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Biomedical subjects

E Wayne Holden

Publications and source records attributed to E Wayne Holden.

13 recordsLinked to original sources
PubMed2006

Use of the family resource scale in children's mental health: reliability and validity among economically diverse samples.

The adequacy of a family's resources has implications for child and family service processes and outcomes. The field needs tools to assess resources in a manner relevant to children's services research. The purpose of this study was to examine the reliability and validity of the FRS among families caring for children who are receiving mental health services and to compare its measurement quality across samples that differ on economic variables. Exploratory and confirmatory factor analyses supported similar factor structures across samples, and internal consistency was equivalent. Findings from the regression analyses provided evidence of construct validity for the FRS. Overall, findings indicated that the FRS holds promise as a reliable and valid tool for assessing perceived adequacy of concrete resources among economically diverse families of children with emotional and behavioral disorders. However, the FRS could benefit from some refinements; those recommendations are discussed.

Child↗
PubMed2006

Evidence-based treatments in the field: a brief report on provider knowledge, implementation, and practice.

This study examined familiarity, perceived effectiveness, and implementation of evidence-based treatments for children in community settings. A sample of service providers in agencies affiliated with federal programs to improve children's mental health services was identified using a snowball sampling procedure. Forty-four percent of the sample (n = 616) responded to a Web-based survey designed to collect data on evidence-based treatments. High familiarity with, relatively high-perceived effectiveness, and generally high use of evidence-based treatments were reported. Partial implementation of treatment protocols within the context of few agency mandates and widely ranging supports for the implementation of evidence-based treatments was found. Results support the inclusion of more complex models of diffusion, dissemination and implementation in research, and development efforts for evidence-based treatments.

Adult↗
PubMed2005

Developing a computer algorithm to identify epilepsy cases in managed care organizations.

The goal of this study was to develop an algorithm for detecting epilepsy cases in managed care organizations (MCOs). A data set of potential epilepsy cases was constructed from an MCO's administrative data system for all health plan members continuously enrolled in the MCO for at least 1 year within the study period of July 1, 1996 through June 30, 1998. Epilepsy status was determined using medical record review for a sample of 617 cases. The best algorithm for detecting epilepsy cases was developed by examining combinations of diagnosis, diagnostic procedures, and medication use. The best algorithm derived in the exploratory phase was then applied to a new set of data from the same MCO covering the period of July 1, 1998 through June 30, 2000. A stratified sample based on ethnicity and age was drawn from the preliminary algorithm-identified epilepsy cases and non-cases. Medical record review was completed for 644 cases to determine the accuracy of the algorithm. Data from both phases were combined to permit refinement of logistic regression models and to provide more stable estimates of the parameters. The best model used diagnoses and antiepileptic drugs as predictors and had a positive predictive value of 84% (sensitivity 82%, specificity 94%). The best model correctly classified 90% of the cases. A stable algorithm that can be used to identify epilepsy patients within MCOs was developed. Implications for use of the algorithm in other health care settings are discussed.

Adult↗
PubMed2005

Estimating prevalence, incidence, and disease-related mortality for patients with epilepsy in managed care organizations.

PURPOSE: The purpose of the present study was to apply computer algorithms to an administrative data set to identify the prevalence of epilepsy, incidence of epilepsy, and epilepsy-related mortality of patients in a managed care organization (MCO). METHODS: The study population consisted of members enrolled in Lovelace Health Plan, a component of Lovelace Health Systems, a statewide MCO headquartered in Albuquerque, New Mexico. Patient records were obtained from July 1996 to June 2001. Four logistic regression models with high sensitivity and specificity were applied to 1-, 3-, and 5-year time frames in which members were continuously enrolled in the MCO. Incidence was defined for patients who did not have an epilepsy-associated code in the 18 months before the first diagnosis entry. Mortality estimates in the population also were assessed by using a matched control group and linkage to a statewide death registry. RESULTS: The data yielded estimated prevalence rates of 7-10 per 1,000, depending on age, sex, ethnicity, and time interval. Annualized incidence was 47 per 100,000 for members continuously enrolled for 3 years and 71 per 100,000 for members continuously enrolled for 5 years. Crude mortality rates were 2-2.5 times higher for epilepsy patients identified with the algorithms than for the matched controls. Conditional logistic regression indicated that the odds of death for epilepsy patients as compared with controls ranged from 1.24 to 2.06. CONCLUSIONS: Accurate estimation of prevalence, incidence, and mortality rates for epilepsy is an essential component of disease management in MCOs. The algorithms in this project can be used to monitor trends in prevalence, incidence, and mortality to inform decisions critical to improving the health care needs and quality of life for patients with epilepsy.

Adult↗
PubMed2004

Developing a measure to assess attitudes toward epilepsy in the US population.

The aim of this study was to develop an instrument to measure the US public's attitudes toward people with epilepsy and to assess the initial reliability and validity of the instrument. A 46-item attitudinal instrument was developed and tested using a proportional, stratified, national, random-digit dial household telephone survey of adults aged > or = 18 (n=758). Exploratory factor analyses revealed four underlying constructs that accounted for 34.4% of the variance in the factor analysis: negative stereotypes (alpha=0.73); risk and safety concerns (alpha=0.85); work and role expectations (alpha=0.76); and personal fear and social avoidance (alpha=0.79). Knowledge was also assessed; participants with less knowledge about epilepsy had more negative attitudes. The results of these analyses provided evidence for reliability and construct validity of the instrument. Additional tests of the reliability, validity, and factor structure of the scales are necessary to refine the instrument.

Analysis of Variance↗
PubMed2004

Assessing the strengths of children referred for community-based mental health services.

This study investigated the relationship between child strengths and functional impairment, specifically whether youth with greater levels of functional impairment also exhibit strengths. The relationship was investigated for children (N = 1,838) of different genders, ages, race, and ethnic backgrounds and whose families were living at different income levels. A moderate relationship was found between child strengths and functional impairment. Those children with even the most severe functional impairment were rated as having average or near average strengths. With the exception of gender, the relationship between impairment and strengths did not differ as a function of demographic characteristics. These findings provide additional support for the construct validity of the Behavioral and Emotional Strengths Rating Scale (M. Epstein & J. Sharma, 1998) and they highlight the need for strength-based assessment and screening for youth entering mental health services. Child strengths as the foundation for service planning and implementation, and other implications are discussed.

Adaptation, Psychological↗
PubMed2003

Female offenders referred for community-based mental health service as compared to other service-referred youth: correlates of conviction.

Data from a large federally supported national evaluation of system-of-care community mental health services were analysed to identify correlates of conviction. Female adolescents with a reported history of criminal conviction (n=88) were compared to three other service-referred youth groups: females without conviction histories (n=664), males with conviction histories (n=199), and males without conviction histories (n=1230) for possible differences in number and type of family, individual, and school-related life challenges. Multinomial regression analyses were first used to compare the quantity of child and family correlates in each conviction group, and then to test specific correlates in the individual, family, and school domains. The conditional odds of reporting a high vs. low number of child correlates was found to be significantly greater for females with a history of conviction compared to all other groups, over and above the number of family risk factors. Further, service-referred females with a conviction history, when compared to other service-referred youth groups, were much more likely to report having experienced a living instability (e.g. history of running away, multiple living arrangements) and personal adverse life events (e.g. history of drug and alcohol use, sexual abuse). Implications for community-based interventions and treatment are discussed.

Adolescent↗
PubMed2003

Children with reported histories of sexual abuse: utilizing multiple perspectives to understand clinical and psychosocial profiles.

OBJECTIVE: The current study examines multiple empirically based perspectives (i.e., child, caregiver, and clinician) of behavior and functioning as they contribute to the clinical and psychosocial profile of children (aged 5 to 17.5 years) with reported histories of sexual abuse. METHOD: A large, multi-site data set of children referred into Comprehensive Community Mental Health Services both with and without reported histories of sexual abuse, was examined. Seven hundred and fifty-nine children with a reported history of sexual abuse were compared to 2722 without such a history on caregiver and child reported behavior, clinician rated functioning, diagnosis, demographic variables, and life challenges. RESULTS: The multiple perspectives contributed unique and specific information to regression models: caregiver-reported behavior contributed information about externalizing behavior while child-reported behavior added information about internalizing behavior and clinician ratings about self-harmful behavior. Children with reported histories of sexual abuse were also more likely to be female, Caucasian, and have reported histories of life challenges (e.g., physical abuse, substance use, running away). Child sexual abuse was associated with higher rates of depression and anxiety diagnoses, and lower rates of substance abuse, conduct, and attention deficit disorder diagnoses. CONCLUSIONS: The findings indicate that the profile of children entering into Comprehensive Community Mental Health Services with reported histories of sexual abuse, as compared to those without such histories, is complex and best understood via multiple perspectives. Caregiver, child and clinician rated information, when taken together, provide a comprehensive clinical and psychosocial profile around which to plan and implement individualized service plans.

Adolescent↗
PubMed2002

Too young for ADHD: the potential role of systems of care.

This article discusses a number of issues related to the diagnosis and treatment of children with attention-deficit hyperactivity disorder (ADHD), with specific implications for preschoolers. A brief review of diagnostic and treatment issues for young children is followed by a discussion of developmental issues that contextualize the preschool years and have an impact on cognitive and emotional development underlying self-regulation. The characteristics of the high numbers of children with ADHD receiving services within community-based systems of care and symptom outcomes are reported, as well as a description of the components of the systems of care approach. Recent federal initiatives that impact the care of children with ADHD within community settings are highlighted. It is concluded that the identification and management of preschool children with ADHD can be effective within the context of fully integrated service system approaches.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

Gender differences in patterns of risk factors among children receiving mental health services: latent class analyses.

Latent class analyses were used to analyze data from a sample of children participating in the national evaluation of the Comprehensive Communities Mental Health Services for Children and Their Families Program (N = 6786). Lifetime risk experiences of the child were analyzed to identify 4 classes of boys and girls with similar risk patterns. While low-risk, status-offense, abuse, and high-risk classes were identified for both boys and girls, there were nearly half the number of girls in the low-risk class, almost as many in the status-offense class, twice as many in the abuse class, and more than 3 three times as many in the high-risk class as there were boys. These findings suggest that there are specific groups of children entering services who differ as a function of their lifetime risk exposure. In addition, the relationship between class membership and child functioning, and class membership and family lifetime risk experiences. Understanding these differences provides critical information to the service planning process. In addition, it may result in immediate improvement in the triage of children into services and a better understanding of their behaviors during and after treatment.

Child↗
PubMedDate not supplied

Child functioning in rural and nonrural areas: how does it compare when using the service program site as the level of analysis?

The current study uses data from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program to examine child functioning in rural (n = 8) as compared to nonrural (n = 18) system-of-care communities across the United States. In this study, the topic of rural versus nonrural differences is approached from a community-level perspective with aggregated functional impairment scores as the dependent variable of interest in weighted least squares regression. The demographic characteristics of children, particularly age, were more important predictors of functional impairment than geographic locale (i.e., rural vs nonrural). Specifically, while children served in nonrural communities were older than those served in rural communities, after controlling for this difference functional impairment levels were similar. It appears from these analyses that youth served in rural and nonrural communities with systems of care were more similar than they were different with regard to their level of functional impairment. This lack of aggregate functional difference between the rural and nonrural sites reminds policymakers and funding agents that youth in rural areas need equity in both access and resource for mental health services. As indicated by the findings in the current investigation youth in rural areas are not immune to the types of mental health challenges often publicized by researchers examining youth in nonrural areas.

Adolescent↗