Patterns and predictors of compliance with utilization management guidelines supporting a state policy to improve the quality of youth mental health services

Despite a need to improve community mental health services for youths, little is known about compliance with state policies created to improve the quality of services in these settings. This study examined rates, patterns, and predictors of compliance with utilization management guidelines developed by the state of Texas to support a public health policy based on empirical evidence of effective mental health services (i.e., an evidence-based policy). Compliance was defined as authorizing policy-recommended service packages, whereas policy "overrides" occurred when recommended service packages were not authorized. The study sample consisted of 688 youths from ethnically and economically diverse backgrounds. Clinics reported that forty-six percent of youths were not authorized the policy-recommended service package. Overrides were primarily based on level of intensity. Most often, authorized services were less intensive than those recommended by the state guidelines. Higher severity at intake across multiple indicators was associated with authorizing less intensive services than what the policy guidelines recommended. Future studies evaluating system-level efforts such as state mental health policies should pay close attention to levels of service intensity, and their relation to the needs of youth in community settings.

Shaping the Jail Inreach Project: program evaluation as a quality improvement measure to inform programmatic decision making and improve outcomes

The Jail Inreach Project was initiated in 2007 as a pilot program by Healthcare for the Homeless-Houston, an FQHC serving homeless individuals in Harris County, Texas, as a collaborative effort with the Harris County Sheriff's Office and the Mental Health Mental Retardation Authority of Harris County. It addresses the disproportionate number of homeless individuals with behavioral health diagnoses cycling through the Harris County Jail without provisions for continuity of care. Throughout the years, several evaluations have been conducted to inform programmatic planning and assess the success of the program on affecting patterns of recidivism of mentally ill homeless clients being served. Findings reinforce the importance of linking releasees to services immediately upon release as a measure for breaking the cycle of repeated incarceration and chronic homelessness. This paper illuminates characteristics of a successful intervention by examining three program evaluations conducted at different times in the program's history. It further illustrates how program evaluation has been utilized to help shape the program design and related policies.

Agreement between chart diagnoses and standardized instrument ratings of youth psychopathology

Rating scales are useful for evidence-based assessment of youth psychopathology. However, it is not known whether these scales contribute information beyond that which clinicians gather without them. This study examined agreement between chart diagnoses and the Child Behavior Checklist (CBCL) for 82 community mental health clinic clients. Agreement was low, suggesting that the CBCL was not redundant with clinicians' clinical impressions. These findings suggest that use of an instrument like the CBCL could potentially improve clinician diagnostic accuracy; future research should examine how best to utilize these scales in the diagnostic process and how to train clinicians in their use.

The Jail Inreach Project: linking homeless inmates who have mental illness with community health services

The Jail Inreach Project is a health care-based intensive case management "inreach" program that engages incarcerated persons from the homeless population who have behavioral health disorders (mental illness, substance use disorder, or both) in establishing a plan for specific postrelease services. The Jail Inreach Project aims to provide continuity of care and integrate this highly marginalized subpopulation of homeless persons into primary and behavioral health care systems by establishing patient-centered health homes. The use of integrated primary and behavioral health models in conjunction with provisions for immediate access to and continuity of care upon release is emerging as a best practice in combating the rapid cycling of this vulnerable population between streets and shelters, emergency centers, and the county jail. Preliminary results indicate that more than half of the persons referred to the program remained successfully linked with services postrelease, whereas slightly less than one-third who engaged in services while incarcerated did not retain linkage on release.

Integrating behavioral health and primary care: the Harris County Community Behavioral Health Program

This column describes and evaluates the Harris County Community Behavioral Health Program, a new integrated care program operating in community health centers serving low-income uninsured residents in Houston, Texas. Patient service data, provider satisfaction, patient outcome data, and appointment waiting periods were obtained to evaluate the initial operation of the program. The integrated care program has been successfully implemented on a large scale at an annual cost of about dollars 800,000, or dollars 268 per patient served. About 3,000 patients were treated for behavioral problems by behavioral health staff during the first 11 months of the program. In addition, efforts were made to expand the scope of behavioral health interventions provided by primary care physicians. Providers were satisfied with the program, improvement was detected among patients treated, and there was an increase in the average number of community-based behavioral health services received per patient since the program was implemented.

The Mental Health Needs Council of Harris County: A Case Report on Community Collaboration and Adult Mental Illness Prevalence Assessment and Service Need Analysis

Accurate mental illness prevalence and service needs assessment are critical to the development and delivery of effective mental health programs. Assessment precision and efficient service development and delivery are best facilitated by a close collaboration of all relevant major stakeholders. This report examines the history, mission, and composition of the Mental Health Needs Council of Harris County, Texas. This Council, located in Houston, has for the past 25 years investigated mental health service problems and recommended strategies for their solution. This Council consists of all of Harris County's major public service providers, professional groups and advocacy organizations. This report traces the evolution of the Council's prevalence and needs assessment methodologies. Its current methodologies are examined. These assessment strategies are applicable to other metropolitan areas. The Mental Health Needs Council is a model for effective community collaboration on the needs and problems of persons with mental illness.

Microbiologic characterization of ligature-induced peri-implantitis in the microswine model

The purpose of this study was to evaluate the microbiologic changes associated with induction of peri-implantitis in the microswine. A split-mouth design was utilized. Three implants were placed in the edentulous mandibular bicuspid region of 2 microswine yielding 12 implants for evaluation. The experimental implant abutments were ligated with 4-0 silk suture material to induce peri-implantitis for a period of 45 days. The control implant abutments were not ligated. The control implants were scaled and cleaned at each time interval using plastic scalers. The attachment level (AL), probing depth (PD), gingival index (GI), and plaque index (PI) were measured at day 0 (baseline) and days 14 and 45. Microbiologic samples were taken from the "sulcus" with paper points at each interval and were dispersed in prereduced media; plated on selective and non-selective media; and grown under aerobic, anaerobic, and capnophilic atmospheres. A greater AL, increased PD, and higher GI and PI scores were noted among the experimental implants. The controls remained essentially unchanged. Radiographs revealed that experimental implants showed an increased amount of bone loss when compared to control. Bone loss caused the implant threads to be exposed in the experimental implants. Microbiologic studies revealed that there was a shift from Gram-positive facultative organisms to Gram-negative obligate anaerobes, including black pigmented Bacteroides, in experimental implants. The microbiota of the control implants remained primarily Gram-positive facultative organisms. The microswine appears to be a suitable animal model for evaluation of osseointegrated implants. Importantly, under the experimental conditions reported, osseointegrated implants were susceptible to "periodontal" breakdown or peri-implantitis.

Psychological approaches to the assessment and treatment of anxiety and depression

Clinical psychology offers a unique and often complementary approach to assessment and treatment of anxiety and depression. Current practices are examined for their scientific validity and clinical utility.

Behavioural-communications treatment of marital interaction: negative behaviours

The present investigation assessed the effectiveness of a behavioural-communications marital intervention package focused solely upon negative behaviours. Treatment effectiveness was evaluated via two independent, within-subject multiple base-line designs. Four target behaviours, selected on the basis of clinical and laboratory assessment, were sequentially and cumulatively introduced over the course of an eight-week treatment programme. Multimodal assessment techniques included self-report, spouse-report, and direct observations of laboratory-based interactions. While slight differences occurred between measurement systems, all results attested to the efficacy of the therapeutic package. One-year follow-up data continued to indicate maintenance of treatment gains over time. These findings were discussed with regard to decelerative targets of intervention, and recommendations were made for continued investigations in the area.