Quality of care in profit vs not-for-profit dialysis centers.
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Hemodialysis Units, Hospital↗
Biomedical subjects
John S Lyons
Publications and source records attributed to John S Lyons.
Clinical and forensic outcomes from the Illinois mental health juvenile justice initiative.
OBJECTIVE: To address the mental health needs of youths who are arrested and detained in Illinois, an initiative was designed and implemented that identified youths with psychotic or affective disorders, linked them to community services, and monitored their cases. This study assessed whether such linkage is possible and whether it improves clinical and forensic outcomes. METHOD: S: Under the initiative, court staff refer youths who may have a mental illness to a clinical liaison. If the youth is eligible for the program, the liaison works with the family to develop a community-based action plan. For the analysis presented here, the Child and Adolescent Needs and Strengths-Mental Health Scale (CANS-MH) and the Child and Adolescent Functional Assessment Scale (CAFAS) were used to assess outcomes among 314 youths who had completed the program at the time of the study. School and forensic outcomes were also monitored. RESULTS: Seventy-five percent of the youths were successfully linked to at least one mental health or community service. A comparison of average CANS-MH dimension scores at enrollment and program completion indicated that youths' emotional problems decreased considerably within three months of referral. CAFAS scores six months after enrollment improved across nearly all dimensions. Home, community, and school functioning were significantly improved from baseline. Only 42 percent of the youths were rearrested, compared with a statewide rate of 72 percent of detained youths. CONCLUSION: S: By linking youths with significant mental health needs to existing community-based services, it appears possible both to ameliorate psychopathology and to reduce delinquency.
Adolescent↗
Factors related to psychiatric hospital readmission among children and adolescents in state custody.
OBJECTIVE: This study examined factors related to psychiatric hospital readmission among children and adolescents who were wards of the Illinois Department of Children and Family Services. METHODS: The authors analyzed service reports and clinical ratings on the Childhood Severity of Psychiatric Illness (CSPI) for 500 randomly selected children and adolescents who underwent psychiatric hospitalization. Children who were readmitted to the hospital within three months of discharge from the index hospitalization were compared with those who were not readmitted in terms of preadmission factors, clinical characteristics at the index hospitalization, services in the hospital, and posthospital services. RESULTS: The children who were readmitted were rated as more learning disabled or developmentally delayed and had received fewer posthospital service hours than the children who were not readmitted. The highest rates of readmission were found among children who lived in congregate care settings before the index hospitalization and those who lived in a rural region. CONCLUSIONS: The findings of this study highlight the significance of enabling factors, notably living arrangement, geographic region, and posthospital services, for children and adolescents in the child welfare system. Prevention of readmission among these children must focus on community-based services.
Adolescent↗
Racial/ethnic differences in rates of depression among preretirement adults.
OBJECTIVES: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators. METHODS: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders. RESULTS: African Americans (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites. CONCLUSIONS: Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.
Black or African American↗
Competency to stand trial in preadjudicated and petitioned juvenile defendants.
As state legislatures across the United States continue to permit younger juvenile defendants to be tried in adult court, juvenile competence to stand trial has become an issue of increasing legal and forensic significance. This study examined competency to stand trial in a sample of preadjudicated and petitioned juvenile defendants. Results revealed that juveniles deemed unfit to stand trial were younger than their competent counterparts, had more severe special education needs, and had more extensive mental health treatment histories. These results are consistent with those of prior research in this area. Implications for treatment planning and system reform are discussed.
Adolescent↗
Panic attacks in schizophrenia.
OBJECTIVE: To determine the association between panic attacks and comorbid mental disorders, psychiatric symptomotology, service utilization, and suicidality among individuals with schizophrenia in the community. METHOD: Data were drawn from the Epidemiologic Catchment Area (ECA) Study (n=20, 291). Differences in comorbid mental disorders, symptomotology, service use, and suicidality were determined between individuals with schizophrenia, with and without panic attacks. RESULTS: Panic attacks (lifetime) were common among almost half (45%) of those with schizophrenia. Individuals with schizophrenia and panic attacks had significantly elevated rates of co-occurring mental disorders, psychotic symptoms, suicidality, and mental health service utilization compared with individuals with schizophrenia who did not suffer from panic attacks. CONCLUSIONS: Panic attacks are common among individuals with schizophrenia in the community and are associated with higher rates of other co-occurring mental disorders, service utilization and suicidality. These results suggest that concurrent treatment for both panic and schizophrenia may be indicated for optimal outcomes. Future research is needed to determine the direct and indirect cost benefit in providing mental health treatment for panic among individuals with schizophrenia in the community.
Adult↗
Use of measurement audit in outcomes management.
With the growing emphasis on accountability in mental health services, outcomes management strategies are gaining popularity. However, for these techniques to be credible, it is necessary to ensure the reliability of clinical data. In other words, outcomes measures must accurately reflect the actual status of service recipients. This article presents the use of the measurement audit as one means of monitoring and improving the reliability of outcomes measurements. The methods and findings from an audit of crisis assessment workers for children in state custody are presented. Clinical assessments completed at the time of service were compared with assessments using the same measure completed via retrospective file review. Findings suggest generally good reliability, 0.72 overall, with some variation by provider and type of information.
Child↗
Mental health service utilization in the United States. The role of personality factors.
BACKGROUND: The aim of this study was to determine the relationship between personality factors and the use of mental health services (past 12 months) among adults in the community. METHOD: Data were drawn from the Midlife Development in the United States Survey (MIDUS), a representative sample of 3,032 adults aged 25-74 in the United States population. Analyses of variance and logistic regression analyses were used to determine the relationship between personality factors and mental health service utilization, in the presence and absence of mental disorders, during the past 12 months. RESULTS: Neuroticism [OR = 1.5 (1.2, 1.9)] was associated with significantly increased likelihood of mental health service utilization among adults in the community. Conscientiousness [OR = 0.7 (0.5, 0.9)] and extraversion [OR = 0.7 (0.5, 0.98)], in contrast, were associated with decreased likelihood of use of mental health services. Among adults with mental disorders, conscientiousness [OR = 0.5 (0.3, 0.8)] was associated with decreased odds of mental health service utilization. Neuroticism [OR = 1.8 (1.3, 2.4)] was associated with increased likelihood of service use among those who did not meet criteria for common mental disorders. CONCLUSIONS: These findings are the first to document a significant association between personality factors and the use of mental health services among adults in the general population. Our results highlight new ways in which personality may influence mental health in the community. This information may be useful in identifying those with unmet need for mental health treatment and developing more effective interventions for those at risk for common mental disorders. Replication of these findings is needed.
Adult↗
The effects of copayments on substance abuse treatment expenditures and treatment reoccurrence.
OBJECTIVE: Employers can influence treatment decisions by adjusting characteristics of the structure of the benefits they offer, such as copayments. The authors estimated the relationship between copayment levels for substance abuse treatment and both the insurers' expenditures for treatment and the reoccurrence of treatment. METHODS: Retrospective data from a Midwestern behavioral health insurer were used to identify persons with a diagnosis of a substance use disorder. The claims data were used to construct episodes of treatment. Using the variation in copayment levels across 211 different employer groups, the authors used multiple regression models to estimate the effect of copayment levels on treatment expenditures and the likelihood of a treatment reoccurrence. RESULTS: Copayment levels had a significant effect on the reoccurrence of substance abuse treatment. Each 10 percent increase in copayment was associated with a 1 percent increase in the probability of reoccurrence. Copayment levels had a significant effect on current-episode treatment expenditures. Each 10 percent increase in copayment was associated with an 8.7 percent decrease in total per-episode expenditures. From the plan's perspective, a $1 increase in copayment for outpatient substance abuse treatment reduced per-episode spending by $110; however, roughly $13 is lost from that saving because of the increased likelihood of treatment reoccurrence. CONCLUSIONS: The longer a person is retained in substance abuse treatment, the greater the likelihood of recovery. Copayments may represent a barrier to retention in treatment. Higher copayments for substance abuse treatment make treatment reoccurrence more likely.
Adult↗
The sensitivity of substance abuse treatment intensity to co-payment levels.
This study exploits variation in co-payment levels among different contractual arrangements within a regional managed behavioral health care organization to estimate the relationship between co-payment levels for substance use treatment services and the intensity of substance use treatment. The substance use treatment benefits involved a range of co-payment levels across nearly 400 employers during the years 1993 through 1998. Multiple regression techniques were used to estimate the effect of co-payment levels on treatment intensity. The results indicate that co-payment levels had a significant negative effect on outpatient and inpatient substance use treatment. For outpatient treatment the effect on intensity implied a co-payment elasticity of -0.18, implying that moving from a $10 co-payment to a $20 co-payment would result in, for example, a reduction from 5 to 4 outpatient visits per episode. However, the effect was larger for persons with combined alcohol and drug use disorders, as they exhibited a co-payment elasticity of -0.27. For inpatient days, the co-payment elasticity was considerably smaller at -0.017. Given the benefits of maintaining persons with substance use disorders in treatment, employers may have an incentive to take steps to minimize the barriers to treatment.
Adult↗