Use of Reimbursed Psychology Videoconference Services in Australia: An Investigation Using Administrative Data.

BACKGROUND: In November 2017, the Australian government approved reimbursement for psychology consultations conducted by videoconference under the Better Access initiative to address inequitable access of mental health services across regions in Australia. OBJECTIVE: This project uses publically available activity data from the Medicare Benefits Scheme to quantify the uptake of videoconference for psychology resulting from the initiative change. METHODS: Data were extracted from the Medicare Benefits Schedule item reports using the item codes for standard consultations and the new item codes for videoconference consultations. Activity data from 2 years before and the first year of the change to the Better Access initiative were compared to examine the uptake of videoconference for psychology. Data were stratified by allied health profession, sex, age and state jurisdiction. RESULTS: In the 1-year period after the introduction of reimbursed videoconference consultations, approximately 5.7 million in-person consultations and 4141 videoconference consultations were funded by Medicare in Australia. Videoconference consultations comprised 0.07% of the total consultations performed in that 1-year period and showed an increased trajectory. The results can guide future research into evaluating the clinical outcomes of patients via both in-person and videoconference delivery modes. CONCLUSIONS: Videoconference mental health services were used in the first year that they were available, although they only accounted for a small percentage of all mental health consultations provided by allied health professionals. This finding lays the foundation for future work which could examine the effectiveness of the scheme in reducing inequity and investigating the economic benefits of the expanded initiative to the government and society.

Telepsychiatry: videoconferencing in the delivery of psychiatric care.

The provision of psychiatric treatment via live interactive videoconferencing, frequently termed telepsychiatry, is a viable option for psychiatrists to provide care to individual patients, populations, and communities faced with limited access and to move the point of care delivery into patients' living environments. Psychiatric providers new to videoconferencing should not be intimidated by the technology or its encompassing logistics, but they do need to develop an awareness of the salient regulatory, administrative, and clinical issues that arise in the practice of videoconferencing-based telepsychiatry. This article provides an overview of the current evidence base in telepsychiatry and reviews administrative and clinical issues in videoconferencing-based treatment. These points are then highlighted in a case example.

Current state of psychiatry in Saudi Arabia.

BACKGROUND: In 1983, an article and accompanying editorial was published on the state of psychiatry in the Kingdom of Saudi Arabia (KSA), which was described as "a mental health system in statu nascendi." METHODS: We provide a 30-year update on advances in mental health care in KSA. Data are reported from a wide range of sources, including the 2007 Saudi Arabian Mental and Social Health Atlas, which compares services in KSA with the rest of the world. RESULTS: We examine how the current mental health system operates in KSA, including recent changes in mental healthcare policy and development of a national mental healthcare plan. Discussed are current needs based on the prevalence and recognition of mental disorders; availability of services and providers (psychiatrists, psychiatric nurses, psychologists, and social workers); education and training in psychiatry; developments in consultation-liaison, addictions, child-adolescent, and geriatric psychiatry; and progress in mental health research. CONCLUSIONS: Mental healthcare in Saudi Arabia has come a long way in a very short time, despite cultural, religious, social, and political challenges, although there still remain areas where improvement is needed. The development of psychiatry in KSA serves as a model for countries in the Middle East and around the world.

[The characteristic of population participating in a community-based rehabilitation program]. / Charakterystyka populacji objetej srodowiskowym systemem rehabilitacji i wsparcia spolecznego.

AIM: The difficulties in social functioning of the mentally ill are widely documented in specialist literature. The social affects addressed to the mentally disabled are an attempt to overcome this particular disability. The aim of the presented research is the characterization of the social group participating in a community-based rehabilitation program realized on Warsaw area. METHOD: 103 long-term patients with mental disorders provided with a community-based rehabilitation program were the participants in the study. They were not hospitalized at the time when the research was conducted. The following instruments were used: the Questionnaire and Map of Social Support by Bizon, the individual interview, and the questionnaire especially prepared for the needs of this research. RESULTS: The studied group consists of people with a long-standing period of illness, with numerous hospitalizations, constantly remaining under psychiatric care. The tested persons are singles and demanding a strong social support. Their individual social networks of support are sparse and in a large part compensated by therapists from the support institution. The tested group highly values the influence of the local rehabilitation program on their functioning. CONCLUSIONS: The chronically mental ill persons show numerous difficulties in their social functioning. Participation in the social support programs protects them against successive hospitalizations. During the last year, preceding the research, the amount of hospitalizations was significantly lower than in the period preceding the taking care by the local systems. It is necessary to treat the local rehabilitation programs as an effective mechanism supporting the functioning of the chronically mental ill people.

Beyond stigma and discrimination: challenges for social work practice in psychiatric rehabilitation and recovery.

The recovery process and social work education share theoretical and practice roots that facilitate a goodness-of-fit between the profession and the empowerment orientation of recovery. This article examines the linkages between the recovery process and social work education, including areas where curricular renewal will assure that master's in social work (MSW) students and graduates embrace the recovery-oriented values that facilitate consumer-driven services. Curricular innovation is also proposed that addresses the need for MSW programs to develop supported education programs that will enable more consumers to pursue and complete graduate social work education.

The economic and social burden of compulsive hoarding.

The aim of the present study was to determine the economic and social burden of compulsive hoarding in a large sample of individuals with self-identified hoarding, as well as a separate sample of family members of individuals who hoard. Self-identified hoarding participants (N=864, 94% female, 65% met research criteria for clinically relevant compulsive hoarding) and family informants (N=655, 58% described a relative who appeared to meet research criteria for compulsive hoarding), completed an internet survey. Questions were derived in part from those used in the National Comorbidity Survey (NCS), and when possible, hoarding participants were compared to NCS participants. Compulsive hoarding was associated with an average 7.0 work impairment days in the past month, equivalent to that reported by individuals with psychotic disorders and significantly greater than that reported by female NCS participants with all other anxiety, mood, and substance use disorders. Severity of hoarding predicted the degree of work impairment after controlling for age, sex, and non-psychiatric medical conditions. Hoarding participants were nearly three times as likely to be overweight or obese as were family members. Compared to female NCS participants, hoarding participants were significantly more likely to report a broad range of chronic and severe medical concerns and had a five-fold higher rate of mental health service utilization. Eight to 12% had been evicted or threatened with eviction due to hoarding, and 0.1-3.0% had a child or elder removed from the home. These results suggest that compulsive hoarding represents a profound public health burden in terms of occupational impairment, poor physical health, and social service involvement.

Promoting the psychosocial health of the elderly- the role of social workers.

With the ageing of the global population, the wellbeing of older people in different parts of the world merits special attention. However, recent findings on certain aspects of the psychosocial health of the elderly are far from reassuring. The first problem is the inconsistency in psychosocial indicators, which give simultaneous high life satisfaction scores and high suicide rates. The second problem is the significant weakening of the social support network of the elderly. This article analyses the service and policy implications of these two problems. Suggestions are then made on the role of social workers in promoting the psychosocial health of the elderly at different levels of intervention, which include the individual level, the family and social network level, the community level and the international level.

Spiritual assessment in aging: a framework for clinicians.

Older adults may benefit from clinical conversations about the role of spirituality in their lives, but social workers and other helping professionals often do not have an understanding of where to proceed beyond initial questions of whether spirituality and/or religion are important and if so, what religious preference is held. Much has been written about definitions of spirituality and religion, but the literature has not yet provided a clear focus on ways to assess whether these are integrated positively or negatively in the lives of older adults. This article identifies eleven domains in spirituality that might be assessed. Within each domain an explanation is provided as well as a brief discussion of the rationale for including it in the classification. Sample interview questions and an illustrative vignette are included. Together these eleven domains build an important framework and resource for spiritual assessment with older adults.

Cost-effectiveness of an activating intervention by social workers for patients with minor mental disorders on sick leave: a randomized controlled trial.

BACKGROUND: Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders. METHODS: In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later. RESULTS: Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group. CONCLUSIONS: Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.

Social services support and expenditure for children with autism.

This article provides information about children with autism who are supported by English social services departments based on the Children in Need Survey 2001 (CIN2001). In 119 authorities, 6310 children were recorded as having a diagnosis of autism or related conditions, probably about one-quarter of all children with such diagnoses and about half of those actually supported. Demographically, this group appears similar to children with autism generally: there are more boys than girls, and learning, communication and behaviour difficulties are common. CIN2001 shows that mean social services support costs tend to be quite high, particularly compared with other disabled children. There are very considerable variations between social services departments in reported numbers and spending. It is unlikely that this variation can be attributed to the prevalence of autism, and more likely that it reflects the case recognition and service provision policies of local agencies.

Outcomes of specialized foster care in a managed child welfare services network.

This study (N = 384) presents results from outcome measurement in a services network providing specialized foster care (SFC) to children in child protective service custody. A majority of participants improved on most outcomes. Global improvement was associated with increased length of stay up to two years, five months, and with younger age, fewer problems, and, paradoxically, the presence of a trauma history. Results suggest the value of SFC within managed services and of research using outcome measurement systems.

Desire to die in terminally ill people: a framework for assessment and intervention.

"Desire-to-die" statements made by people with terminal illness may be expressions of depression, suicidal intent, or coping. Careful evaluation can help the social worker understand the meaning of a particular patient's statement. The framework presented in this article suggests that all patients expressing a wish for death be assessed for both depression and suicide risk. This assessment can identify those patients who are depressed or suicidal, as well as those using these statements as a way of coping or as an indication of a rational choice for suicide. Differentiating among patients' meanings in this way leads to appropriate interventions.

An agency-based representative payee program and improved community tenure of persons with mental illness.

OBJECTIVE: Representative payee programs help severely mentally ill individuals manage money from their Social Security payments to cover expenses for necessities and to avoid homelessness and rehospitalization. This study examined a representative payee program operated by a community mental health center to determine the criteria used by clinicians and ease managers to refer clients to the program and to learn whether participation in the program was associated with reductions in hospitalization. METHODS: The retrospective study included 56 individuals with severe mental illness who were enrolled in the representative payee program at Community Counseling Centers of Chicago for one year and who also had received services from the agency for at least one year before enrollment. Criteria used to refer clients to the representative payee program were determined through chart reviews. Data on state hospitalizations before and after enrollment were available for the entire sample; additional data on Medicaid-funded private hospitalizations were available for a subset of 33 clients. RESULTS: The most common criteria for enrollment in the representative payee program were comorbid substance abuse or dependence (49 percent), a history of homelessness (33 percent), and frequent hospitalizations (32 percent). During the year of participation in the representative payee program, the mean number of days spent in state hospitals decreased markedly compared with the year before enrollment, from 68 days to seven days. A similar reduction was noted in the number of days spent in state and private hospitals, from 97 days to 15 days. CONCLUSIONS: Findings from this pre- and postintervention retrospective study are tentative in the absence of a more rigorous design. However, the results suggest that the representative payee program is quite effective in reducing hospital stays.

Responding to hidden abuse: a role for social work in reforming mental health systems.

Clients in a state-funded intensive case management program, most of whom were identified as heavy users of acute care and psychiatric emergency rooms, had undetected brutal life experiences: 50 percent were adult children of alcoholics, and many were sexually and physically abused as children or adults. None had been asked about or appropriately treated for these aspects of their background. Statistical analysis indicated high levels of correlation between exposure to alcohol abuse in the family, physical or sexual abuse, repeated hospitalization, and contemporary suffering. Social work can use this and related data to make mental health systems more responsive to clients' needs at both the clinical and systems levels.

Child pornography: a hidden dimension of child abuse.

In the decade of the 70s, much was learned about abused and neglected children and their families. Public outcry demanded action at the state, regional and national level hoping that the effort would generate more effective methods of identification, intervention and treatment. Consequently, researchers and theoreticians initiated efforts that were aimed at providing a better understanding of why some parents abuse or neglect their children while others do not. In spite of all the energy and time, one form of child abuse continues to flourish relatively unnoticed--child pornography, or as it is more commonly known in the trade, "kiddie" or "chicken" porn. Because of the dearth of information about the subject, this paper addresses five key issues: Who are the children who become the young stars of pornographic films? How many children are estimated to be involved in this activity? What are the presumed effects of such involvement on children? Legal issues related to the control of the pornographic industry; and What is the challenge to social work and other helping professionals?

The management of psychocial problems in primary medical care: a potential role for social work.

A significant proportion of patients are motivated in seeking care, in part, because of psychological distress or the physical problems compounded by such distress. The appropriate diagnosis and management of these problems constitute formidable clinical problems. The potential role of social work practice within ambulatory medical care is examined in relation to improving the responsiveness of care for such patients, and attention is given to strategies of management. Factors inhibiting the introduction of such services include the traditional orientations of social work and the discontinuity between public conceptions of medical care and social work practice.