Performance Improvement 2010. Enable Mental Health Interventions


An evaluation examined a one-year old telephonic care management program in Rhode Island that tried to encourage depressed parents receiving Medicaid to seek mental health services.  The program is one of four strategies being studied in the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project (HtE).  The HtE project is evaluating diverse strategies designed to improve employment and other outcomes for several populations including prisoners reentering the community, Head Start parents and children, and long-term welfare recipients.  Care managers called study participants in the program group to encourage them to seek treatment, to make sure that they were complying with treatment, and to provide telephonic counseling.  The study found that care mangers effectively engaged people with depression via telephone; an increased the use of mental health services; and a change in the distribution of depression severity, particularly reducing the number of people who were severely depressed while increasing the number who were moderately depressed.  The program increased visits for Hispanic participants to mental health professionals, increased the filling of antidepressant medications for Hispanic participants, and reduced depression for Hispanic sample members. (9174)

Early mental health intervention involves providing services and supports for people before they are disabled enough to qualify for SSI or SSDI in order to keep them connected to employment, community and family life.  One of the major challenges of intervening earlier is the need to align policies relating to income support, disability benefits, health care insurance and delivery, employment supports, rehabilitation services and evidence-based practices for the treatment and rehabilitation of mental impairments.  An ASPE-funded Technical Expert Panel explored earlier intervention for this population.  The panel concluded that there is a continuum of illness prior to first onset of mental illness to the point at which a person might apply for public benefits, but is not yet disabled enough to qualify.  Interventions at any point along this continuum would be considered "early" in the context of current practice.  The experts agreed that the best time to intervene is at the initial onset of a person's mental illness, or as early as possible because mental health conditions launch people on a declining trajectory and it is important to reduce the duration of untreated psychosis.  The effectiveness of interventions diminishes over the illness course. (9322)

An analysis of national longitudinal survey data examined depression in female caregivers of children younger than 5 years old involved in the child welfare system.  Indications of major depression were reported in 22 percent to 25 percent of caregivers at some point in time over the five to six year period.  The caregivers were almost 3 times as likely to have suffered from major depression in their lifetime as the national estimate of adult lifetime prevalence of depression.  Factors most associated with symptoms of major depression were having been a victim of intimate partner violence, fair or poor health, being single, and being white.  (9157)

For many adolescents, mental health disorders make the successful transition to adulthood particularly difficult.  A population of interest is youth who have had contact with service systems, including child welfare, juvenile justice, and runaway and homeless programs.  Although these service systems are not generally viewed as mental health programs, many children and adolescents who have come in contact with these services either require, or have obtained mental health services through them.  This vulnerable population is a small group of hard to serve adolescents who, without the proper intervention, may experience negative outcomes during adolescence and the transition to adulthood.  A study focusing on this group found that approximately 10 percent had contact with at least one service system.  Youth who were in contact with service systems were more likely to report having ever received mental health services; yet these youth had poor mental health.  Youth who had contact with multiple service systems did not experience better outcomes transitioning to adulthood.  About 35 percent of youth is at risk for contact but has not been in contact with one of the service systems.  These youth experienced poor mental health and poor outcomes during the transition to adulthood.  (9202) 

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