Impacts of a Medicaid Wraparound Model Demonstration Program on Youth Specialty Mental Health Services Use.

Effective coordination of mental health care is critical in Medicaid wraparound model programs for youth. This study examined participation over time in mental health services for youth diverted or transitioned from residential care to a Medicaid wraparound demonstration program. Youth in wraparound had more sustained use of mental health outpatient clinic services than did propensity score matched youth who were not in wraparound. However, the rate of outpatient clinic follow-up after inpatient discharge was no greater in wraparound. Routine assessment of wraparound programs' impacts on receipt of mental health care may inform the development of Medicaid wraparound program performance standards.

Psychosocial interventions for use in pediatric primary care: An examination of providers' perspectives.

INTRODUCTION: The integration of psychosocial interventions in primary care settings is 1 mechanism to increase access to mental health care to youth in need. Although the delivery of psychosocial interventions by primary care providers (PCPs) reflects 1 example of this integration, research indicates that various barriers to implementation by PCPs exist. With the goal of informing a framework to guide the selection of treatments amenable to PCP practice, the authors sought to examine which criteria might influence a PCP's intention to use a given psychosocial intervention. METHOD: Using survey methodology, 49 PCPs ranked characteristics of interventions for feasibility and applicability to their patient populations and setting. RESULTS: Survey respondents found the following characteristics most important: time to employ, applicability to multiple disorders, ease of use, and ease of learning. Providers who endorsed more negative beliefs and attitudes toward addressing psychosocial concerns in youth were more likely to see certain criteria, such as ease of use and ease of learning, as more important. DISCUSSION: The authors illustrate the potential application of these findings to the selection of psychosocial interventions for use in primary care and discuss future research directions. (PsycINFO Database Record

Telemental Health in Schools.

OBJECTIVE: The purpose of this study was to describe the potential and limits of school telemental health (TMH) to support a full continuum from mental health promotion to intervention, particularly for students less likely to access community care. METHODS: A review of school TMH literature and model programs, and of data from focus groups with child psychiatry fellows, was undertaken to inform best practices and future directions for TMH in schools. RESULTS: Existing data suggest that TMH with children and adolescents is promising and well received. Child and adolescent psychiatrists use various models for conducting school-based TMH, which differ in the level of direct care and types of services provided. Literature review and focus group data suggest that advantages of school TMH include greater efficiency, the capacity for higher volume, and increased access to care for many students who would be unlikely to reach traditional community mental healthcare because of barriers such as transportation and healthcare coverage. Disadvantages of school TMH service provision include patient concerns about their own privacy as well as concerns related to the psychiatrist's ability to effectively engage families in care without being present in person. Fellows also noted that the training experience of physically being in the school building and experiencing the school expectations and culture helps them move toward greater appreciation and understanding of the structures, policies, and opportunities and challenges for schools and school-based professionals. Most agreed that a "hybrid" model of care, with some in-person and some TMH care may be most beneficial to all parties, promoting both engagement and efficiency simultaneously. CONCLUSIONS: School TMH should be considered as part of a comprehensive service delivery system for students, in order to address shortages and gaps in specialty child and adolescent mental healthcare, and to maximize efficiency and productivity.

Youth, Caregiver, and Staff Perspectives on an Initiative to Promote Success of Emerging Adults with Emotional and Behavioral Disabilities.

Transitioning to adulthood is more challenging for youth with emotional and behavioral disorders (EBD) as compared to youth with other disability types and typically-developing peers. Outcomes for emerging adults with EBD as a group are particularly concerning in the domains of unemployment, educational dropout rates, and interactions with the judicial system including incarceration, early parenting, homelessness, substance abuse, mental health problems, and suicide. The current study presents qualitative program evaluation data for one of seven grantee states awarded 5-year cooperative agreements by the Substance Abuse Mental Health Services Administration (SAMHSA) to build developmentally-appropriate and effective youth-guided local systems of care for transition age youth, ages 16-25 years, to promote positive transition outcomes. Findings, obtained from focus groups of 25 participating transition age youth, caregivers, staff, and supervisors, include strategies for maintaining and expanding on the strengths of program, as well as for improving specific program areas. Also, consistent with the goals of the program, this process provided an opportunity for the youth and caregivers to voice their opinions and perspectives regarding their services. Implications for research and practice on effectively serving the unique needs of young adults experiencing EBD and their families in areas such as navigating special education, providing emotional and behavioral supports, and leveraging interagency collaboration are discussed.

The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study.

The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.

Connecting Students to Mental Health Care: Pilot Findings from an Engagement Program for School Nurses.

Schools function as the major provider of mental health services (MHS) for youth, but can struggle with engaging them in services. School nurses are well-positioned to facilitate referrals for MHS. This pilot study examined the feasibility, acceptability, and preliminary efficacy of an engagement protocol (EP) designed to enhance school nurses' utilization of evidence-based engagement practices when referring youth to MHS. Participants were six school nurses and twenty-five adolescents in a large, urban school district. School nurses reported positive attitudes towards the EP, suggesting that they found it feasible and acceptable. Though there were small increases in school nurses' use of engagement practices and in adolescents' readiness for services following training, due to limited sample size, differences were not statistically significant. Still, pilot results suggest preliminary efficacy of training school nurses to strategically implement evidence-based engagement practices to increase adolescents' engagement in MHS.

Strategies for integrating mental health into schools via a multitiered system of support.

To fully realize the potential of mental health supports in academic settings, it is essential to consider how to effectively integrate the mental health and education systems and their respective resources, staffing, and structures. Historically, school mental health services have not effectively spanned a full continuum of care from mental health promotion to treatment, and several implementation and service challenges have evolved. After an overview of these challenges, best practices and strategies for school and community partners are reviewed to systematically integrate mental health interventions within a school's multitiered system of student support.

The role of schools in substance use prevention and intervention.

Schools provide an ideal setting for screening, brief interventions, and outpatient treatment for substance use disorders (SUD). Individual treatment for SUD is effective at decreasing substance use as well as substance-related harm. In some contexts, rather than being helpful, group interventions can result in harm to participants; therefore, individual treatment may be preferred. Early interventions for adolescents who are using alcohol and other drugs (AOD) are generally effective in decreasing frequency and quantity of AOD use as well as decreasing risky behaviors.

School-based approaches to reducing the duration of untreated psychosis.

Students with emerging psychosis often experience delays in diagnosis and treatment that impact mental health and academic outcomes. School systems have tremendous potential to improve early identification and treatment of adolescent psychosis. As a community-based resource, schools can support outreach, education, and screening for adolescents with psychosis and engage identified students and their families for treatment. The concept of duration of untreated psychosis (DUP; the gap between symptom onset and treatment initiation) in adolescent psychosis and the potential role of schools in reducing DUP are reviewed. Future directions for clinical care and research needed to support school-based interventions are proposed.

Supporting the transition from inpatient hospitalization to school.

The School Transition Program (STP) is a 3-month intervention developed to address the unique needs of youth transitioning back to school from an inpatient psychiatric hospitalization. The STP focuses on promoting communication across school, home, and hospital. It includes psychoeducation, emotional support for caregivers, and the creation of transition plans in collaboration with school staff and families. Matching interventions to the academic, social, emotional/behavioral needs of these youth and increasing support to their caregivers has the potential to ease stress, reduce challenges and promote success during and after the transition period.

Youth in group home care: youth characteristics and predictors of later functioning.

This paper presents the findings of an exploratory research study of foster care youth residing in group homes in a mid-Atlantic state in the USA. The aims of the present study were to (1) describe youth characteristics, (2) explore whether baseline functioning differed by gender or ethnicity, (3) explore predictors of cross-time differences in psychosocial functioning, and (4) explore predictors of later functioning, specifically age, gender, and length of stay. Psychosocial functioning at two time points (i.e., T1 = admission into group home; T2 = current or discharge) in 180 charts from 29 randomly selected group homes were reviewed. Youth were on average 14.86 years of age, predominantly male (71%; n = 128), and predominantly African American (79%). Findings suggest that group home placement may benefit some youth but not others, particularly girls and younger children with lower initial level of need. Findings underscore the potential complexity of intervention impact in the context of unique youth, family, and environment factors.

The effect of waiting time on youth engagement to evidence based treatments.

Prolonged waiting times to receive mental health services are common and may have negative consequences. This study examines the relationship between waiting time and treatment engagement among 2,054 youth referred to an evidence based treatment (EBT). Findings indicate that families are more likely to refuse services if they face longer waiting times. Families exposed to a prolonged waiting time were also more likely to drop out prematurely from Functional Family Therapy, but this relationship was not significant among youth receiving Multisystemic Therapy. Implications for EBT implementation and strategies for engaging families are discussed.

Challenges and ideas from a research program on high-quality, evidence-based practice in school mental health.

This article reviews the progression of a research program designed to develop, implement, and study the implementation of "achievable" evidence-based practices (EBPs) in schools. We review challenges encountered and ideas to overcome them to enhance this avenue of research. The article presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on personal wellness. In both studies, primary aims focused on changes in clinician attitudes and behavior, including the delivery of high-quality EBPs and secondary aims focused on student-level impacts. A number of challenges, many not reported in the literature, are reviewed, and ideas for overcoming them are presented. Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.

Mental health interventions in schools 1: Mental health interventions in schools in high-income countries.

Mental health services embedded within school systems can create a continuum of integrative care that improves both mental health and educational attainment for children. To strengthen this continuum, and for optimum child development, a reconfiguration of education and mental health systems to aid implementation of evidence-based practice might be needed. Integrative strategies that combine classroom-level and student-level interventions have much potential. A robust research agenda is needed that focuses on system-level implementation and maintenance of interventions over time. Both ethical and scientific justifications exist for integration of mental health and education: integration democratises access to services and, if coupled with use of evidence-based practices, can promote the healthy development of children.

Providers' perspectives: utilizing telepsychiatry in schools.

BACKGROUND: The field of telepsychiatry has rapidly advanced a focus on decreasing health disparities by improving access to mental healthcare for children and adolescents. However, perfecting the quality and effectiveness of telemental healthcare is an ongoing process in the face of various documented barriers. Although consumer and provider satisfactions have been investigated in the telepsychiatry literature, perspectives of psychiatrists who consult with schools have been relatively understudied. The current study focuses on the utilization of telepsychiatry consultation to school mental health providers, by reporting on the perspectives of psychiatrists who provide consultation services. MATERIALS AND METHODS: Using quantitative and qualitative data, the psychiatrists' perspectives about their consultation experiences were examined and compared with previously obtained data from school mental health providers about their experiences with the telepsychiatry consultation. RESULTS: Results indicate positive provider experiences with telepsychiatry, including reports that students were more likely to disclose clinical information via video compared with face-to-face contact. However, concerns regarding technological difficulties, logistics, and information sharing were endorsed by some of the psychiatrists. Comparison with clinician reports revealed many similarities; however, differences were noted in regard to the psychiatrists' ability to communicate with the students and their level of preparedness for the consultations. CONCLUSIONS: Recommendations for ongoing evaluation and implementation of effective telepsychiatry consultation for schools are provided. Improvements in communication, scheduling, and addressing technological difficulties within the consultation team through training and consultation are recommended. Future directions for including student, caregiver, and other provider perspectives are also discussed.

Children's behavioral health system transformation: one state's context and strategies for sustained change.

The purpose of this paper was to examine the State of Maryland as a case study of sustained change efforts in the service delivery system for children with significant behavioral health needs and their families. A punctuated equilibrium paradigm is introduced to describe Maryland's behavioral health system transformation over the course of three decades. The context and specific strategies that characterized Maryland's execution of its recent Mental Health Transformation State Incentive Grant are highlighted. There is a discussion of one of the pinnacle achievements of Maryland's transformation efforts, the recent statewide establishment of care management entities for children with behavioral health challenges, and its implications for behavioral health in the context of health care reform changes. This case study illustrates how a state can systematically and incrementally develop systems of care for children and families that are values-based, sustainable, and flexible.

Integrating the Family Check-Up and the parent Coping Power program.

Engaging families in school-based preventive interventions for aggressive youth can be especially challenging. The current article describes an integration of a parent engagement model, called the Family Check-Up, with an evidence-based intervention for youth with aggressive behaviours called Coping Power. The overall goal of the integration was to increase parental involvement and exposure to the core elements of the Coping Power programme to optimize impact on families and their children. We describe both models, summarize evidence of their efficacy when implemented alone, and provide a rationale for their integration. We also provide case examples to illustrate the implementation of the integrated programme in schools as well as feasibility data to support its continued study and implementation.

Telepsychiatry and school mental health.

The provision of mental health services in schools has been one effective strategy for reaching out to a greater number of youth to identify and provide treatment for mental health issues. With the increasing challenges related to shortages in child and adolescent psychiatrists, it is critical to develop models of care that can maximize a full range of mental health services for all children and adolescents who need them. Telehealth offers an innovative distance technology strategy to effectively and efficiently provide access to psychiatric services in schools. Telepsychiatry has the potential to better link and enhance the provision of health services, and can be particularly beneficial in addressing geographic distance and/or capacity issues. This article describes the clinical, educational, and administrative uses of telemental health in the school environment with mental health professionals and staff.