Emerging adults discontinue behavioral health treatment at rates ranging from 30% to 50%. This study explored dropout using semi-structured interviews (N = 20). Participants were engaged in a group therapy program, Healthy Transitions. Findings revealed the lack of therapeutic relationship and logistical issues such as cost, transportation, and conflicting work schedules contributed to dropout. Participants indicated that alleviating logistical barriers and feeling a connection to their peers and group leader prevented dropout. This program was free, transportation was provided, and sessions were in the evening. Participants expressed peer educators made them feel less judged and/or stigmatized than a one-on-one therapy appointment. These findings reinforce logistical issues and lack of a therapeutic relationship contribute to dropout and highlight the benefits of flexible scheduling and reinforce the importance of a therapeutic relationship in preventing dropout.

Trauma exposure and comorbid substance use are highly prevalent among female drug court participants. Despite the pervasiveness of the issue, few studies have investigated the impact of posttraumatic stress symptoms (PTSS) and nonmedical prescription drug use among this specific population. The present study examined the impact of posttraumatic stress, social support, and nonmedical prescription drug use on graduation outcomes among female participants in a specialized drug court program (N = 210). Participants either received motivational enhancement therapy/cognitive behavioral therapy (MET-CBT; N = 210) or both MET-CBT and Seeking Safety through intensive outpatient treatment (n = 109). The findings indicated that graduation was negatively correlated with posttraumatic stress, r = -.19, p = .007, d = 0.40; past 90-day nonmedical prescription painkiller, opiate, and analgesic use, r = -.19, p = .001, d = 0.44; tangible social support, r = -.24, p = < .001, d = 0.51; and past-month substance use problems, r = -.25, p < .001, d = .50. In addition, past-month substance use problems, OR = 0.84, 95% CI [0.72, 0.97]; PTSS, OR = 0.90, 95 % CI [0.82, 0.99]; and tangible social support, OR = 0.94, 95% CI [0.89, 0.98], were significant negative predictors of graduation. These results speak to the importance of facilitating the development of specialized evidence-based drug court interventions that target and improve comorbid substance use and trauma outcomes among female drug court participants to reduce recidivism and set a precedent for future research to replicate and expand upon these findings.

PurposeThe Center for Epidemiologic Studies Depression (CES-D) scale is a widely used instrument for studying depression in the general population. It has been translated into several languages. Cross-cultural relevance of the construct of depression and cultural equivalence of the CES-D items used to measure it are crucial for international research on depression. Given the increasing number of refugees from Eritrea entering the USA and Europe, there is a need among health care researchers and providers for an instrument to assess depressive symptoms in the native language of this vulnerable population. The paper aims to discuss these issues.Design/methodology/approachThe study employed forward–backward translation and assessed the CES-D scale for cross-cultural research and depression screening among Tigrigna-speaking Eritrean refugees. Forward–backward translation, cognitive interview and semantic analysis were conducted to ensure equivalence of comprehension of the items and instructions between Tigrigna- and English-speaking samples. Multi-group confirmatory factor analysis was used to assess the measurement invariance of the translated version.FindingsTranslation efforts were successful as reflected by the results of semantic analysis and pilot testing. Evidence supporting the measurement invariance of data collected using the Tigrigna version of the CES-D was obtained from a sample of 253 Eritrean refugees in the USA.Practical implicationsThe findings of this study provide support for reliability and validity of data collected using the Tigrigna version of the CES-D scale. This important tool for assessing depression symptoms among Eritrean refugees is now available for health care providers and researchers working with this vulnerable population.Originality/valueThis work is an original work of the authors and it has not been published previously.

This study examined the relationship between continuing bonds (CBs) among 50 bereaved youth (ages 11-17) and their bereaved adult caregivers, and predictors of CBs among youth. Results indicated there was not a significant relationship between caregiver CB and youth CB. However, significant relationships were found between youth bereavement symptomatology, their relationship to the deceased, and youth CB. Specifically, youth with higher levels of symptomatology and those who lost an immediate family member were more likely to maintain CBs. Results suggest the need for practitioners to incorporate grief symptomatology and CBs in assessment and intervention with bereaved youth.

Since 1993, the Substance Abuse and Mental Health Services Administration has invested more than $1 billion establishing systems of care (SOC) in over 173 local communities to provide services to children with mental, emotional, and behavioral problems and their families. The SOC model requires that effective partnerships be developed between parents and professionals and also among different service sectors and agencies. To date, there has been no systematic examination of these interagency partnerships associated with the presence of conflict and its management. This paper reports the findings from a survey of the members of the governing boards of currently funded and graduated SOC sites related to interorganizational conflict. The results indicated that conflict was common in SOC regardless of the stage of the system's development. The most common types of conflict included incompatible goals, interpersonal relationships, and overlapping authority. When conflict occurred, a number of management efforts were used including analyzing the conflict and developing a strategy to deal with it and dealing with the conflict behind the scenes. Suggestions are provided for identifying and managing conflict.

The purpose of this study was to examine the prevalence of self-perceived oral health needs among Medicaid-enrolled adults with and without mental health problems and to identify factors predictive of enrollees' perceived oral health needs. The study involved a secondary analysis of 1,721 respondents to the Florida Health Services Survey. Contrary to the previous research, the findings from this study indicated that respondents with mental health problems (52.9%) did not differ significantly in their dental needs compared to those who did not have mental health problems (49.3%). The results from a logistic regression suggested that after controlling for demographic characteristics, substance abuse problems and functional needs increased the likelihood of self-reported oral health needs, whereas the receipt of Supplemental Security Income (SSI) was associated with decreased dental needs. The prevalence of unmet dental needs among these respondents (i.e., 23%) supported the conclusion that a significant gap exists in the accessibility of oral health services among this population.

Community collaboration has become increasingly common in behavioral health services. Conflict is likely to occur in any community coalition bringing together organizations with differing mandates, missions, and histories. However, research on how coalitions identify and handle conflict, and on the impact of conflict on sustainability is scarce. An exploratory study examined conflict in two federally funded children's "systems of care" using site visits and concept mapping to describe differences in how sites conceptualize and respond to conflict. Results suggest that unacknowledged and unaddressed conflict can negatively affect the development and sustainability of sites, and that focusing on cooperation may, paradoxically, make it more difficult to acknowledge conflict and to implement conflict transformation processes. Implications for behavioral health administrators are discussed, including potential interventions that could address these issues.

Objectives To (1) examine the quality of life of individuals with Ménierè’s disease in relation to symptom severity, social supports, and coping styles and (2) develop a prediction model to identify factors most strongly associated with quality of life. Methods Data were collected using a web-based survey that included previously developed and validated measures (i.e. SF-12, Dizziness Handicap Inventory, Hearing Handicap Inventory for Elderly Screening Version, Iowa Tinnitus Handicap Questionnaire, Interpersonal Support Evaluation List, Brief COPES, Lehman’s Quality of Life). Ninety-five individuals with Ménierè’s disease who were members of one of five online Ménierè’s disease support groups responded to the survey. Results The findings indicated that symptom severity was negatively associated with patients’ quality of life, social supports were positively associated with quality of life, and the use of negative coping styles (e.g. substance use, blaming) was negatively associated with quality of life. Four predictors (i.e. SF-12 mental health, dizziness severity, self-esteem support, and negative coping styles) accounted for 62% of the variance in quality of life. Discussion The findings suggest that the factors associated with the quality of life of patients with Ménierè’s disease are similar to those reported in the literature among patients with other chronic illnesses. The results also suggested that emphasis on psychosocial factors may be an important aspect of a comprehensive treatment intervention for individuals with Ménierè’s disease.

BACKGROUND AND PURPOSE:The longitudinal invariance of the Center for Epidemiologic Studies-Depression (CES-D) scale among middle-aged and older adults is unknown. This study examined the factorial invariance of the CES-D scale in a large cohort of community-based adults longitudinally.METHODS:1,204 participants completed the 20-item CES-D scale at 4 time points 1 year apart. Structural equation modeling was used to identify best fitting model using longitudinal data at baseline and at 1-, 2-, and 3-year follow-up.RESULTS:The 4-factor model showed partial invariance over 3 years. Two of the 6 noninvariant items were consistently noninvariant at the 3 follow-up points.CONCLUSION:Special consideration should be given to these 2 items when using the CES-D scale in healthy adults (45-75 years old).

In randomized controlled trials (RCTs), the most compelling need is to determine whether the treatment condition was more effective than control. However, it is generally recognized that not all participants in the treatment group of most clinical trials benefit equally. While subgroup analyses are often used to compare treatment effectiveness across pre-determined subgroups categorized by patient characteristics, methods to empirically identify naturally occurring clusters of persons who benefit most from the treatment group have rarely been implemented. This article provides a modeling framework to accomplish this important task. Utilizing information about individuals from the treatment group who had poor outcomes, the present study proposes an a priori clustering strategy that classifies the individuals with initially good outcomes in the treatment group into: (a) group GE (good outcome, effective), the latent subgroup of individuals for whom the treatment is likely to be effective and (b) group GI (good outcome, ineffective), the latent subgroup of individuals for whom the treatment is not likely to be effective. The method is illustrated through a re-analysis of a publically available data set from the National Institute on Drug Abuse. The RCT examines the effectiveness of motivational enhancement therapy from 461 outpatients with substance abuse problems. The proposed method identified latent subgroups GE and GI, and the comparison between the two groups revealed several significantly different and informative characteristics even though both subgroups had good outcomes during the immediate post-therapy period. As a diagnostic means utilizing out-of-sample forecasting performance, the present study compared the relapse rates during the long-term follow-up period for the two subgroups. As expected, group GI, composed of individuals for whom the treatment was hypothesized to be ineffective, had a significantly higher relapse rate than group GE (63% vs. 27%; χ2 = 9.99, p-value = .002).

Depression is the fourth leading cause of global burden of disease [1]. Depression is present in all regions of the world, significantly affecting the younger and older age groups (World Health Organization [WHO], 2000; Institute for Health Metrics and Evaluation [IHME], 2013) [2]. It is estimated that upwards of 8% of adolescents meet criteria for depression [3]. Depression during adolescence is a disabling condition that is associated with serious long-term morbidities and an increased risk of suicide [3-6]. It has been reported that among adolescents with major depression, as many as 7% commit suicide in their early adult years [7]. Yet despite these alarming statistics, adolescent depression often goes undiagnosed despite the availability of screening tools that have been demonstrated to be effective (National Institute for Health Care Management [NIHCM], 2010).

The Simple Screening Instrument for Substance Abuse (SSI-SA) is gaining widespread use as a self-report measure of substance abuse; yet, little information exists regarding the instrument’s psychometric properties. This study examined the SSI’s psychometric properties within a population of 6,664 adult Medicaid enrollees in Florida, who responded to a survey conducted as part of a statewide evaluation of Medicaid services. The SSI-SA had excellent internal consistency (.85). Evidence of the SSI’s validity was strong; SSI-SA scores distinguished among individuals with and without substance abuse needs and were significantly correlated with a measure of functioning in daily living. Using the recommended SSI-SA cutoff score of 4 or higher to indicate the presence of a substance abuse problem, the SSI-SA had respectable sensitivity (.82) and specificity (.90).

How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.

A major impediment to obtaining national information on systems of care implementation has been the lack of a psychometrically sound large-scale survey instrument. The present study provided information on the factorial and concurrent validity of the Systems of Care Implementation Survey scales. Multilevel confirmatory factor analysis and multilevel regression analysis were used to test these indicators of internal and external validity. Two hundred twenty-five counties were randomly selected and stratified by population size and poverty level. Nine hundred ten informants responded to the survey questionnaire, M = 4.04 informants per county (SD = 3.17). Results indicated that all models had at least adequate fit to the data, with nine of the 14 factor models having excellent fit. Overall, 11 of the 14 factors had some indication that receiving federal funding to create systems of care was associated with higher scores on the factors. Implications for future research were discussed.

The children's system of care framework has been extensively implemented in the U.S. Since its inception in 1993, the Comprehensive Community Mental Health Services for Children and Their Families Program has invested in excess of $1 billion supporting the development of systems of care in 164 grantee sites across the country. Despite these efforts to implement children's systems of care nationally, little is known about the extent to which the principles and values actually have been put into practice outside of the funded grantee sites. This paper describes the development of the Systems of Care Implementation Survey, a measure designed specifically for the first ever study assessing the level of implementation of factors contributing to effective children's systems of care in a nationally representative sample of counties throughout the U.S.

The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed.

Ethical standards and issues associated with the access and use of state Medicaid administrative data for research purposes from the data owners’ perspective (i.e., state Medicaid authorities) were examined. Key informants at Medicaid authorities were surveyed regarding their states’ policies and procedures related to the access and use of Medicaid data for research purposes. Results indicate that although a majority of states permit the use of Medicaid data by independent investigators for research purposes (74%), there is substantial variability across states in both the frequency with which access is granted as well as with the policies and procedures governing the access to these data. Literature on existing “best practices” by data owners regarding the use of administrative data in research is combined with survey findings to add the discussion in this highly important area and proposed guiding principles for administrative data owners and custodians are offered.