Prevalence of serious mental illness among parents in the United States: results from the National Survey of Drug Use and Health, 2008-2014.

PURPOSE: This brief research report presents findings from a US national household survey on the number and percentage of parents with mental illness. METHODS: Using combined annual data from the 2008-2014 National Survey on Drug Use and Health, parents were defined as having children in the household from birth to 18 years. Prediction models developed in an earlier clinical study using a National Survey on Drug Use and Health subsample were used to estimate serious mental illness (SMI). RESULTS: A total of 2.7 million parents (3.8%) had a SMI in the past year and 12.8 million parents (18.2%) had any mental illness in the past year. Mental illness was more common among mothers than fathers and least common among Asians compared with other races. SMI was less prevalent in parents who were aged 50 years and older compared with younger age groups. CONCLUSIONS: The burden of mental illness in parents is high in the United States, especially among mothers. Physicians who treat parents should routinely screen for mental illness and discuss its implications for parenting.

Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review.

BACKGROUND: Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics. METHODS: Sources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes. RESULTS: We identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions. CONCLUSIONS: Several strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy. TRIAL REGISTRATION: PROSPERO, CRD42015024759 .

Service system involvement and delinquent offending at system of care entry.

This study examines correlates of delinquent offending among 2,554 youths presenting to community-based treatment in Center for Mental Health Services-funded systems of care. Variables in five key domains, including demographics, family risk, child clinical risk, school, and service system involvement, were examined in relation to severity of offending at treatment entry for early/middle (11-15 years) versus late (16-18 years) adolescents. Significant correlates of offending severity were identified in all domains except family risk for the 11 to 15 year olds and in demographics and child clinical risk for the 16 to 18 year olds. Service system involvement was a unique correlate of delinquency in the younger group. Findings add to other studies showing that correlates of offending appear to differ across stages of adolescence; specifically, school and service system involvement may be less important for older adolescents than for younger adolescents. Service system involvement should be included in longitudinal studies of risk for adolescent offending.

Mental health service use during the transition to adulthood for adolescents reported to the child welfare system.

OBJECTIVE: This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence. METHODS: Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood. RESULTS: Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood. CONCLUSIONS: Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.