Evaluating Managed Mental Health Services

Bickman, Leonard; Guthrie, Pamela R.; Foster, E. Michael; Lambert, E. Warren; Summerfelt, Wm. Thomas; Breda, Carolyn S.; Heflinger, Craig Anne

doi:10.1007/978-1-4899-1071-4

Cited by 218 publications

(160 citation statements)

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“…Site differences were, however, found in clinician diagnoses. Similarity of research diagnosis agrees with Bickman and colleague's reports of extremely similar populations among sites (Bickman et al, 1995). Despite this similarity in case characteristics at the Demonstration and Comparison sites, clinician diagnoses of Depression and Adjustment Disorder were more common in the Comparison group, while Elimination Disorders and Oppositional Defiant Disorder were more common in the Demonstration group.…”

Section: Discussionsupporting

confidence: 82%

“…The participants reported on in this paper are 984 dependent children of military personnel (ages 5-17) who received mental health treatment in the Fort Bragg Evaluation Project (Bickman, 1996b;Bickman et al, 1995). The Fort Bragg Evaluation Project employed three United States Army posts as sites.…”

Section: Methods Subjectsmentioning

confidence: 99%

“…However, this potential bias has not been investigated with children and adolescents. This paper presents data-driven evidence from the Fort Bragg Evaluation Project (FBEP; Bickman, 1996aBickman, , 1996bBickman et al, 1995), which provides a large sample (N=984 youths ages 6-18) for analysis of these topics.…”

Section: Bias In Assigning Formal Diagnosis Based On Informantmentioning

confidence: 99%

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Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

Bickman

Wighton

Lambert

et al. 2012

Journal of Methods and Measurement in the Social Sciences

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This paper presents results from a three-part study on diagnosis of children with affective and behavior disorders. We examined the reliability, discriminant, and predictive validity of common diagnoses used in mental health services research using a research diagnostic interview. Results suggest four problems: a) some diagnoses demonstrate internal consistency only slightly better than symptoms chosen at random; b) diagnosis did not add appreciably to a brief global functioning screen in predicting service use; c) low interrater reliability among informants and clinicians for six of the most common diagnoses; and d) clinician diagnoses differed between sites in ways that reflect different reimbursement strategies. The study concludes that clinicians and researchers should not assume diagnosis is a useful measure of child and adolescent problems and outcomes until there is more evidence supporting the validity of diagnosis.

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Section: Discussionsupporting

confidence: 82%

Section: Methods Subjectsmentioning

confidence: 99%

Section: Bias In Assigning Formal Diagnosis Based On Informantmentioning

confidence: 99%

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Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

Bickman

Wighton

Lambert

et al. 2012

Journal of Methods and Measurement in the Social Sciences

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“…The Caregiver Strain Questionnaire (CGSQ) has 21 items rated on a 5-point Likert scale that assess ''demands, responsibilities, difficulties and negative psychic consequences of caring for a relative with special needs.'' 50,51 Higher scores indicate greater strain. Internal consistency of the CGSQ was 0.92.…”

Section: Outcomes and Study Measuresmentioning

confidence: 99%

Teletherapy Delivery of Caregiver Behavior Training for Children with Attention-Deficit Hyperactivity Disorder

Tse

McCarty

Stoep

et al. 2015

Telemedicine and e-Health

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Background: Preliminary studies suggest that videoteleconferencing (VTC) may be an effective means to deliver behavioral interventions to families. Subjects consisted of a subsample of children (n = 37) and caregivers who participated in the Children's Attention-Deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) (n = 223), a randomized trial testing the effectiveness of delivering treatments for ADHD to families residing in their home communities using distant technologies. Families randomized to the CATTS intervention arm received pharmacotherapy and caregiver behavior training. Materials and Methods: Thirty-seven families from the CATTS intervention arm participated. All families received pharmacotherapy through VTC. Twelve families received the caregiver behavior training through VTC, or teletherapy, and 25 received the intervention in-person. We assessed children's outcomes at 25 weeks with the Vanderbilt ADHD Parent Rating Scale and the Columbia Impairment Scale. We assessed caregivers' outcomes using measures of distress in caring for a child with ADHD, including depression, stress, strain, and empowerment. We used analysis of covariance to assess outcomes from baseline to 25 weeks. Results: Families in the two conditions showed comparable attendance at sessions and satisfaction with their care. Caregivers in both conditions reported comparable outcomes for their children's ADHD-related behaviors and functioning, but caregivers in the teletherapy group did not report improvement in their own distress. Conclusions: Findings support the feasibility, acceptability, and effectiveness of treating children with ADHD through teletherapy. Future work should investigate how teletherapy may improve caregivers' distress. Teletherapy is a promising modality for delivering behavioral interventions for children with ADHD.

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“…Over the last 2 decades, numerous examples of comprehensive, coordinated, community-based systems of care have been implemented and evaluated. [57][58][59][60] Most of them showed no improvement in patient outcomes but significant improvement in other areas such as patient/family satisfaction, decreased wait time, and more appropriate care. [57][58][59][60] In the chronic care medical literature, PC professionals have been encouraged to provide a medical home for their patients with chronic conditions.…”

Section: Initial Management Of Adolescent Depressionmentioning

confidence: 99%

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment, and Initial Management

et al. 2007

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OBJECTIVES. To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This first part of the guidelines addresses identification, assessment, and initial management of adolescent depression in primary care settings.METHODS. By using a combination of evidence-and consensus-based methodologies, guidelines were developed by an expert steering committee in 5 phases, as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) draft revision and iteration among members of the steering committee.RESULTS. Guidelines were developed for youth aged 10 to 21 years and correspond to initial phases of adolescent depression management in primary care, including identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The identification, assessment, and initial management section of the guidelines includes recommendations for (1) identification of depression in youth at high risk, (2) systematic assessment procedures using reliable depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, (3) patient and family psychoeducation, (4) establishing relevant links in the community, and (5) the establishment of a safety plan.CONCLUSIONS. This part of the guidelines is intended to assist primary care clinicians in the identification and initial management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists but cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for adolescent depression management. Additional research that addresses the identification and initial management of depressed youth in primary care is needed, including empirical testing of these guidelines. 4,5 Even when diagnosed by PC physicians, only half of these patients are treated appropriately. 3 Furthermore, rates of completion of specialty mental health referral for youth with a recognized emotional disorder from general medical settings are quite low (J. V. Campo, MD, written communication, 2006).In view of the shortage of mental health clinicians and barriers to children having access to mental health professionals, the well-documented need for PC clinicians to learn how to manage this condition, the increasing evidence base available to guide clinical practice, increased selective serotonin reuptake inhibitor-prescribing rates in pediatric PC, 6,7 and new evidence that a multifaceted approach with mental health consultation may improve the management of depression in PC settings, [8][9][10][11] guidelines may be a necessary first step in the identification and management of depression in adolescents in PC. Unfortunately, no depression-management guidelines have been developed for use in the PC setting in the United S...

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Evaluating Managed Mental Health Services

Cited by 218 publications

References 0 publications

Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

Teletherapy Delivery of Caregiver Behavior Training for Children with Attention-Deficit Hyperactivity Disorder

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment, and Initial Management

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