The Mokihana Program: The effectiveness of an integrated department of education and department of health school-based behavioral health approach.

As a result of difficulties with access to care and resulting low levels of service utilization, the mental health problems of children often go undiagnosed and untreated. One of the most promising approaches to increasing access to care is the delivery of mental health services in school settings, where almost all of the children in a community can be accessed. However, as a result of competing needs, cultures, and objectives, integrating mental health services into schools can be challenging. In the wake of a devastating hurricane in 1992 and efforts to identify and treat children with posttraumatic stress, many of these barriers were overcome on the island of Kauai, Hawaii and led to the development of the Mokihana Program, an integrated Department of Education and Hawaii Department of Health initiative for providing school-based behavioral health services. This study examined the effectiveness of the Mokihana Program in the treatment of 123 elementary age children and 56 adolescents by comparing teacher ratings of behavior problems and adaptive skills at intake and at 1-year follow-up. It was hypothesized that symptom severity would decrease from pretreatment to follow-up. Findings showed statistically significant improvements across a wide spectrum of behavioral problems and adaptive functioning. The authors explore the challenges and opportunities in sustaining and replicating this type of departmental integration in the service of children and youth.

MCMI-III Scores on Substance Abusers With and Without Histories of Suicide Attempts.

Sixty-eight patients with a history of suicide attempt were compared to 340 patients without a history of suicide attempt using the MCMI-III, a frequently used test for measuring personality disorders. Patients with a suicide attempt history scored higher on Schizoid, Avoidant, Depression, Dependent, Passive-Aggressive (Negativistic), Self-Defeating, and Paranoid and significantly lower on Histrionic and Compulsive and scored higher on all clinical syndrome scales except for Drug Dependence and Delusional Disorder. Logistic regression correctly predicted the no-suicide-history group with 97% accuracy, but only accurately predicted 16% of the patients with a suicide attempt history. A discriminant function analysis correctly predicted 90% of the patients with a suicidal attempt history and 63% of the patients with no history of suicide attempt. Results suggest that MCMI-III scores may be able to detect patients with a history of suicide attempt, using multivariate statistics.