The benefits of outpatient mental health services for children in long-term foster care

2010 ◽  
Vol 15 (4) ◽  
pp. 467-479 ◽  
Author(s):  
Jennifer L. Bellamy ◽  
Geetha Gopalan ◽  
Dorian E. Traube

Despite the tremendous mental health need evidenced by children in foster care and high rates of use of mental health services among children in foster care, little is known about the impact of outpatient mental health services on the behavioral health of this population. This study utilizes data from the National Survey of Child and Adolescent Well-being (NSCAW), the first nationally representative study of child welfare in the United States. A subsample of 439 children who have experienced long-term foster care were included in this study. These data were used to estimate the impact of outpatient mental health services on the externalizing and internalizing behavior problems of children in long-term foster care. A propensity score matching model was employed to produce a robust estimate of the treatment effect. Results indicate that children who have experienced long-term foster care do not benefit from the receipt of outpatient mental health services. Study results are discussed in the context of earlier research on the quality of mental health services for children in foster care.


2004 ◽  
Vol 28 (6) ◽  
pp. 697-712 ◽  
Author(s):  
Laurel K Leslie ◽  
Michael S Hurlburt ◽  
John Landsverk ◽  
Richard Barth ◽  
Donald J Slymen

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.


Author(s):  
Scott Bloom

Mental health problems in children are a major deterrent to learning. Yet the President’s New Freedom Commission on Mental Health in 2002 pointed out that mental health services for children are so fragmented as to be ineffective in major ways. The commission’s report emphasizes the importance of using the school system as the means of delivering such services. The school-based approach to mental health helps accomplish several goals: • Minimizing barriers to learning • Overcoming stigma and inadequate access to care • Providing comprehensive on-site counseling services • Creating a school climate that promotes students’ social and emotional functioning • Promoting healthy psychological and social development This chapter will describe the mental health services at the Children’s Aid Society (CAS) community schools, focusing on staffing, structure, and strategies and describing the clinic at one school in greater detail. Questions of space, accountability, and funding will be explored, and some conclusions based on our work will be discussed. CAS’s school-based clinics, located in elementary and middle schools, provide individual and family counseling, group therapy, in-depth assessments and referrals, and crisis intervention for students and their family members. Referrals to the clinic are made by students, teachers, and parents. Assessment and intervention plans include the active participation of the child, his or her family, school staff, and anyone else who can help in understanding the child’s needs. Based on the assessment, the child and/or family are engaged in shortor long-term individual, group, or family counseling aimed at ameliorating the problems that precipitated the referral. An in-depth psychosocial assessment is the first step in developing a comprehensive treatment plan that includes short- and long-term goals. Psychological and psychiatric evaluations are scheduled as appropriate. Clinicians (social workers with M.S.W. or C.S.W. degrees) generally have caseloads of 18–22 students, with enough room in their schedules to see walk-ins and emergencies. Problems that have been successfully treated include suicide ideation, physical and sexual abuse, drug and alcohol use, disruptive school behaviors, academic delays, hyperactivity, family and peer conflicts, and depression.


2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S21-S22
Author(s):  
Andrew McAleavey ◽  
Mariel Emrich ◽  
Adina R Jick ◽  
Collette L McGuire ◽  
JoAnn Difede

Abstract Introduction Psychological distress, including posttraumatic stress disorder, acute stress disorder, and depressive disorders, are common after burn injury. These conditions are major determinants of long-term quality of life and productivity loss among burn patients, yet are generally under treated. Among the many reasons for limited treatment are lack of accessible quality care, limited clinical staff expertise in assessing these conditions, and patient avoidance of effective services. Methods During December 2018 to September, 2019, patients awaiting outpatient visits at an urban burn center were asked to complete brief standardized self-report questionnaires assessing symptoms of posttraumatic distress, anxiety, and depression. Using pre-defined criteria, we attempted to reach individuals with greater than moderate distress using contact information provided voluntarily and engage these patients in outpatient mental health services. Results 747 questionnaires were completed by 511 individuals in the assessment period, and of these 98 (19.2%) individuals had a likely PTSD diagnosis. Visual analog scale assessments for current anxiety, depression and stress all suggested high average distress in the overall group. Using pre-defined criteria to identify potential distress, we identified 195 people (38.2%) to whom we would proactively offer services. Only 159 provided contact information, and several more were not eligible for available clinical services so were not contacted. We called 128 individuals (81%). This led to direct communication with 48 patients (37.5% of those contacted), but only 22 individuals (17.2% of all those contacted) still endorsed distress at the time of the phone call (which was planned to occur within one week of the patients’ report) and 11 individuals were interested in seeking mental health services. Of these, 4 were referred to other services, 3 declined specific offers of service, 4 were scheduled for appointments and only 2 individuals attended appointments with the in-hospital psychological trauma group. Conclusions Psychological distress is highly prevalent in the burn outpatient clinic, with roughly one in five patients likely meeting criteria for PTSD. However, engaging patients in psychological and psychiatric treatment remains a major challenge for the effective care in this population. We discuss strategies tried here and systemic barriers to overcome in future research and care. Applicability of Research to Practice High prevalence of PTSD in outpatient burn clinics and difficulty engaging patients in separate outpatient mental health services suggest co-located and collaborative care models would be highly helpful in this population.


2001 ◽  
Vol 16 (3) ◽  
pp. 162-166 ◽  
Author(s):  
A.C. Schrier ◽  
B.J.M. van de Wetering ◽  
P.G.H. Mulder ◽  
J.P. Selten

SummaryObjectiveReports of an increased incidence of schizophrenia in some immigrant groups to The Netherlands are based exclusively on hospital data. The aims of our study were: 1) to determine the treated point prevalence of schizophrenia at outpatient mental health services in Rotterdam and to compare the results for immigrants to those for natives; and 2) to compare groups born in The Netherlands and immigrant groups in terms of the proportions of patients with a previous hospital admission.MethodWe included all patients aged between 20 and 64 who were treated for a non-affective psychosis at any of the outpatient mental health services in Rotterdam on October 1, 1994. The mental health professionals responsible reported on the socio-demographic and clinical characteristics of each patient.ResultsSeven hundred and thirteen patients with a diagnosis of schizophrenia (DSM-III-R) were identified (rate: 2.1 per 1000). The (treated) prevalence of schizophrenia in male immigrants from Surinam and Morocco and in female immigrants from Surinam, the Netherlands Antilles and Cape Verde was significantly higher than that in their native-born counterparts (odds ratios between 2 and 3). The (treated) prevalence was not significantly higher in immigrants from Turkey, female immigrants from Morocco or male immigrants from the Antilles. Proportions of patients with a previous hospital admission were similar in each ethnic group (81–93%).ConclusionThese findings are generally in line with earlier studies, based on the Dutch psychiatric registry, which has reported an increase in the (treated) incidence of schizophrenia in immigrants from Surinam and the Netherlands Antilles and in male immigrants from Morocco, and no increase in the (treated) incidence in immigrants from Turkey or female immigrants from Morocco.


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