[Changing health behavior II. Suggestions for the organization of community health programs].
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Attitude to Health↗
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[Health behavior among students of public and private schools in the metropolitan area of São Paulo, Brazil].
OBJECTIVE: To investigate the prevalence of several health behaviors among students of public and private schools in S. Paulo, Brazil. METHODS: An epidemiological survey about health behaviors among high school students was carried out in S. Paulo in 1998. Seventh to eleventh graders from ten public and seven private schools were interviewed. All students were asked to fill out a Portuguese version of the questionnaire used by the Centers for Disease Control and Prevention in their annual "Youth Health Risk Behavior Survey". This questionnaire includes questions on driving-related behavior, violence, substance abuse, sexual practices, dietary habits and body weight control. RESULTS: A significant proportion of the students, mainly in the range of 15--18 years old, reported engaging in health-risk behaviors. In public schools, the most prominent risk behaviors were: riding a motorcycle without helmets (reported by 70.4% of the students who were either passengers or the driver); not using condoms in the last sexual intercourse (34% among those sexually active); carrying guns (4.8% in the last year), and suicide attempts (8.6% in the last year). In private schools, substance abuse was the most prominent risk-behavior: 25% reported at least one episode of binge-drinking in the last 30 days, 20.2% sniffed solvents at least once in the last year and 22.2% smoked marijuana in the same period; 13.8% reported using tobacco on a regular basis. Not wearing helmets while riding a motorcycle was also very high, reported by 66.3%. Female students reported less risk-behaviors, except for suicide attempts and unhealthy weight control methods. CONCLUSIONS: The information gathered could contribute to the development of preventive programs at school level, which takes into consideration the students' risk behaviors.
Adolescent↗
The Multidimensional Health Behavior Inventory.
Gaps in knowledge about what constitutes healthy and risky behaviors for young people hinder successful health promotion intervention strategies. With the development of appropriate instruments, behaviors can be measured and interventions can be implemented to improve health outcomes. The structure of a new health behavior instrument, the Multidimensional Health Behavior Inventory (MHBI), was explored with data from 1,077 college students, ages 18 to 24 years. Factor analysis of 116 health behavior questions yielded 7 factor-based scales with 57 items: diet (13 items), substance use (10 items), safety (9 items), checkup (9 items), social (6 items), stress (6 items), and exercise (4 items). Evaluation of the 7 behavior scales of the MHBI using subgroups defined by age, gender, and race will contribute to an understanding of health behaviors of older adolescents and young adults and will provide directions for research and clinical interventions.
Adolescent↗
How a managed behavioral health care carve-out plan affected spending for episodes of treatment.
OBJECTIVE: This study examined the impact on spending for episodes of mental health and substance abuse treatment of a managed behavioral health care carve-out program implemented by the Massachusetts Group Insurance Commission in July 1993. METHODS: Episodes of mental health and substance abuse treatment were defined using claims and enrollment data from before and after the carve-out implementation. Regression models were used to compare spending per episode for different types of episodes of mental health and substance abuse care: those involving care provided only in an inpatient facility (that is, inpatient care or partial hospitalization), those involving both inpatient-facility and outpatient care, and those involving only outpatient care. RESULTS: Adoption of the carve-out plan was associated with a large decrease in spending per episode across all three episode types, particularly for episodes involving inpatient-facility care. The decrease was 54 percent for inpatient-facility-only episodes, 46 percent for combined inpatient facility and outpatient episodes, and 21 percent for outpatient-only episodes. The decrease in spending per episode was larger for episodes involving a diagnosis of either unipolar depression or substance dependence. CONCLUSIONS: The findings suggest that spending per episode of mental health and substance abuse treatment may drop substantially after a carve-out is implemented. Individuals with a diagnosis of either unipolar depression or substance dependence seem to be disproportionately affected. It appears that even weak financial incentives placed on the managed behavioral health care vendor can result in dramatic changes in spending patterns for episodes of mental health and substance abuse treatment.
Adult↗
A model for managed behavioral health care in an academic department of psychiatry.
In response to the effects of the managed care environment on patient flow and care, the department of psychiatry and behavioral sciences of the Johns Hopkins School of Medicine developed and has been managing a capitated behavioral health care program. The program is responsible for providing mental health and substance abuse services for 22,000 members of the TRICARE Uniformed Services Family Health Plan (USFHP), directed by the U.S. Department of Defense. The integration of primary care and behavioral health care is a major feature of the USFHP/TRICARE program. The authors describe the transition from a carve-out for-profit managed care organization to the integrated program managed by the department. During the first two years of the program, access to services increased and use of inpatient services decreased without the need to deny service use. To supplement previous reports of the involvement of academic psychiatry departments in behavioral health care, the authors supply utilization and financial data that may serve as benchmarks for similar efforts by other departments.
Academic Medical Centers↗
Improving continuity of care: success of a behavioral health program.
This article documents the quality improvement process implemented by HIP Health Plan of New York (HIP) for the behavioral health continuity-of-care measure, Follow-Up After Hospitalization for Mental Illness. This Health Plan Employer Data and Information Set (HEDIS) measure identifies the percentage of members who receive psychiatric follow-up care after their hospital discharge. Studies indicate that post-hospitalization psychiatric follow-up care is an effective method for reducing hospital readmissions. HIP's mental health services department pursued a number of improvement initiatives with this HEDIS measure. The development of a case management unit proved the most effective intervention as compliance rates for post-hospitalization after-care visits improved and hospital readmittance rates declined. These findings provide valuable resource information for behavioral health providers throughout the United States.
Accreditation↗
A preliminary survey of the health behaviors of community leaders.
The purpose of this study was to investigate the health behavior of a town ' s community leaders and other issues associated with that behavior. Structured questionnaires designed by the researchers were used to collect data at a meeting for the announcement of community building; they were filled out in the 10 or 20 minutes before the meeting began and 70 valid responses were received. The SPSS for Window version 10.0 software package was used for data analysis. The results of the study showed that the community leaders demonstrated higher standards of health-protective behaviors (i.e. elder/adult checkups, Pap smear exam and breast self-examination) than others living in the community. Variables such as gender, educational level, self-perceived health status, number of chronic illnesses were correlated with different types of dietary behavior. Subjects who were 40 years old and over, educated to junior high school or lower, who had performed less than one year of community service and were free of chronic illness engaged in relatively regular exercise. Subjects who had performed more than one year of community service were more likely to utilize the preventive services provided by national health insurance. It is recommended that public health nurses improve their cooperation with community leaders over providing health -related activities in order to promote better health behavior on the part of such leaders.
Adult↗
Predictors of health behavior from an behavior-analytic orientation.
The frequencies of American college students' positive self-talk, emotional reactions, and other positive thoughts for engaging in five health behaviors were assessed and found to be highly correlated; they then were combined into a composite measure. A similar composite resulted for negative self-talk, emotional reactions, and other negative thoughts for engaging in unhealthy alternative behaviors. Effortfulness and pleasantness of the health behaviors were also assessed. One or (in some cases) both composites, effortfulness, and pleasantness were substantially related to vigorous exercise, use of seat belts, and avoidance of alcoholic beverages. Mild exercise and avoidance of junk food were less well predicted.
Adolescent↗
Health behavior and related factors in adolescents with a history of abortion and never-pregnant adolescents.
Although prevention of unintended births among adolescents is health promoting, abortion, as one of those methods, has not been examined from a health promotion perspective. The authors describe and compare health behaviors, problem-solving appraisal, self-image, age, and use of contraceptives at first and most recent coitus in adolescents with a history of abortion and never-pregnant adolescents. A cross-sectional design with 26 pairs of adolescents matched on age, race, grade level, and Medicaid status was used. No significant differences were found between the 2 groups. The matched pairs' health behaviors and problem-solving scores were less favorable than those reported in the literature for nonmetropolitan women. Although the 2 groups of adolescents had similar self-image scores, they were significantly below those of the norm reference group. The matched pairs initiated coitus at an earlier age, and a smaller proportion used contraceptives at first and last coitus than national norms. These findings support the need for early intervention to enhance self-image, problem-solving confidence, and coitus delay. The findings point to the importance of aggressive family planning interventions and maintenance of access to abortion services.
Abortion, Induced↗
Use of the pediatric symptom checklist in strategies to improve preventive behavioral health care.
OBJECTIVE: The purpose of this study was to examine the utility of the Pediatric Symptom Checklist (PSC) in identifying youth at risk of behavioral health problems and to develop strategies to meet their mental health needs. METHODS: The PSC was completed by the parents of 570 children aged two to 18 years at three urban health centers in Massachusetts. Follow-up interviews were conducted with the parents of 95 of the children. Multidisciplinary teams held case conferences to review the cases of 43 of the 95 children who were interviewed and who were determined to have moderate to severe behavioral health problems. RESULTS: Of the 570 children in the screening sample, 144 (25 percent) had moderate to severe behavioral health problems, as indicated by a positive score on the PSC, and 2 percent had a serious emotional disturbance. Of the 297 pre-school-aged children (younger than six years), 67 (23 percent) received a positive score. Of the 283 school-aged children (age six and older) from both English- and Spanish-speaking families, 77 (27 percent) received a positive score. About one-third of the severely emotionally disturbed youth were receiving some mental health treatment, but only 20 percent were rated by the multidisciplinary team as receiving adequate treatment. CONCLUSIONS: The study provided further support for the validity and reliability of the PSC and confirmed the results of earlier studies that found a high level of unmet needs for mental health services among this population. Use of the PSC in this study promoted an increase in referrals for children in need.
Adolescent↗
Elements of behavioral health intervention in geriatric long-term care settings.
The somewhat alarming incidence of mental disorders among institutionalized elderly persons has necessitated improved ways of dealing with their behavioral health needs. Because conventional psychotherapy has not been feasible with this population, alternative types of behavioral health interventions have been suggested. The present paper lists a number of elements which may be helpful in delivering focused behavioral health services to residents in long-term care facilities.
Aged↗
Alaska/Russian Far East behavioral health projects: a progress report on recent activities.
A number of "behavioral health" exchange activities between Alaska and the Russian Far East took place during 1992-93. These included visits by a psychiatrist running one of the first "private polyclinics" in Magadan and by a narcologist to discuss the latest developments in alcohol services; a Behavioral Health Conference where Native health workers from Russia and Alaska shared experiences; beginning a multi-year epidemiology project; and a project to assess needs for a fetal alcohol syndrome (FAS) prevention program in Magadan.
Adolescent↗
Health behaviors in elderly people. A 5-year follow-up of 75-year-old people living in three Nordic localities. Smoking, physical activity, alcohol consumption, and healthy eating, and attitudes to their importance.
Few studies about health behavior among elderly persons in the Nordic countries are available, and our knowledge about longitudinal changes is especially limited. The purpose of this study was to assess the prevalence of selected health behaviors as reported at age 75 years in Finland, Sweden and Denmark together with answers regarding attitudes to such habits, and study longitudinal changes between 75 and 80 years. The study population included 499 men and 704 women born in 1914/15 and examined in 1989/90 in Jyväskylä (Finland), Göteborg (Sweden), and Glostrup (Denmark). Survivors were re-examined in 1994/95. A self-administered validated questionnaire developed from the Danish Nationwide Health Surveys was given to the participants during a home visit and checked when the subjects came to the laboratory examination. The Danes had the highest proportion of smokers and persons with daily alcoholic beverage consumption and the smallest proportion of healthy eaters, but the Swedes had the most sedentary life-style. Women had the healthiest life-style. Between ages 75 and 80 years, the proportion of participants who tried to improve their health decreased, but there was no change in believing the importance of one's own effort in maintaining health. The free-time physical activity decreased, but there was no change in the attitude towards physical activity. There were major cross-national differences among the three Nordic localities, but the health behaviors were rather stable, though the proportion of participants who tried to improve their health decreased. Not more than 60 to 70% of the subjects believed that their own efforts are important to health.
Aged↗
Behavioral health and managed care contracting under SCHIP.
This Policy Brief examines behavioral health managed care contracting under separately administered State Children's Health Insurance Programs (SCHIP), i.e., programs that operate under the direct authority of Title XXI of the Social Security Act rather than as expansions of Medicaid. Most separate SCHIP programs buy managed care style health insurance for some or most of their enrolled children. Because Title XXI provides states with far greater administrative flexibility than Medicaid with respect to coverage and benefit design, provision of services, and administration of managed care arrangements,studying separate SCHIP managed care products sheds important light on how states might approach insurance and managed care design generally in the area of behavioral health were Medicaid modified through section 1115 demonstration or federal statutory authority to permit greater latitude. To conduct this analysis, two nationwide databases maintained by the George Washington University Center for Health Services Research and Policy (CHSRP) were used: a database consisting of all Medicaid MCO-style managed care contracts in use in Calendar Year 2000; and a nationwide database consisting of contracts used by separate SCHIP programs for the same calendar year. As of the point of collection in 2000 there were 33 such separate programs; according to CMS' latest website information, that total has now reached 35. Both sets of contracts were analyzed and separated into their components by lawyers experienced in managed care contract analysis and interpretation. The data were entered into working tables that organize the contents of the contracts into a series of searchable domains.
Child↗
Use of consumer ratings for quality improvement in behavioral health insurance plans.
BACKGROUND: The Consumer Assessment of Behavioral Healthcare Services (CABHS) survey collects consumers' reports about their health care plans and treatment. The use of the CABHS to identify opportunities for improvement, with specific attention to how organizations have used the survey information for quality improvement, is described. METHODS: In 1998 and 1999, data were collected from five groups of adult patients in commercial health plans and five groups of adult patients in public assistance health plans with services received through four organizations (one of three managed behavioral health care organizations or a health system). Patients who received behavioral health care services during the previous year were mailed the CABHS survey. Non-respondents were contacted by telephone to complete the survey. RESULTS: Response rates ranged from 49% to 65% for commercial patient groups and from 36% to 51% for public assistance patients. Promptly getting treatment from clinicians and aspects of care most influenced by health plan policies and operations, such as access to treatment and plan administrative services, received the least positive responses, whereas questions about communication received the most positive responses. In addition, questions about access- and plan-related aspects of quality showed the most interplan variability. Three of the organizations in this study focused quality improvement efforts on access to treatment. DISCUSSION: Surveys such as the CABHS can identify aspects of the plan and treatment that are improvement priorities. Use of these data is likely to extend beyond the behavioral health plan to consumers, purchasers, regulators, and policymakers, particularly because the National Committee for Quality Assurance is encouraging behavioral health plans to use a similar survey for accreditation purposes.
Adolescent↗
Evaluation of the HEDIS measure of behavioral health care quality. Health Plan Employer Data and Information Set.
OBJECTIVE: The Health Plan Employer Data and Information Set (HEDIS) is the most widely used "report card" system comparing health care plans across different dimensions of performance. HEDIS uses only one measure of the quality of behavioral health care-the rate of follow-up after hospitalization for major affective disorder. This study used data from a national Veterans Affairs database to evaluate the generalizability of the HEDIS behavioral health quality measure. METHODS: Using administrative data from a nationwide sample of 114 VA hospitals, the HEDIS (version 2.5) quality measure was compared with several related performance measures including readmission rates and outpatient follow-up rates for other psychiatric disorders and for substance use disorders. The magnitude and statistical significance of Pearson's r value for correlation between measures was calculated. RESULTS: The HEDIS measure was moderately correlated with 30-day follow-up after hospitalization for other psychiatric disorders and with other performance measures of outpatient care. However, it was poorly correlated with follow-up for substance use disorders, inpatient measures including readmission rates, and several other measures of quality. CONCLUSIONS: Caution is needed in drawing conclusions about the quality of behavioral health plans based on the single measure used in HEDIS, version 2.5. Inclusion of other performance measures may be warranted.
Adult↗
Health behaviors during and after a cancer diagnosis.
With improvements in cancer survival rates, more patients with cancer are living longer, and hence, cancer is becoming viewed as a chronic illness requiring long-term management. An important aspect of patient care during and after cancer treatment is patient health behaviors. For example, sequelae from various cancer treatments, such as chemotherapy and radiotherapy (RT), can compromise health in a variety ways, including decreased immune functioning, cardiotoxic effects of chemotherapy and/or RT, and weight gain. In addition, the stress caused by a cancer diagnosis and its treatment can disrupt existing health behaviors or exacerbate unhealthy behaviors. Continued smoking or alcohol use can complicate treatment and increase risk for further malignancy. Furthermore, decreased physical activity and poor nutrition can cause weight gain, which may contribute to secondary health problems such as cardiovascular disease and diabetes. The authors reviewed the extant literature on four key health behaviors among patients with cancer and survivors: healthy diet, reduced tobacco use, reduced alcohol use, and increased physical activity. They described the prevalence of these behaviors, reviewed the effects of interventions designed to alter unhealthy behaviors, and discussed the implications and future directions for this emerging area of research.
Adolescent↗
Use and costs of public-sector behavioral health services for african-american and white women.
OBJECTIVE: The purpose of this study was to identify differences between African-American and white women in the use of behavioral health services and factors associated with these differences. METHODS: In one large public behavioral health system, data on demographic characteristics, financial resources, clinical disorders, service use patterns, and costs of care were analyzed for 10,905 African-American and 19,069 white women between the ages of 18 and 59 years who received behavioral health services in 1997. RESULTS: The African-American women were more likely to be older, never married, unemployed, and eligible for Medicaid and to have a diagnosis of a psychotic disorder or a substance use disorder. African-American women were more likely than white women to receive inpatient substance abuse services and to receive more community-based day treatment services, medication services, and case management services. However, the costs of that care differed by only 2 to 4 percent from those for white women. Presence of a psychotic disorder and co-occurring substance use-need-related factors-were significant predictors of higher inpatient care costs for all the women in the sample. Presence of a psychotic or major affective disorder and eligibility for Medicaid-an enabling factor-were the most significant predictors of higher outpatient costs for the sample. Receipt of more community-based services was significantly and inversely related to inpatient care costs, regardless of race. CONCLUSIONS: In this sample of African-American and white women, consumers' needs were a significant predictor of service use. Patterns of care that were tailored to consumers' needs were not significantly more costly overall.
Adolescent↗