Social capital in the college setting: the impact of participation in campus activities on drinking and alcohol-related harms

OBJECTIVE

The authors aimed to replicate previous findings on social capital and harmful alcohol outcomes in the college setting and to ascertain the protective effects of additional indicators of social capital.

METHODS

Over 4 years (2000-2004), the authors conducted annual cross-sectional, random-sample student surveys at 32 US institutions of higher education (N = 15,875) and constructed multilevel models to examine the association between individual- and campus-level participation in campus activities and harmful drinking outcomes.

RESULTS

At the individual level, community volunteerism was protective against harmful drinking outcomes. In contrast to past research, campus-level volunteerism was not significantly associated with the outcome measures. At both the individual and campus levels, participation in a religious organization was protective. Greek membership and varsity athletic participation were risk factors at the individual level.

CONCLUSIONS

Results did not corroborate previous findings and revealed mixed results for other measures of participation at the campus level. The influence of social capital on college alcohol consumption deserves further attention.

The use of an electronic audience response system for data collection

BACKGROUND

Gathering complete and accurate data from community groups, particularly medically underserved populations, is challenging.

METHODS

An electronic audience response system (ARS) is a novel method for the efficient collection of data while maintaining participant confidentiality in group settings.

RESULTS

Because data are captured electronically, an ARS eliminates the need to transfer data from paper forms, reducing errors and the amount of time required for data management.

CONCLUSIONS

ARS is a useful data collection tool that works well with diverse populations and greatly increases data accuracy and completeness while maintaining participant confidentiality.

The effect of area HMO market share on cancer screening

OBJECTIVE

Managed care may have widespread impacts on health care delivery for all patients in the areas where they operate. We examine the relationship between area managed care activity and screening for breast, cervical, and prostate cancer among patients enrolled in more managed care plans and patients who are enrolled in less managed plans.

DATA AND METHODS

Data on cancer screening from the 1996 Medical Expenditure Panel Survey (MEPS) were linked to data on health maintenance organization (HMO) and preferred provider organization (PPO) market share and HMO competition at the metropolitan statistical area (MSA) level. Logistic regression analysis was used to examine the relationship between area managed care prevalence and the use of mammography, clinical breast examination, Pap smear, and prostate cancer screening in the past two years, controlling for important covariates.

RESULTS

Among all patients, increases in area-level HMO market share are associated with increases in the appropriate use of mammography, clinical breast exam, and Pap smear (OR for high relative to low managed care areas are 1.75, p < .01, for mammography, 1.58, p < .05, for clinical breast exam, and 1.71, p < .01, for Pap smear). In analyses of subgroups, the relationship is significant only for individuals who are enrolled in the nonmanaged plans; there is no relationship for individuals in more managed plans. No relationship is observed between area HMO market share and prostate cancer screening in any analysis. Neither the level of competition between area HMOs nor area PPO market share is associated with screening rates.

CONCLUSIONS

Area-level managed care activity can influence preventive care treatment patterns.

Assessing the psychosocial and academic needs of Latino youth to inform the development of school-based programs

A survey was made of the leaders in the Latino community from four East coast cities on the mental health, academic, and behavioral needs of Latino youth, services available to them, and recommendations to better address their needs. Of the 112 Latino leaders recruited, 46 responded to the survey, expressing their views that Latino youth experience significant stress in the United States, present behavioral and academic adjustment problems, and generally have difficulty accessing appropriate services and resources. Programs for these youth were presented as limited in number and lacking in cultural sensitivity. Community leaders endorsed the development of comprehensive and culturally sensitive programs for Latino youth in schools that address their psychosocial and academic needs.

Psychiatric emergencies in children

OBJECTIVE

To examine the demographic and clinical characteristics of children using the pediatric emergency department (ED) in a medical center in Baltimore, Maryland. The rate of admission and length of stay for children who were evaluated in the ED were also examined.

SETTING

A large, urban medical center with approximately 15,500 visits per year.

RESULTS

During a 13-month period, more than 600 visits to the ED were made for mental health concerns for children aged 2 to 18 years, with psychiatric visits constituting more than 5% of total visits to the ED. Psychiatric visits averaged more than 5 hours' duration in the ED and involved significant effort by medical staff, with approximately one half of visitors undergoing psychiatric admission. Interviews conducted with the ED staff revealed that addressing psychiatric problems in children is a considerable burden and that there is a general lack of resources within the ED and the surrounding community to respond to the needs of children with psychiatric emergencies.

CONCLUSION

The challenge in most communities is to build a true system of care that involves proactive and more preventive care in natural settings, such as schools, and coordination and improvement of care for youth with more serious problems.

A clinically useful screening interview to assess violence exposure in youth

The Exposure to Violence Screening Measure (EVSM) was evaluated as a structured interview for assessing violence exposure among inner-city youth. Psychometric analysis of the measure on a sample of 352 inner-city teenagers indicated adequate internal consistency. The validity of the EVSM was supported by significant correlations between the total score and measures of life stress and behavioral problems.

Advancing efforts to address youth violence involvement

Discusses the increased public attention on violence-related problems among youth and the concomitant increased diversity in research. Youth violence involvement is a complex construct that includes violence experienced in multiple settings (home, school, neighborhood) and in multiple forms (as victims, witnesses, perpetrators, and through family members, friends, and the media). Potential impacts of such violence involvement are considerable, including increased internalizing and externalizing behaviors among youth and future problems in school adjustment and life-course development. This introductory article reviews key dimensions of youth-related violence, describes an American Psychological Association Task Force (Division 12) developed to advance relevant research, and presents examples of national resources and efforts that attempt to address this critical public health issue.

Assessing the status of research on violence-related problems among youth

Presents results of a systematic review of abstracts on studies related to violence and youth in an effort to identify areas that have received little attention in the psychological literature and to present recommendations for future research. A total of 1,168 empirical articles on violence-related problems in youth were identified by a PsycINFO (American Psychological Association, 1980-1999) search. These articles were then classified in a multidimensional grid, allowing for comparisons among different types of articles. A review of abstracts from these articles indicated that most of the research activity has been descriptive (e.g., reviewing correlates or predictors of violence involvement) or assessment related (e.g., evaluating specific measures). Fewer articles examined the treatment or prevention of violence-related problems among youth. Further, the majority of studies pertained to direct exposure to violence (as a victim or perpetrator), with very few studies looking at the effects of witnessing violence, knowing individuals exposed to violence, or being exposed to violence through the media. Comparing treatment and prevention articles, we found that the least empirical attention was paid to the prevention of violence-related problems in youth, and not a single study was identified through this search that sought to examine the prevention of youth witnessing violence. Implications for future research agendas are discussed.

Toward a public mental health promotion and intervention system for youth

Substantial limitations exist at all levels of mental health care for youth in most communities in the United States. Particular gaps exist in the areas of prevention, mental health promotion, and early intervention programs. The national movement toward enhancing mental health programs for youth in schools offers an important opportunity to fill gaps in the prevention-services continuum toward the development of a Public Mental Health Promotion and Intervention System for Youth. A strategy--the Child and Adolescent Program Planning Schema (CAPPS)--is presented to analyze gaps in a community's system of mental health programs for youth, and to facilitate planning toward development of a full continuum of programs from broad, population-based prevention, and mental health promotion strategies to treatment of youth with more established problems.

Mental health, health, and education staff working together in schools

The movement to develop expanded school mental health programs is still in its early stages. For child and adolescent psychiatrists to become involved and effective means negotiating a culture that is novel for many schools and forming and maintaining relationships with diverse staff in mental health, health, and education.

Evaluation of expanded school mental health programs

Expanded school mental health programs provide a full range of mental health services (assessment, treatment, case management, prevention) to youth in regular and special education, and typically involve close collaboration between schools and community agencies. A major challenge for these programs is documenting that provided services are of high quality and leading to enhanced outcomes for the youth and schools served by them. Dimensions of school mental health evaluations and a step-by-step process for conducting them are presented, using the example of a well established program in Baltimore. Challenges to such evaluation and strategies for overcoming challenges are also presented.

A questionnaire to measure factors that protect youth against stressors of inner-city life

This study reports the development of the My Life Questionnaire (MLQ), a self-report measure of factors that protect inner-city youth against stressors such as poverty, crime, and violence. An initial pool of 23 items reflecting important protective factors was developed through focus groups with inner-city youth and clinicians working with them in a school-based mental health program. Item-total correlations and factor analysis resulted in a 12-item measure containing three factors: avoiding negative peer influences, focusing on the future, and religious involvement. Scores on the MLQ were negatively correlated with behavioral problems, supporting its validity. The measure holds promise for use in clinical and research efforts with disadvantaged urban youth.

Expanded school mental health services: assessing needs related to school level and geography

We surveyed 62 school administrators from three midatlantic (MD, VA, WV) and one northeastern (CT) state on factors relevant to developing school-based mental health programs. Administrators were from schools that varied on education level (elementary, middle, and high) and geographic location (urban, suburban, and rural), with equivalent numbers in each subgroup. Administrators provided ratings to questions grouped in five categories: (a) Stressful Conditions, (b) Internalizing Behavioral Problems, (c) Externalizing Behavioral Problems, (d) Substance Abuse, and (e) Barriers to Mental Health Care, and provided open-ended comments on needs of youth and mental health programs for them. They rated behavioral and substance abuse problems as progressively more serious as students advanced in school level. Urban youth were reported to encounter higher stress and present more severe internalizing problems than suburban or rural youth. Suburban and rural schools provided more health and mental health services than urban schools. Across geographic locales, physical health services far outnumbered mental health services. Findings related to barriers to mental health care, and the viability of schools as delivery sites for comprehensive mental health services, are discussed.

Overcoming challenges in outcome evaluations of school mental health programs

Significant growth and improvement of school mental health programs has occurred in recent years. However, evaluation of outcomes for children receiving these services is needed to provide accountability data and ensure the sustainability of these programs. When designing studies, evaluators must overcome several challenges that may threaten the validity of their conclusions. In this paper, threats or challenges to the internal and external validity of results from evaluation studies are reviewed. Suggestions are provided for overcoming these challenges, in order to encourage future evaluation activities in this developing field and to document the impact of services for youth and their families.

Expanded school mental health programs: advancing reform and closing the gap between research and practice

Expanded school mental health (ESMH) programs provide a range of mental health services to youth in special and regular education including prevention, assessment, treatment, and case management. Despite the rapid growth of ESMH programs in the United States and elsewhere, many communities still do not have ESMH programs and those that do exist often fail to implement empirically validated intervention and treatment strategies. Systematic prevention efforts remain a lauded, yet illusive goal. For ESMH programs to fulfill their promise of improved access, increased productivity and improved behavioral outcomes, researchers, school-based mental health service providers, and educators must work together to move child mental health programs beyond limiting constructs and approaches. These issues are reviewed and an example of an "ideal" approach to implement best practices in schools and close the gap between research and practice is offered.

Toward collaboration in the growing education-mental health interface

Expanded school mental health (ESMH) programs involve the provision of comprehensive mental health services for youth in schools, including assessment, intervention, prevention, and consultation. Related to increased awareness of the benefits of these programs, and growing disenchantment with traditional forms of mental health service delivery for children, ESMH programs are growing rapidly in the United States. Coinciding with the growth of these programs is a developing interface between and among education and mental health professionals in schools. In this interface, there is an increasing need for real collaboration; however, associated with differences in professional training, language, and expectations, and related to "turf," such collaboration is often an elusive prospect. In this article, we review historical trends that provide background to the growing education-mental health interface in schools. We discuss tensions that arise between staff of various disciplines when ESMH programs are developed, and provide recommendations on strategies to develop truly collaborative approaches to the provision of comprehensive mental health services in schools.

Progress in adolescent mental health

This chapter reviews the status of emotional and behavioral problems in adolescents and current issues in their assessment and treatment. The authors emphasize the need for the development of mental health programs for adolescents in natural settings such as schools, and present a conceptual framework for intervention based on provider knowledge of risk and protective factors.

Psychosocial functioning of youth receiving mental health services in the schools versus community mental health centers

Evaluated psychosocial differences between youth receiving mental health services in Community Mental Health Centers (CMHCs; n = 79) as compared to youth receiving services from a program operating in 10 Baltimore schools (n = 186). Racial and gender differences were shown, with more African American youth and females in the School than CMHC sample. Multivariate analyses that controlled for these racial and gender differences failed to reveal significant effects, indicating comparable functioning on measures of life stress, violence exposure, family support, self-concept, and emotional/behavioral problems for youth from the two samples. However, particularly for those with internalizing disturbances, youth in the School sample were less likely to have received prior mental health services than youth from the CMHCs. Findings support the conclusion that school-based mental health programs are reaching youth who need mental health services, who otherwise may not receive them.

Family involvement in expanded school mental health

Expanded school mental health (ESMH) programs address the limitations of traditional mental health agencies in meeting the needs of youth by providing a full range of services in a familiar and nonstigmatizing setting. Because of the central role families play in the lives of children, their involvement in ESMH can enhance the effectiveness of treatments and ensure that services are responsive to the needs of the larger community. Increasing family involvement, however, is a complex and resource-intensive endeavor, and requires consideration of the goals of the ESMH program and potential obstacles to meeting those goals. The challenges of involving family members in ESMH, guidelines for determining the program's goals with respect to family involvement, and strategies for achieving these goals are described. Underlying the strategies is the need to be flexible, creative, and respectful of the beliefs and concerns of the families served by the ESMH program.

Self-reported delinquent behavior and psychosocial functioning in inner-city teenagers: a brief report

Evaluated psychosocial characteristics of inner-city ninth graders exceeding a cutoff for clinically significant delinquent behaviors (n = 27), as compared to youth whose self-reported delinquent behaviors fell below this cutoff (n = 136). Youth reporting high levels of delinquent behavior reported more life stress, depression and anxiety, lower self-concept, and less cohesive families than other students. Females reporting high levels of delinquent behavior were more likely to have poor classroom and school attendance than other females; this relationship did not hold for males.

An interdisciplinary health team training program for school staff in Minnesota

This paper describes an interdisciplinary health team training program for school-based clinic staff in Minnesota. The project sought to improve team functioning, level of practice, and health care services at the school sites. Participants were interdisciplinary staff members from clinics in senior high, middle, and elementary schools. The program consisted of further development in team training knowledge and skills and educational sessions on issues identified by participants. Evaluations indicated participants reported greater knowledge and improved team functioning experiences from the team training. Gains also were shown in knowledge and skills in specific school topic areas such as violence, resiliency, working with resistant families, and self-care. The program could serve as a model for other interdisciplinary school health team training.