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Mental Health and Substance Abuse: Latest Work
Reports | Journal Articles | Issue Briefs | Main Mental Health/Substance Abuse Page
Reports |
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| "Administration of Mental Health Services by Medicaid Agencies." James Verdier, Allison Barrett, and Sarah Davis, 2007. Medicaid spending for mental health care accounted for 26 percent of total mental health expenditures by all public and private payers combined in 2003, and 10 percent of all Medicaid dollars were spent on mental health services in that year. Medicaid now funds more than half of all mental health services administered by states and could account for two-thirds of such spending by 2017. This report, based on telephone interviews with state Medicaid directors in all 50 states and the District of Columbia between July 2005 and February 2006, provides state-by-state comparative information on how Medicaid and mental health agencies are structured, the degree and extent of their collaboration, how they share authority, and how Medicaid mental health services are funded. |
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"Public Financing of Home and Community Services for Children and Youth with Serious Emotional Disturbances: Selected State Strategies."
Henry T. Ireys, Sheila Pires, and Meredith Lee, June 2006. Strengthening the financing of intensive home and community services for youth with serious emotional disorders (SEDs) brings into play a complex set of policy issues, payment mechanisms, and service system reforms. This report presents critical background information on these topics. It includes examples of effective partnerships between agencies that serve youth with SED, describes the background and policy context for innovative programs in selected states, and identifies the strengths and weaknesses of four major financing mechanisms: HCBS waivers, the Medicaid rehabilitation option, case rates for high-risk populations, and provisions in the Tax Equity and Fiscal Responsibility Act (TEFRA), also known as the Katie Beckett provision. Finally, the report presents a synthesis of findings and discusses their implications for states that are planning to develop demonstration projects, authorized under the 2005 Deficit Reduction Act, to strengthen the financing of intensive home and community services for youth with SEDs and their families. |
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| "State Regulation of Residential Facilities for Adults with Mental Illness." Henry Ireys, Lori Achman, and Ama Takyi, 2006. There is little national information on the policies and procedures used by states to regulate residential treatment facilities for adults and children with mental illness. As a result, policymakers and program administrators face major difficulties in determining both the effectiveness of current policies and the potential need for new policies that are responsive to emerging trends in mental health care. Two new reports, based on a 2003 survey of state officials, provide the most accurate national data available concerning methods that states use to license and regulate residential facilities for adults and children with mental illness. Findings demonstrated that organizations operating facilities for children and adults with mental illness typically faced a complex regulatory environment. In addition, many states lack ready access to important data about these residential facilities. |
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| "State Regulation of Residential Facilities for Children with Mental Illness." Henry Ireys, Lori Achman, and Ama Takyi, 2006. There is little national information on the policies and procedures used by states to regulate residential treatment facilities for adults and children with mental illness. As a result, policymakers and program administrators face major difficulties in determining both the effectiveness of current policies and the potential need for new policies that are responsive to emerging trends in mental health care. Two new reports, based on a 2003 survey of state officials, provide the most accurate national data available concerning methods that states use to license and regulate residential facilities for adults and children with mental illness. Findings demonstrated that organizations operating facilities for children and adults with mental illness typically faced a complex regulatory environment. In addition, many states lack ready access to important data about these residential facilities. |
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Journal Articles |
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| "The Co-Occurrence of Smoking and a Major Depressive Episode Among Mothers 15 Months After Delivery." Preventive Medicine, December 2007, Robert C. Whitaker, Sean M. Orzol, and Robert S. Kahn. Using data from the Fragile Families and Child Wellbeing Study, the authors examine the association between maternal smoking 15 months after delivery and the occurrence of a major depressive episode in the prior 12 months. After adjusting for sociodemographic characteristics, the authors found that the prevalence of a major depressive episode was higher among smokers than nonsmokers. Smoking was also more common among mothers with a major depressive episode than in those without one. This suggests that these conditions should not be diagnosed or treated in isolation from each other and that the care of mothers and children should be integrated. Reprints available while supply lasts; call 609-275-2350. |
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| "Measuring Trends in Mental Health Care Disparities, 2000–2004." Psychiatric Services, December 2007, Benjamin L. Cook, Thomas McGuire, and Jeanne Miranda. This article reports on trends in disparities in mental health care by use of an improved method that applies the Institute of Medicine (IOM) definition of racial-ethnic disparities. Data from the 2000–2001 and 2003–2004 Medical Expenditure Panel Surveys were used to estimate trends in two global measures of racial-ethnic disparities in mental health care: (1) having any mental health visit, and (2) total mental health care expenditure in the past year. Disparities between African Americans, Hispanics, and white Americans were examined by applying a new methodology based on the IOM definition of racial disparity that adjusts for health status and allows for mediation of racial-ethnic disparities through socioeconomic factors. Results found by use of this measure show that the mental health care system continues to provide less care to persons in African American and Hispanic minority groups than to whites, suggesting the need for policy initiatives to improve services for these minority groups. |
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| "Physician and Patient Characteristics Associated with Discussion of Psychosocial Health During Pediatric Primary Care Visits." Clinical Pediatrics, November 2007, Jonathan D. Brown, Lawrence S. Wissow, and Anne W. Riley. Primary care providers often miss opportunities to address child mental health problems but research has not clarified specific mechanisms for intervention. This article, based on 800 primary care visits to 54 providers in 13 diverse health clinics, examines factors associated with the discussion of children's behavior, mood, getting along with others, school performance, family stress, and parent stress. The discussion of these topics was more common when the child demonstrated hyperactivity symptoms and when the provider was female or had greater confidence in mental health treatment skills. The presence of moderate physical pain interfered with the discussion of psychosocial health, even when parents were seeking help for their child's mental health problem and when youth demonstrated mental health impairment according to a standardized assessment. The article notes that primary care providers need clinical skills that can be used to effectively communicate with families about mental health and overcome the competing demands of physical and mental health problems. |
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| "Receiving Advice About Child Mental Health from a Primary Care Provider: African American and Hispanic Parent Attitudes.” Medical Care, November 2007, Jonathan D. Brown, Lawrence S. Wissow, Ciara Zachary, and Benjamin L. Cook. African American and Hispanic youth with mental health problems are less likely than their Caucasian counterparts to receive mental health services. Primary care providers are often the source of mental health care for children and may play a role in reducing disparities. This research investigated parent attitudes associated with receiving advice about child mental health in primary care and whether attitudes differed according to race and ethnicity during 773 visits to 54 providers in 13 clinics. Hispanics were more likely than non-Hispanics to agree that primary care providers should treat child mental health and were more willing to allow their child to receive medications or visit a therapist for a mental health problem if recommended by the provider. African American parents were significantly less willing than Caucasians and Hispanics to allow their child to receive medications for mental health but did not differ in their willingness to visit a therapist. These findings suggest that African American parents are generally as willing as Caucasian parents to have their child's mental health needs addressed in primary care and that primary care may be a particularly good point of intervention for Hispanic youth with mental health problems. |
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| "A National Survey of State Licensing, Regulating, and Monitoring of Residential Facilities for Children with Mental Illness." Psychiatric Services (subscription required), Judith L. Teich and Henry T. Ireys, July 2007. |
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| "Identification of Youth Psychosocial Problems During Pediatric Primary Care Visits.” Administration and Policy in Mental Health and Mental Health Services Research, May 2007, Jonathan D. Brown, Anne W. Riley, and Lawrence S. Wissow. Pediatric primary care providers (PCPs) are the gateway to mental health services for children and adolescents. However, PCPs often fail to identify youth with mental health needs during visits, and few studies have examined how identification could be improved. This study found that PCPs who reported greater burden associated with treating mental health problems and those who reported easier access to mental health specialists were less likely to accurately identify youth with mental health needs, compared with a standard screening. |
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| "Parent and Teacher Mental Health Ratings of Children Using Primary-Care Services: Interrater Agreement and Implications for Mental Health Screening." Ambulatory Pediatrics, November 2006, Jonathan Brown, Lawrence Wissow, Anne Gadomski, Clara Zachary, Edward Bartlett, and Ivor Horn. Mental health screening in pediatric primary care settings has become a more common practice to improve the identification and treatment of child mental health problems. This article examines agreement between parents and teachers in their ratings of the mental health of children using primary care. Parents and teachers rarely identified the same child as having mental health problems, and parents failed to detect 52 percent of children the teacher identified as seriously disturbed. The results suggest that screening in primary care may require the development of algorithms to help providers judge when to solicit information from teachers, and that providers need skills to interpret conflicting information from parents and teachers. |
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| "Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in Their Preschool-Aged Children." Pediatrics, vol. 118, no. 3, September 2006, Robert C. Whitaker, Shannon M. Phillips, and Sean M. Orzol. Stressful social circumstances, particularly constrained economic resources, have been linked to behavioral problems in young children and to symptoms of depression and anxiety in mothers. Using data Mathematica collected for the Fragile Families and Child Wellbeing Study, researchers sought to determine if the prevalence of depression and anxiety in mothers and the prevalence of behavior problems in preschool-aged children are more common when mothers report being food insecure. They found that 71 percent of respondents were fully food secure, 17 percent were marginally secure, and 12 percent were insecure. Mental health problems in mothers and behavior problems in their children were twice as likely in food-insecure households, after controlling for multiple factors, including income and other forms of material hardship. Alleviating food insecurity might be one way to enhance the mental and emotional well-being of mothers and their young children.
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| "National Estimates of Mental Health Insurance Benefits." Myles Maxfield, Lori Achman, Jeffrey Buck, and Judith Teich. Journal of Behavioral Health Services & Research , May 2006. This article presents estimates of the proportion of the U.S. population that had mental health benefits in 1999, the extent of their coverage, and the proportion enrolled in health plans subject to the Mental Health Parity Act of 1996 (MHPA). Over three-quarters (76 percent) had mental health benefits as part of their health insurance. Approximately 18 percent had no such benefits; for the remaining 6 percent, mental health benefits could not be determined. Of the 18 percent with no mental health benefits, 84 percent also had no health insurance; the remainder (16 percent) had health insurance that did not cover mental health benefits. Estimates of the generosity of coverage indicate that for 44 percent of the population, benefits included prescription drugs as well as at least 30 inpatient days and 20 outpatient visits for psychiatric care. For 12 percent of the population, benefit generosity could not be determined. Finally, study results suggest that the MHPA affected only 42 percent of the U.S. population. |
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Issue Briefs |
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"Quality Care for Children with ADHD: The Role of Primary Care Physicians." Quality Care for Special Kids: Profiles of Children with Chronic Conditions and Disabilities, Update #6. Stephanie Peterson, Shanna Shulman, and Henry Ireys, April 2007. This brief, the sixth in a series on critical issues involved in caring for children with special health care needs, notes that 40 percent of children with special health care needs enrolled in commercial health insurance plans have an emotional or behavioral disorder. Of these children, 34 percent have a diagnosis of attention deficit hyperactivity disorder (ADHD) alone, and an additional 22 percent have ADHD along with another chronic condition. Children with ADHD receive most of their care from primary care clinicians and use significantly more health care services than do children without ADHD. The brief lists some newly developed health care tools that health plans can use to help ensure that treatment for these children is delivered efficiently and appropriately in primary care offices.
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"Children with Special Health Care Needs: Building a Quality-of-Care Initiative.” Rebecca Nyman and Henry Ireys, November 2004. Nearly two-thirds of children with special health care needs (CSHCN) are insured through employer-based health insurance. This four-page issue brief summarizes recent studies investigating utilization and cost patterns for a large sample of CSHCN enrolled in two commercial managed care plans. CSHCN incur almost half the total costs of care for children in these plans, even though they are only 12 percent of enrolled children, and there are opportunities to improve care for this high-cost, high-risk group. Key to implementing quality improvement efforts is finding an effective, broad-based strategy for identifying this population. In addition, an effective quality improvement project needs a team of health plan staff with experience in pediatrics, quality assessment, and data management.
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