and reported event reactions. RESULTS: Nine percent of service recipients reached by community-based Project Liberty providers were children, whereas census data for the 15 counties and boroughs served by Project Liberty indicated that children constituted 25 percent of the population. Service use as a function of race or ethnicity and of gender was consistent with census data. Similar to findings for adults, the most common emotional event reactions reported for children were experiencing sadness and tearfulness, being anxious and fearful, having difficulty concentrating, experiencing irritability and anger, having intrusive thoughts or images, and having difficulty sleeping. Behavioral event reactions listed on service logs suggested that older children (12 to 17 years) were more likely to use drugs whereas elementary school-age children were more likely to display signs of anxiety, isolation and withdrawal, and difficulties with concentration and memory. CONCLUSIONS: Sensitivity to differences in the event reaction patterns shown by younger and older children may be useful in refining treatments to help reduce the psychological impact of children's trauma after terrorist incidents.     

Use of Project Liberty counseling services over time by individuals in various risk categories

OBJECTIVE: The authors examined temporal changes in the rates at which people sought access to Project Liberty services after the attacks of September 11, 2001, according to risk category (family of missing or deceased, persons directly affected, uniformed personnel, other rescue or recovery workers, schoolchildren, displaced employed and unemployed workers, persons with disabilities, and the general population). METHODS: First visits to individual counseling services, as determined from logs of 465,428 service encounters, were proportioned among risk categories and plotted across 27 months. RESULTS: Individuals who lost family members accounted for 40 percent of visits in the first month but dropped to 5 percent or fewer visits by five months. Uniformed personnel used disproportionately larger percentages of services after the first year. Occupationally displaced and unemployed workers sought counseling at relatively steady rates. CONCLUSIONS: Postdisaster counseling should be made available for extended periods, with shifting emphases to meet the changing needs of high-risk groups.     

Outcomes of enhanced counseling services provided to adults through Project Liberty

OBJECTIVE: Project Liberty provided brief crisis counseling to 753,015 residents of New York City and surrounding counties after the attacks on the World Trade Center. Most regained predisaster functioning after counseling. For those who did not, Project Liberty provided enhanced services by specially trained, licensed mental health professionals. Individuals receiving crisis counseling and enhanced services responded to confidential telephone interviews about 18 and 24 months, respectively, after the attacks. Impairment was compared between groups to determine whether enhanced services recipients reported improved functioning and fewer symptoms of depression, posttraumatic stress, and complicated grief. METHODS: Crisis counseling recipients (N=153) were interviewed once and enhanced services recipients (N=76) were interviewed twice about symptomatology and daily functioning. RESULTS: The samples did not differ in age or gender. Significantly greater proportions of enhanced services recipients reported knowing someone who died as a result of the attacks, having been involved in rescue efforts, or having lost their job because of the attacks. Compared with crisis counseling respondents, enhanced services recipients at their first interview reported significantly more symptoms of depression, grief, and traumatic stress and significantly poorer daily functioning in five life areas. At follow-up, enhanced services respondents reported significant improvement in three of five functioning domains, significantly fewer symptoms of depression and grief, and marginally less traumatic stress. CONCLUSIONS: Recipients of enhanced services were more impaired than people who received only crisis counseling. On the basis of reports from service recipients, meaningful improvements in functioning and symptoms may be associated with the receipt of enhanced services.     

Clusters of event reactions among recipients of Project Liberty mental health counseling

OBJECTIVE: This study aimed to determine a pattern in the frequency with which individuals who manifested distress reactions resembling diagnostic syndromes of posttraumatic stress disorder (PTSD) and major depressive disorder accessed services provided by Project Liberty. METHODS: Hierarchical cluster analysis was applied to 31 reactions to stress (event reactions) shown by 465,428 recipients of Project Liberty counseling, to determine how well event reactions mapped onto traditional diagnostic criteria. Service recipients were tracked when they first sought Project Liberty counseling during the 27 months after the attacks. Those who reported three or more reactions associated with these clusters were characterized as having possible diagnosable conditions. RESULTS: Strong consistent clusters corresponding to traumatic stress and depressive symptoms emerged, with 26 percent, 16 percent, and 8 percent of service recipients rated as having possible PTSD, major depressive disorder, or both, respectively. Taken together, this group constituted over 40 percent of service recipients served by Project Liberty almost every month throughout the 27 months of its existence. CONCLUSIONS: Event reactions, as reported by Project Liberty crisis counselors, many of whom were nonclinicians, mapped coherently onto diagnostic syndromes, suggesting that a checklist of such reactions may be useful to disaster counselors as a cost-effective screening and planning instrument. The steady entry over time into Project Liberty counseling by a substantial number of individuals experiencing high levels of distress underscores the need for providing long-term access to mental health services postdisaster.     

Analyzing vocational outcomes of individuals with psychiatric disabilities who received state vocational rehabilitation services: a data mining approach

This study examines factors affecting vocational outcomes in the vocational rehabilitation process for individuals experiencing psychiatric disabilities who had received state vocational rehabilitation (VR) services. A data mining approach was used to analyze the Rehabilitation Services Administration FY 2001 Case Service Report (RSA-911). Receiving job placement services was found to be the most important variable differentiating individuals who were working from those who were not working. Results regarding vocational outcomes suggest a positive effect for persons receiving job placement services.     

Health services received by individuals with duchenne/becker muscular dystrophy

Introduction: Anecdotal reports from families and care providers suggest a wide variation in services received by individuals with Duchenne/Becker muscular dystrophy (DBMD). Methods: We documented the type and frequency of health services received by individuals with DBMD using the Muscular Dystrophy Surveillance Tracking and Research Network (MD STARnet) interview data released in June 2012. Interviews with eligible caregivers from 5 sites (Arizona, Colorado, Georgia, Iowa, and western New York) were conducted from April 2007 to March 2012. Results: Two hundred ninety‐six caregivers (66% of those contactable) participated in the interview. There were significant differences among sites in the specialists seen and services received. Concurrence with cardiac recommendations was higher than that with respiratory recommendations. Conclusions: The results of this survey support and quantify the anecdotal reports from families and care providers regarding the disparities in services received by individuals with DBMD. It remains to be determined whether these differences affect outcomes. Muscle Nerve 53: 191–197, 2016     

Characteristics of Project Liberty clients that predicted referrals to intensive mental health services

OBJECTIVE: The authors describe characteristics of Project Liberty crisis counseling recipients that predicted referral to more intensive professional mental health treatments over the two-year period after the terrorist attacks on the World Trade Center. METHODS: Random-effects ordinal regression models were applied to data from 684,500 logs of Project Liberty service encounters for individual counseling sessions. RESULTS: Overall, about 9 percent of individual counseling visits ended with a referral to professional mental health services. Individuals needing intensive mental health treatment continued to enter Project Liberty for two years after the World Trade Center attacks. The strongest predictor of referral was having reactions to the attack that fell into a greater number of the four domains assessed-behavioral, emotional, physical, or cognitive domains. Individuals with reactions in four domains were most likely to be referred. Those who had greater attack-related exposure were also more likely to be referred. CONCLUSIONS: It is important to provide long-term access to brief counseling and triage services and to target these interventions specifically to individuals displaying greater distress or impairment and having more traumatic exposure.     

Demographic and clinical profiles of patients who make multiple visits to psychiatric emergency services

OBJECTIVE: The study identified clinical and sociodemographic characteristics of patients making multiple visits to a psychiatric emergency service. METHODS: Information was obtained for patients visiting a hospital psychiatric emergency service in Montreal from 1985 to 2000. Profiles were determined for four groups: one visit, two visits, three to ten visits, and 11 or more visits. To determine whether the profile for those with 11 or more visits was generalizable, data for patients visiting the main site and three other such services from 2002 to 2004 were similarly analyzed. RESULTS: At the main study site (1985 to 2000), patients with single visits accounted for 36% of the 29,569 visits. The 292 patients with 11 or more visits accounted for almost 21% of total visits. Timing of the visit-time of day and day of the week-did not differentiate between groups. However, time itself was important in identifying patients with 11 or more visits: use of 30-month observation periods resulted in identification of only 8% of this group. Patients with 11 or more visits were more likely to be diagnosed as having schizophrenia and as having a comorbid diagnosis and were generally younger at the index visit and more economically impaired than those in the other groups. Overall, and at two of the three other sites, schizophrenia was overrepresented in the highest user group. CONCLUSIONS: Most visits to the psychiatric emergency service were made by frequent users who had distinctive profiles, which are potentially useful for developing clinical strategies to reduce the impact of this patient group on this service.     

Demographic and clinical characteristics of individuals in a bipolar disorder case registry

BACKGROUND: The goal of this analysis was to characterize a cohort of 3000 persons who self-identified as having bipolar disorder by demographic, clinical, and treatment characteristics and to document the burden that this disorder imposed on their lives. METHOD: The Stanley Center Bipolar Disorder Registry used a variety of recruitment methods to reach people with bipolar disorder. The cohort included those currently in treatment and those active in support groups. Registrants completed an interviewer-administered questionnaire to obtain information on demographic characteristics, clinical history, and treatment history. RESULTS: The median age of the 2839 patients who were analyzed was 40.1 years, 64.5% were women, and over 90% were white. The median age at onset was 17.5 years, and the mean was 19.8 years. Despite the fact that over 60% completed at least some college and 30% completed college, 64% were currently unemployed. The patients' family histories point to a high prevalence of mental disorder in the families, especially mood disorders. Patients were concurrently taking multiple medications, and more than one third were taking at least 3 types of psychotropic medications. This pattern of pharmacotherapy was consistent with participants' overall mood ratings, which demonstrated how unusual it was for them to be symptom-free over a 6-month period. CONCLUSION: Our present findings point to the chronicity and severity of bipolar disorder as experienced in the community. We still need to develop better interventions, ensure access to care consistent with current consensus guidelines, and initiate care as early as possible in the course of the condition.     

Using staff focus groups to refine a feedback process for people who used Project Liberty

Project Liberty provided free counseling services to those affected by the September 11th attacks. Focus groups were conducted with Project Liberty provider staff to gain feedback on their participation in the process of evaluating Project Liberty individual crisis counseling services. Focus groups provided information regarding barriers to eliciting feedback from people who used Project Liberty services that informed planning for the next phase of the evaluation. Focus groups proved to be a valuable method for collecting data from service providers across provider sites that differed geographically, culturally, ethnically, and organizationally, as well as in methods of offering services to individuals with mental health problems related to the attack on the World Trade Centers.     

Mental health services received by depressed persons who visited general practitioners and family doctors

OBJECTIVES: This study estimated the rates of mental health service provision and of specialist referral in primary care in Canada and investigated factors associated with receiving mental health services and with referral to mental health specialists among persons who reported major depressive episodes. METHOD:S: Data from the 1998-1999 Canadian National Population Health Survey were used. The 608 respondents who reported having major depressive episodes in the 12 months preceding the survey and who reported contacting a general practitioner or family doctor during that time were included in the study. The rates of provision of mental health services by general practitioners and family doctors and of referral to mental health specialists were calculated. Demographic, socioeconomic, and clinical characteristics associated with receiving mental health services and with referral to specialists were investigated. RESULTS: Among the 608 respondents who had contacted general practitioners or family doctors for any reason, 153 had contacted them for emotional or mental problems. Of this subgroup of 153, 64.5 percent received mental health services either from these practitioners or by referral to specialists, and 26 percent were referred to mental health specialists. Depressed respondents who reported having talked to a general practitioner or family doctor about mental health problems, who reported impairment, and whose depressive symptoms had lasted eight or more weeks were more likely to have received mental health services. Respondents aged 12 to 24 years were more likely to be referred to mental health specialists. CONCLUSION:S: Impairment associated with depression and chronicity of depressive symptoms appear to be the primary determinants of the decisions made by general practitioners and family doctors about providing mental health services. Patients' willingness to consult with general practitioners or family doctors for mental health problems may also be a key factor, both for effective management of depression in primary care settings and for referral to mental health specialists.     

A systematic review of long-term outcomes of patients with psychosis who received early intervention services

Abstract

Despite convincing evidence of short-term symptom control and functional recovery of patients with psychosis after receiving early intervention (EI) services, little is known about the long-term outcomes of EI for these patients. This review aims to evaluate the effectiveness of EI services in improving long-term outcomes of patients with psychosis. A systematic literature search was conducted on PubMed, PsycINFO, Scopus, Medline, CINAHL, BIOSIS, and EMBASE electronic databases to identify studies that evaluated long-term outcomes of patients with psychosis measured 5 years or beyond after entering the EI service. Of 13,005 articles returned from the search, 14 eligible articles reporting study cohorts from nine EI services in seven countries and regions were identified. Data on study design, patient characteristics, intervention components, and outcomes were extracted and reviewed. Only a few studies reported better longitudinal outcomes for negative symptoms, mortality, employment, and hospitalization in patients received EI services. However, results from cross-sectional measurements provided little evidence for long-term impacts of EI services on clinical and functional outcomes. A dilution effect of benefits over time was also demonstrated in several studies. This review highlights the gap in current EI service provision and suggests possible future directions for service improvement and further research.     

The evolution and effectiveness of telephone counseling services

Despite dramatic expansion of telephone counseling services during the last three decades and widespread belief in their preventive and therapeutic value, empirical evidence of their effectiveness is limited, partly because of methodological and practical difficulties associated with research in the field. A review of existing studies indicates that telephone counselors may perform valuable listening, information giving, and referral roles. Evidence is lacking, however, on the ability of telephone counseling to produce behavior change in callers or to reduce suicide rates. Recent studies indicate that contract telephone counseling may have considerable therapeutic potential for monitoring and supporting clients with ongoing problems or chronic disabilities.     

Community services, issues, and service gaps for individuals with developmental disabilities who exhibit inappropriate sexual behaviors

Inappropriate sexual behaviors represent the most challenging behaviors for community service providers. A national survey of 243 community agencies was conducted to describe services provided for individuals with developmental disabilities who exhibit high-risk sexual behaviors and to identify issues and service gaps. The most common types of offenses were sexual behavior (a) in public situations, (b) that inappropriately involved others, and (c) involved minors. Community agencies used multifaceted approaches to serve these individuals. The major issues and problems were systemic, specifically staff issues and service gaps, followed by funding. Implications of this study are that increased knowledge and skills related to sexuality and inappropriate sexual behavior and mental health resources are needed to build community capacity to serve this population.     

Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide.

OBJECTIVE: This study compares demographic and clinical characteristics of 52 individuals with schizophrenia or schizoaffective disorder who had attempted suicide with those of 104 individuals with schizophrenia or schizoaffective disorder who had not made a suicide attempt. METHOD: Participants were interviewed with the Diagnostic Interview for Genetic Studies. RESULTS: Most suicide attempts were of moderate to severe lethality, required medical attention, and involved significant suicidal intent. Individuals who had and had not attempted suicide did not differ with respect to demographic variables, duration of illness, rate of depression, or substance abuse. The two groups are affected differentially when depressed. CONCLUSIONS: Biopsychosocial assessments and interventions are essential for reducing the risk for suicidal behavior in individuals with schizophrenia.     

Remission from nicotine dependence among people with severe mental illness who received help/services for tobacco/nicotine use

ObjectivesA growing body of evidence supports pharmacological interventions to assist smoking cessation in people with severe mental illness (SMI); that is, lifetime major depressive disorder, bipolar disorders, or schizophrenia. Little is known about whether behavioral services are also associated with high probability of remission from nicotine dependence as compared to other types of help/services received (pharmacological, behavioral, or both).MethodsA sample of 726 American lifetime adult smokers with SMI and a history of nicotine dependence, who received help/services for tobacco/nicotine use, were identified. These data came from a limited public use dataset, the 2012–2013 NESARC‐III. Survival analysis was used to compare the probability of remission from nicotine dependence and the time needed for full remission from nicotine dependence by type of help/services received for tobacco/nicotine use.ResultsRemission was more frequent among those who received behavioral services. In addition, the average time from onset of nicotine dependence until full remission from nicotine dependence was shorter among those who received behavioral services.ConclusionsThe current study suggests a clinical need for behavioral interventions to promote the probability of remission from nicotine dependence among smokers with SMI. Health care providers could play a role in educating and encouraging smokers with SMI to seek and utilize behavioral services.