Beyond COVID-19: Five commentaries on reimagining governance for future crises and resilience.

Several Canadian and international scholars offer commentaries on the implications of the COVID-19 pandemic for governments and public service institutions, and fruitful directions for public administration research and practice. This second suite of commentaries considers the challenges confronting governments as a result of the COVID-19 pandemic and in the decades to come with an increasingly broad lens: the need to understand and rethink the architecture of the state given recent and future challenges awaiting governments; the need to rethink government-civil society relations and policies to deliver services for increasingly diverse citizens and communities; the need for new repertoires and sensibilities on the part of governments for recognizing, anticipating, and engaging on governance risks despite imperfect expert knowledge and public skepticism; how the COVID-19 crisis has caused us to reconceive international and sub-national borders where new "borders" are being drawn; and the need to anticipate a steady stream of crises similar to the COVID-19 pandemic arising from climate change and related challenges, and develop new national and international governance strategies for fostering population and community resilience.

Plusieurs universitaires canadiens et internationaux ont offert des suggestions sur les implications de la pandémie du COVID­19 pour les gouvernements et les institutions de la fonction publique, ainsi que des orientations futures pour la recherche et la pratique en administration publique. Cette deuxième série de commentaires examine les défis que devront affronter les gouvernements en raison de la pandémie de COVID­19 et dans les décennies à venir, dans une optique large. Cette série souligne le besoin de comprendre et de repenser l'architecture de l'État, de revoir les relations entre le gouvernement et la société civile pour fournir des services à des citoyens et des communautés de plus en plus divers, d'élaborer de nouvelles façons d'identifier et d'anticiper les risques, et de s'engager malgré l'imperfection des connaissances d'experts et le scepticisme du public, de repenser les frontières, tout ceci en tenant compte des crises et défis à venir, de façon à promouvoir la résilience de la population et des communautés.

Quality of mental health care for depressed adolescents.

Understanding the quality of routine care for adolescent depression constitutes the initial step in designing and implementing improvement strategies. This study assessed depression detection and type and duration of services for adolescents in mental health care settings. Medical record diagnosis and standardized research interview results were compared for youth seeking mental health treatment. The majority of depressed adolescents received care consistent with guidelines and evidence. However, only 51% received appropriate medication; fewer than half received at least 8 sessions of outpatient care or follow-up after hospitalization. Males received significantly fewer components of quality care compared with females. Depression diagnoses in routine care may be facilitated by using structured interviews or questionnaires. Quality monitoring and improvement initiatives may also increase rates of care components that are consistent with guidelines and evidence. Methods tested in this study may facilitate the evaluation of quality improvement initiatives for adolescent depression or other mental health disorders.

Organizational management: what service providers are doing while researchers are disseminating interventions.

Much of the recent discussion about how to make interventions with demonstrated effectiveness more routinely available to clients emphasizes the role of change agents in promoting service providers' use of new interventions. This study provides a complimentary perspective; it describes what happens in service provider organizations as they go about making changes in the services they provide. The data used in this study come from quarterly progress reports of participants in the National Child Traumatic Stress Network. The results provide a roadmap for anticipating the types of efforts and extent of changes that may need to occur for organizations to learn about interventions, form favorable opinions toward them, and integrate them into the services they offer.

Roger Alan Myers (1930-2015).

Presents an obituary for Roger Alan Myers, who passed away September 13, 2015, in Stuart, Florida, at age 85. Meyers was a long-time national leader of counseling psychology.

Detection and outcomes of substance use disorders in adolescents seeking mental health treatment.

OBJECTIVE: To compare detection rates, service use, and outcomes of substance use disorder (SUD) in adolescents seeking mental health treatment. METHOD: Adolescents (n = 237) and their parents or caregivers completed parallel, self-administered versions of the Adolescent Treatment Outcomes Module (ATOM) at intake and 6-month follow-up. SUD was assessed using the Diagnostic Interview Schedule for Children (DISC). RESULTS: Although 42 (16.6%) adolescents seeking mental health treatment met DISC criteria for any SUD at baseline, clinicians detected only 19 of these (kappa = 0.51). Sensitivity and specificity were high for a screening tool for adolescent SUD (95.2 and 82.0, respectively). Adolescents with undetected SUD were less likely to receive SUD services and to have more legal problems at 6-month follow-up compared to adolescents with detected SUD. CONCLUSIONS: SUD rates may be high in adolescents seeking mental health treatment, confirming the need for routine screening in this population. Results confirm that a large gap exists between the need for and access to SUD treatments, which may contribute to poorer outcomes for all adolescents with SUD.

Mental health need and access to mental health services by youths involved with child welfare: a national survey.

OBJECTIVE: This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment. METHOD: Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were weighted to provide population estimates. RESULTS: Nearly half (47.9%) of the youths aged 2 to 14 years (N = 3,803) with completed child welfare investigations had clinically significant emotional or behavioral problems. Youths with mental health need (defined by a clinical range score on the Child Behavior Checklist) were much more likely to receive mental health services than lower scoring youth; still, only one fourth of such youths received any specialty mental health care during the previous 12 months. Clinical need was related to receipt of mental health care across all age groups (odds ratio = 2.7-3.5). In addition, for young children (2-5 years), sexual abuse (versus neglect) increased access to mental health services. For latency-age youths, African-American race and living at home significantly reduced the likelihood of care. Adolescents living at home were also less likely to receive services, whereas having a parent with severe mental illness increased (odds ratio = 2.4) the likelihood of service use. CONCLUSIONS: Routine screening for mental health need and increasing access to mental health professionals for further evaluation and treatment should be a priority for children early in their contact with the child welfare system.

Pathways into and through mental health services for children and adolescents.

OBJECTIVE: This study examined points of entry into the mental health service system for children and adolescents as well as patterns of movement through five service sectors: specialty mental health services, education, general medicine, juvenile justice, and child welfare. METHODS: The data were from the Great Smoky Mountains Study, a longitudinal epidemiologic study of mental health problems and service use among youths. The sample consisted of 1,420 youths who were nine, 11, or 13 years old at study entry. Each youth and a parent were interviewed at baseline and every year thereafter about the use of services for mental health problems over the three-year study period. RESULTS: Population estimates indicated that 54 percent of youths have used mental health services at some time during their lives. The education sector was the most common point of entry and provider of services across all age groups. The specialty mental health sector was the second most common point of entry for youths up to age 13 years, and juvenile justice was the second most common point of entry for youths between the ages of 14 and 16. Youths who entered the mental health system through the specialty mental health sector were the most likely to subsequently receive services from other sectors, and those who entered through the education sector were the least likely to do so. CONCLUSIONS: The education sector plays a central role as a point of entry into the mental health system. Interagency collaboration among three primary sectors-education, specialty mental health services, and general medicine-is critical to ensuring that youths who are in need of mental health care receive appropriate services.

Case-mix adjustment of adolescent mental health treatment outcomes.

Case-mix adjustment methods are needed to account for differences between providers when the youth they treat have characteristics that adversely affect treatment success. This study explores variables for adjusting mental health treatment outcomes for adolescents and the differential effects of case-mix adjustment on providers' performance. Linear regression modeling was used to identify case-mix variables for five outcomes. Predictive equations for each outcome were developed for models based on intake clinical data alone, clinical data plus administrative data, and clinical data plus data describing youth history and family environment. Variance explained by intake clinical data alone did not increase appreciably with the addition of administrative data or data describing youth history and family environment. Adjusting outcomes changed the relative performance of certain individual providers substantially, but had a more moderate impact on the overall interpretation of providers' performance.

Parental arrest and children involved with child welfare services agencies.

Data from the National Survey of Child and Adolescent Well-Being show that approximately 1 in 8 (12.5%) children who are subjects of reports of maltreatment investigated by child welfare services (CWS) agencies have parents who were recently arrested. Compared with other children who come to the attention of CWS agencies, those with arrested parents are younger, disproportionately African American, and significantly more likely tp be in out-of-home care. Approximately 2 in 5 children age 2 and older with arrested parents had a clinically significant emotional or behavioral problem, yet only 1 in 10 received mental health care. Although parent characteristics varied by race, rates of substance abuse, serious mental illness, domestic violence, and problems meeting basic needs were higher among arrested parents than among other parents.

Learning from the ground up: responding to children affected by parental incarceration.

Beginning in the fall of 2007, Illinois' Division of Mental Health began piloting an early intervention program targeting children of incarcerated parents. The pilot program was situated within a community-based agency on the Westside of Chicago with a high number of currently and formerly incarcerated community members. This article describes the program theory upon which the pilot program was based, the perceived benefits from the perspective of participants and the service provider agency, lessons learned, and recommendations for making incarceration-sensitive interventions a routine part of children's mental health services.

Improving practice-research connections through technology transfer networks.

This paper presents a first look at network and survey data collected to ascertain the salience and value-added of technology transfer networks in reducing the science-to-service gap in behavioral healthcare services. The National Child Traumatic Stress Network served as the case setting upon which administrative and survey data were analyzed. Results show a rich set of formal relationships within the National Child Traumatic Stress Network and suggest participants found these relationships and this medium useful in altering their day-to-day practices and increasing their professional knowledge. The implications of these findings are that technology transfer networks are useful mechanisms worthy of investment of scarce resources.

The assertive community treatment team as a complex dynamic system of care.

This paper presents a dynamic systems view of assertive community treatment (ACT), a recognized evidence-based treatment for adults with severe and persistent mental illness (SPMI). It is argued that because an ACT team operates as a complex adaptive system (CAS), it engages in the organizational processes of "sensemaking" and self-organization, which help to bring order to the actions of team members and sustainability of the intervention itself. Consequently, successful implementation of ACT requires that management technologies such as meaning-creation and design are used in conjunction with traditional "command and control" technologies of policies, procedures, processes, and structures.

Disagreement between parent and adolescent reports of functional impairment.

OBJECTIVE: Adolescents' functional impairment has become increasingly important as a criterion for diagnosis and service eligibility as well as a target of therapeutic intervention in mental health settings. This study examines three critical issues in measuring functioning: 1) agreement between parent and adolescent reports of functioning, 2) explanations for disagreement, and 3) clinicians' ratings of functioning compared with parent and adolescent reports. METHODS: Agreement between parent and adolescent reports of functioning was estimated using the kappa statistic and conditional agreement in a sample of 258 adolescents. Rates of and reasons for expected disagreements between informants were explored in semi-structured interviews (n = 43). ANOVA was calculated for clinician ratings for parent-adolescent pairs categorized on the basis of their agreement or disagreement on impairment. Finally, the independent contribution of parents' or adolescents' reports of impairment on clinician ratings of functioning was examined. RESULTS: From 12% to 97% of problems reported by one informant were denied by the other. Agreement was particularly poor for questions about relationships with friends, peers' delinquent behaviors, and leisure activities. On average, parents and adolescents were more likely to expect the other would agree with their ratings rather than disagree. Reasons for disagreement included: 1) differences in how parents and adolescents interpreted questions; 2) lack of parental awareness of adolescents' behaviors; and 3) different thresholds for what is considered problematic. Results also demonstrated that clinicians perceive problems reported only by parents as somewhat more serious than problems reported only by adolescents. CONCLUSIONS: Implications for diagnosis, treatment planning and outcomes measurement are discussed.