Trends in mental health service use by age among adults with serious mental illness.

PURPOSE: This study examines trends in mental health service use among 18- to 64-year-old adults with serious mental illness (SMI). METHODS: Data are from approximately 22,200 adults with SMI who participated in the National Survey on Drug Use and Health, an annual nationally representative survey of the U.S. civilian, noninstitutionalized population. A regression restricted spline modeled the trend in mental health service use by age among adults with SMI. RESULTS: Approximately 20 to 50% of adults with SMI did not receive past-year mental health services. The odds of past-year service use increased by 3% per year until age 52 years. CONCLUSIONS: From age 18 to 52 years, age incrementally increases the likelihood that an adult with SMI makes treatment contact.

Correction to: Strategies to Support the Education Goals of Youth and Young Adults with Serious Mental Health Conditions: A Case Study.

The original version of this article unfortunately contained a mistake. The spelling of the fifth author's name was incorrectly published as Masha Ellison.

Strategies to Support the Education Goals of Youth and Young Adults with Serious Mental Health Conditions: A Case Study.

This manuscript describes efforts to support youth and young adults living with serious mental health conditions (SMHC) as they pursue their education goals. Case studies were conducted with three supported education initiatives across the US. Data were collected through individual interviews and focus groups. Key ingredients exist across various settings (e.g., mental health, post-secondary education) to support the pursuit of education goals for students living with SMHC, while individual settings have unique circumstances to address. Findings can inform stakeholders of relevant core components and implementation strategies across settings that support education goals for students with SMHCs.

Postsecondary students with psychiatric disabilities identify core services and key ingredients to supporting education goals.

OBJECTIVE: Accessing and successfully completing postsecondary educational opportunities may be challenging for those living with psychiatric disabilities. This exploratory study highlights the experiences of individuals with psychiatric disabilities participating in postsecondary educational support initiatives. METHOD: Investigators conducted case studies with 3 education support initiatives across the United States. Focus groups revealed what concrete supported education services were helpful and key ingredients in delivering education supports. RESULTS: Access to specialists, mindfulness techniques, help with time management and procrastination, and facilitating classroom accommodations were identified as critical. Developing authentic relationships with supported education staff, flexibility in service delivery and access to student peers living with psychiatric disabilities were noted as key ingredients in service delivery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Incorporating the voice of students with psychiatric disabilities into supported education services can increase access, involvement, and retention, therein providing more supports to students with psychiatric disabilities achieving their postsecondary education goals. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Supported education for individuals with psychiatric disabilities: State of the practice and policy implications.

OBJECTIVE: Supported education (SEd) is a promising practice that supports and encourages educational goals and attainment among individuals with psychiatric disabilities. This paper provides insights into how SEd objectives are pursued in different settings, assesses the evidence base, and discusses policy implications. METHOD: Insights from 3 data sources were synthesized: published literature, an environmental scan, and 3 site visits to programs that support the education goals of individuals with psychiatric disabilities. RESULTS: While setting, target populations, level of coordination with supported employment, and financing strategies varied, common SEd components emerged: specialized and dedicated staffing, one-on-one and group skill-building activities, assistance with navigating the academic setting and coordinating different services, and linkages with mental health counseling. The evidence base is growing; however, many published studies to date do not employ rigorous methodology. Conclusions and Implications for Policy and Practice: Continued specification, operationalization, and testing of SEd core components are needed. The components of the evolving SEd model would benefit from rigorous testing to evaluate impact on degree completion and other key impacts such as employment; health, mental health, or recovery; and community participation. In addition to funding streams from special education and Medicaid, new opportunities for increasing the availability of SEd include the Workforce Innovation and Opportunities Act (WIOA) reauthorization, which requires state vocational rehabilitation agencies to fund preemployment services for transition-age individuals. New "set-aside" requirements for the Mental Health Services Block Grant will increase funding for early intervention services for individuals with serious mental illness, potentially including SEd. (PsycINFO Database Record

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.

Mental Health Service Use in Adolescence: Findings From the National Survey on Drug Use and Health.

OBJECTIVE: This study examined mental health service use, by service type, of adolescents ages 12-17. METHODS: Data were from approximately 113,000 adolescents who participated in the 2008-2012 National Survey on Drug Use and Health, an annual nationally representative survey of the civilian, noninstitutionalized U.S. POPULATION: Polynomial contrasts tested for linear and quadratic changes across age in the use of three types of past-year mental health services: school-based services, outpatient therapist or clinic, and overnight hospital stay. RESULTS: Although mental health service use increased from age 12 to age 14 across all service types, it decreased or stabilized from age 15 to 17. School-based services were the most commonly used service and showed the steepest decline in use from age 12 to 17. CONCLUSIONS: Although adolescence can be marked by an increasing prevalence of mental disorders, mental health service use declined or leveled off for many service types by age 14 or 15.

Correlates of Mental Health Service Use Among Young Adults With Mental Illness: Results From the National Survey on Drug Use and Health.

OBJECTIVE: This study examined correlates of use of outpatient and inpatient mental health services and psychotropic medication in a large, nationally representative sample of young adults ages 18-26 with mental illness (N=22,600). METHODS: Data were from the 2008-2012 National Survey on Drug Use and Health, an annual nationally representative survey of the civilian, noninstitutionalized U.S. POPULATION: Separate logistic regression models examined past-year use of three mental health service types (outpatient services, inpatient services, and psychotropic medication). Correlates included demographic characteristics, factors developmentally relevant to young adults, and general medical and mental health status. RESULTS: Within this sample of young adults with mental illness, 20.4% used outpatient services, 3.6% used inpatient services, and 25.4% used psychotropic medication. Variables associated with use of one or more types of mental health services included being female (outpatient and medication), one to two moves in the past year (medication), having health insurance (all types), past-year criminal justice involvement (all types), poor health (inpatient and medication), substance use disorders (inpatient and medication), and mental illness with severe impairment (all types). Non-Hispanic blacks, Asians, and Hispanics were less likely than non-Hispanic whites to receive outpatient mental health services or psychotropic medications. Surprisingly, young adults employed full-time were less likely than those who were unemployed to receive services, and living with a partner (versus living alone) was not associated with a likelihood of using outpatient services. CONCLUSIONS: Results support the unique nature of young adulthood and the need to tailor mental health services to close gaps in service use during this developmental period.

Estimating the prevalence of any impairing childhood mental disorder in the national health interview survey.

This study investigates whether the six-item Strengths and Difficulties Questionnaire SDQ (five symptoms and one impact item) included in the National Health Interview Survey (NHIS) can be used to construct models that accurately estimate the prevalence of any impairing mental disorder among children 4-17 years old as measured by a shortened Child/Adolescent or Preschool Age Psychiatric Assessment (CAPA or PAPA). A subsample of 217 NHIS respondents completed a follow-up CAPA or PAPA interview. Logistic regression models were developed to model presence of any child mental disorder with impairment (MDI) or with severe impairment (MDSI). Models containing only the SDQ impact item exhibited highly biased prevalence estimates. The best-performing model included information from both the five symptom SDQ items and the impact item, where absolute bias was reduced and sensitivity and concordance were increased. This study illustrates the importance of using all available information from the six-item SDQ to accurately estimate the prevalence of any impairing childhood mental disorder from the NHIS. Copyright © 2015 John Wiley & Sons, Ltd.

Families in need of domestic violence services reported to the child welfare system: Changes in the National Survey of Child and Adolescent Well-Being between 1999-2000 and 2008-2009.

This study aimed to determine if identification of intimate partner violence (IPV) has improved by caseworkers that investigate reports of child maltreatment and if mothers who are victims of IPV are more likely to report receipt of services. The study data were drawn from the two cohorts of the National Survey of Child and Adolescent Well-Being (NSCAW I and II), the first in 1999-2000 with a sample of 5,501 children reported for maltreatment and the second in 2008-2009 with a sample of 5,872 children reported for maltreatment. The analyses focused on IPV victimization of 3,625 mothers in NSCAW I and 3,351 mothers in NSCAW II whose children remained in home after the maltreatment investigation. Multiple group logistic regression was used to compare NSCAW I and II. A significant decrease in mother-reported IPV victimization (28.9-24.7%) was observed, representing a 15% decline. There were no significant changes in caseworker identification of history of domestic violence or active domestic violence. In both cohorts, substance abuse by the secondary caregiver was associated with a lower likelihood for the caseworker to miss a history of active domestic violence, while substantiation reduced the likelihood that the caseworker will miss active domestic violence. There were no changes in caseworkers' service referral, or service receipt among victims. The next decade of efforts to reduce IPV and child maltreatment should focus simultaneously on increasing caseworkers' ability to identify IPV and on funding needed services for families impacted by IPV and child maltreatment.

Workforce development and the organization of work: the science we need.

The industrialization of health care, underway for several decades, offers instructive guidance and models for speeding access of children and families to clinically and cost effective preventive, treatment, and palliative interventions. This industrialization--i.e., the systematized production of goods or services in large-scale enterprises--has the potential to increase the value and effects of care for consumers, providers, and payers (Hayes and Gregg in Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. Academic Press, San Diego, 2001), and to generate efficiencies in care delivery, in part because workforce responsibilities become more functional and differentiated such that individuals with diverse educational and professional backgrounds can effectively execute substantive clinical roles (Rees in Clin Exp Dermatol, 33, 39-393, 2008). To date, however, the models suggested by this industrialization have not been applied to children's mental health services. A combination of policy, regulatory, fiscal, systemic, and organizational changes will be needed to fully penetrate the mental health and substance abuse service sectors. In addition, problems with the availability, preparation, functioning, and status of the mental health workforce decried for over a decade will need to be addressed if consumers and payers are to gain access to effective interventions irrespective of geographic location, ethnic background, or financial status. This paper suggests that critical knowledge gaps exist regarding (a) the knowledge, skills, and competencies of a workforce prepared to deliver effective interventions; (b) the efficient and effective organization of work; and (c) the development and replication of effective workforce training and support strategies to sustain effective services. Three sets of questions are identified for which evidence-based answers are needed. Suggestions are provided to inform the development of a scientific agenda to answer these questions.

A framework for measurement feedback to improve decision-making in mental health.

The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field.

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.

Special health care needs among children in the child welfare system.

OBJECTIVE: The aim of this study was to determine levels of special health care need among children in the child welfare system and how these needs may affect children's functioning. METHODS: Data were from the National Survey of Child and Adolescent Well-being, a national probability study of children investigated for child maltreatment. The sample consisted of 5496 children aged 0 to 15 years at baseline. For analysis, we used descriptive statistics to determine special health care needs and children's functioning from baseline to 3-year follow-up. Logistic regression was used to examine correlates of special health care needs. RESULTS: At any point in the study period, approximately one third of the children were identified as having special health care needs. Overall, across 3 years of follow-up data, 50.3% of the children were identified as having special health care needs. Boys were significantly more likely than girls to have had special health care needs, and children aged 0 to 2 years at baseline were significantly less likely to have had special health care needs than older children. Adopted and foster children were significantly more likely to have had special health care needs than children never placed out of the home. The most commonly reported type of chronic health condition was asthma. The most commonly reported type of special need was a learning disability. CONCLUSIONS: Special health care needs are prevalent among children in the child welfare system. Many children with special health care needs have cognitive, language, adaptive, social, or behavioral functional impairments. Mechanisms are needed to ensure that this vulnerable population has access to and receives coordinated health and related social services.

Developmental needs and individualized family service plans among infants and toddlers in the child welfare system.

This study examines levels of developmental need in young children investigated by child protective services, estimates early intervention service use, and examines need and service use variations during the 5-6 years after investigation on the basis of maltreatment substantiation status. Data were from the National Survey of Child and Adolescent Well-Being, the first nationally representative study of children investigated for maltreatment. The sample comprised 1,845 children aged 0 to 36 months at baseline. Logistic regression with covariate adjustment was used to examine the relationship between having an Individualized Family Service Plan (IFSP; a proxy and marker of early intervention services through Part C of the Individuals With Disabilities Education Act) and substantiation status. A high prevalence of developmental problems was found among children with substantiated cases and children with unsubstantiated cases. Few children with developmental needs had an IFSP. Substantiation status and level of child welfare system involvement were significantly associated with having an IFSP.

Federal, state, and foundation initiatives around evidence-based practices for child and adolescent mental health.

This article is a survey of many of the initiatives developed by federal and state agencies and foundations focusing on evidence-based mental health practices for children and adolescents. The article intends to show the tremendous interest in the development, dissemination, and implementation of evidence-based practice in child and adolescent mental health that is held by a wide variety of agencies and organizations. Several "next steps" for the field are suggested that might be developed in a subsequent series of initiatives. These steps include a better understanding of dissemination and implementation processes, increased clarity around definitions and terms, increased efforts to build infrastructure and support policy change, and the potential for an aggregation of data already gathered on the implementation of evidence-based practices.

Recognition and treatment of mental disorders in children: considerations for pediatric health systems.

General healthcare systems currently play an active role in the identification and treatment of children with mental disorders. As many as one-third of children identified and treated for mental health problems receive outpatient mental healthcare from primary care providers. Although some children do receive treatment, over half of those who need mental health care do not receive this service. Fortunately, current levels of unmet need for adequate care coincide with mounting scientific evidence to support the efficacious use of psychosocial, community-based, and pharmacological interventions. Scientific evidence indicates that the appropriate identification and treatment of mental disorders in childhood can reduce symptoms of child psychopathology, improve adaptive functioning, and sometimes serve as a buffer to further long-term impairment. However, mental health treatment can only be beneficial if it reaches those families in need, is amenable to clinical practice implementation, and is administered with an adequate dose. Future challenges lie in creating practice-relevant efficacious interventions to improve the identification of child mental health needs and to improve access to high quality, appropriate mental healthcare. Primary care settings will play an important role in this activity. Although many barriers exist, pediatric health systems will continue to play an important role in the identification and treatment of mental disorders in children. The quality of current pediatric mental healthcare could be enhanced by increased opportunities for physician training, a restructuring of current training efforts, an increased focus on patient engagement strategies, equitable care incentives and reimbursement, as well as an integrated view of physical and mental health.