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PubMed2002

The training gap: an acute crisis in behavioral health education.

Changes in health care have outpaced changes in the educational programs offered to the behavioral health workforce. The result is a training gap that leaves graduate students, working professionals, and other direct care providers inadequately prepared for practice in the current health care environment. This article is based on a keynote address delivered at the Annapolis Conference on Behavioral Health Workforce Education and Training. Major changes in health care are reviewed, followed by a description of the training gap as an acute crisis that impedes the delivery of effective and efficient mental health and addiction services. The author describes a national initiative to narrow the training gap and he calls for collective action by the varied groups and organizations that have a stake in this agenda.

Allied Health Personnel↗

PubMed2006

Factors predicting birth weight in a low-risk sample: the role of modifiable pregnancy health behaviors.

OBJECTIVES: The purpose of the present study was to examine background and modifiable pregnancy health behavior factors predicting infant birthweight in an economically and educationally disadvantaged sample with low medical risk. METHODS: PARTICIPANTS were recruited from a family practice center in rural Appalachia. PARTICIPANTS: Over 220, predominantly Caucasian and lower SES women with low risk pregnancies were included in the sample. Data were collected through systematic chart review. Half of the women smoked during pregnancy and over 10% gave birth to low birth weight (LBW; < 2500 g) babies. RESULTS: Compared with those who gave birth to normal weight newborns, women with LBW babies had more miscarriages, but did not differ significantly on other background factors. Women who delivered LBW babies gained less weight during pregnancy and were more likely to smoke than remaining women. After control for background factors, modifiable pregnancy health behavior factors (weight gain, prenatal care, smoking, alcohol and substance use) accounted for over 11% of birth weight variance, with nearly 7% attributable solely to smoking. CONCLUSIONS: Pregnancy smoking was the strongest behavioral predictor of LBW in this economically and educationally disadvantaged rural sample, suggesting that efforts to reduce LBW in similar populations should include targeting pregnancy smoking.

Abortion, Habitual↗

PubMed1999

Effects of a behavioral health carve-out on inpatient-related quality indicators for major depression treatment.

OBJECTIVES: To analyze the effects of the 1993 Massachusetts behavioral health carve-out for state employees on readmissions and follow-up treatment after hospitalization for major depressive disorder (MDD). METHODS: The sample consisted of 218 continuous enrollees in preferred provider organization and/or indemnity plans who had any MDD admissions during fiscal years 1992 to 1995. These users accounted for 310 MDD admissions. Eligibility files and behavioral health claims were used to analyze readmissions and follow-up treatment after discharge. Kaplan-Meier survival functions were obtained for pre/post (pre-carve-out vs. post-carve-out) comparisons of the two indicators. Cox regression models were used to estimate carve-out effects on readmission and follow-up treatment while controlling for patient variables. Postdischarge contact categories were also compared. RESULTS: The risk of readmission did not change significantly after the carve-out, in either the Kaplan-Meier or Cox regression analyses. Follow-up treatment was significantly more likely after the carve-out, including in the early postdischarge period. There was a significant decrease in the proportion of discharged patients followed by readmission only, and a significant increase in patients receiving follow-up treatment prior to a readmission. CONCLUSIONS: Under this behavioral health carve-out, follow-up treatment was more likely, and estimated risk of readmission did not change significantly for a seriously ill subgroup of enrollees. This was true even when controlling for patient variables and using data for extended time "at risk" for each indicator. Future research on carveouts should move toward direct clinical quality measurement.

Adolescent↗

PubMed1999

Use of psychiatrists, psychologists, and master's-level therapists in managed behavioral health care carve-out plans.

OBJECTIVE: Outpatient claims data from a managed behavioral health company for 1996 were examined to determine the extent to which patients received services from different types of mental health care providers. METHODS: Claims data for 1996 were obtained from 75 plans with more than 600,000 members that were managed by one behavioral health care organization. Data were examined by type of provider and diagnosis. RESULTS: A total of 349,686 claims were examined. Doctoral-level psychologists accounted for most claims (33.4 percent), followed by psychiatrists (30.5 percent), social workers (19.8 percent), and other master's-level therapists (13.8 percent). Ninety-five percent of patients with a psychotic disorder and 86.2 percent of individuals with bipolar disorder were seen either by a psychiatrist alone or by a psychiatrist in combination with another provider. Among depressed patients, 62.9 percent were seen by a psychiatrist, alone or in combination with another provider. Only 23 percent of patients with an adjustment disorder and 14.1 percent of those with a V-code diagnosis were treated by a psychiatrist, alone or in combination with another provider. Because psychiatrists treated sicker patients, their proportion of patients treated (24.7 percent) was smaller than their proportion of all claims filed. Most patients (78.9 percent) saw only one type of provider. CONCLUSIONS: The results allay concerns that managed care shifts patients away from psychiatrists to doctoral-level psychologists and less expensive providers. The majority of patients with depressive disorders and almost all patients with psychotic disorders had contact with a psychiatrist.

Behavioral Medicine↗

PubMedDate not supplied

Patterns of medical resource and psychotropic medicine use among adult depressed managed behavioral health patients.

Medical and pharmacy utilization patterns were examined among 782 depressed patients seen by independent clinicians through a Managed Behavioral Health Organization using behavioral, medical and pharmacy claims spanning 2 years. Two-thirds received psychiatric care in the medical and mental health sector concurrently, 43% had comorbid medical disorders, 61% received psychotropic medications, and 54% were on antidepressants. Fewer depressed medically comorbid patients used medical services while in mental health treatment than before or after treatment, while the per patient costs remained the same. For those with chronic conditions, medical utilization and costs remained the same. A quarter of depressed patients received mental health treatment before seeing a mental health specialist, and a quarter remained in treatment in the medical sector after treatment in the mental health sector. Despite increases in mental health services access made available through managed behavioral health organizations, patients continue receiving mental health treatment in the medical sector.

Adolescent↗

PubMed2001

Health risk behaviors and health perceptions in the Peruvian Amazon.

Behavioral health risk factor and health belief data for the indigenous population of the Peruvian Amazon are unavailable. Therefore, we conducted structured interviews of adults living in 5 towns in the remote Amazon region of Peru. Respondents (n = 179) were 67% women with a mean age of 35.4 years. The average household size was 6.7 people. A majority (72%) were unable to see a doctor when needed because of lack of money and distance. Only 6% reported excellent health, and nearly half (49%) reported fair health. Forty-eight percent drank alcohol and 73% smoked. Only 34% thought mosquitoes cause malaria, but 98% were using mosquito nets. In conclusion, our findings indicate the indigenous population of the Peruvian Amazon has limited access to basic health care. Although most of those surveyed use mosquito netting, few know that mosquitoes transmit malaria. Tobacco and alcohol use are major behavioral health risk factors.

Adolescent↗

PubMed1997

In the eye of the storm. Promoting quality initiatives for behavioral health care.

The restructuring of how behavioral health care services are financed, managed, and delivered has controlled costs but raised concerns about quality. The need and opportunity has never been stronger for professionals and organizations from previously disparate segments of the field to closely collaborate on broad-based quality initiatives. This article reviews the collaborative initiatives established by one organization that are affecting all segments of the field through research projects, publications to disseminate information, and conferences to promote discussion. Implications, new directions, and opportunities for evaluation researchers are proposed.

Health Promotion↗

PubMed2001

[Models of health behavior].

One of the challenges for health professionals is to understand how individuals adopt and maintain healthy behaviours that lead to a better quality of life. This review of health behaviour models will help nurses determine appropriate interventions, and enhance programs that promote health and prevent sickness in individuals or groups of individuals. In order to establish priorities and to prevent omitting important points in planning such health programs, many theoretical and conceptual models have attempted to explain health behaviours as well as the indicators of compliance. The purpose of this article is to summarise the most utilised health behaviour models, to offer a schematic representation, and to explain the advantages and disadvantages of each model. Until now, no article had reviewed these models into the same work. This article will be of assistance to nurse researchers and clinicians working in health prevention, who are interested in choosing a health behaviour model to plan a scientific research, or to develop a clinical program. The models are presented according to the following classifications: cognitive value expectation; theories of personality; communication theories; models of program planning; and models of integration.

Attitude to Health↗

PubMed1999

Benefit limits in managed behavioral health care: do they matter?

More than half of Americans with insurance coverage for mental health services are enrolled in plans that carve out behavioral health care services with a vendor specializing in the management of these services. However, utilization management has not taken the place of benefit limitations. Do benefit limits matter? This article reports the percentage of enrollees in managed behavioral health care carve-out plans that encounter benefit limits. Estimates are provided on the impact and savings of imposing benefit limits on enrollees in unrestricted plans. Costs to eliminate benefit limits are estimated to be very small. This study finds that benefit limits do matter but only to a very small number of plan enrollees. Furthermore, the results of this study show that for inpatient limits, children are especially vulnerable. These issues have important implications for discussions about the impact of managed care in mental health and for discussions concerning parity legislation.

Adult↗

PubMedDate not supplied

[Health behavior of schoolchildren in a metropolitan area of Madrid].

BACKGROUND: To describe health behavior of students about diet, alcohol and tobacco, dental-oral hygiene, leisure time activities and interpersonal relations. METHODS: 942 Students have been carried out. Children come from six schools of the town of Parla (in the south of Madrid). They are from 9 to 14 years old. The instruments have been made for this study, helping by teachers of EGB. RESULTS: 50% of the students doesn't eat any food at 12 o'clock, after drinking a glass of milk only at breakfast (8 o'clock). 10% never eats greens. 37% of the children in the upper level drinks alcohol sometimes and, in the same level, 12% smokes sometimes. Around 25% of children brush their teeth three times in the day. The students watch television three hours and half, means, in the day. The communication with the teacher is evaluated from "not too bad" to "bad" by 70% of the students of upper level. 42% and 39.4% of the children talks about abortion and contraceptives, respectively, with nobody. CONCLUSIONS: In general, girls have better habits than boys. Only exercise is more prevalent in the boys than in the girls.

Adolescent↗

PubMed1997

Acceptability of genital herpes immunization. The role of health beliefs and health behaviors.

BACKGROUND AND OBJECTIVES: Little is known about the acceptability of vaccines for prevention of sexually transmitted diseases (STDs). The purpose of this study was to examine potential predictors of genital herpes simplex virus type 2 (HSV-2) vaccine acceptability. GOALS: To evaluate the relationship of health beliefs and health behaviors to HSV-2 vaccine acceptability. STUDY DESIGN: Three hundred twenty-one subjects participating in two phase III clinical trials for an HSV-2 vaccine completed surveys addressing health beliefs, health behaviors, and acceptability of hypothetical HSV-2 vaccines. RESULTS: Bivariate analyses found that perceived benefits of vaccination, seatbelt use, a healthy diet, and having had cholesterol levels checked were associated with higher acceptability. Perceived limitations of HSV-2 immunization, alcohol use, and exercise were associated with lower acceptability. Multiple regression analysis identified perceived benefits of vaccination, decreased exercise, and lower alcohol use as significant independent predictors of greater HSV-2 vaccine acceptability. CONCLUSIONS: In groups of high-risk individuals who had completed participation in HSV-2 clinical trials, health beliefs and health behaviors influenced acceptability of hypothetical HSV-2 vaccination. The findings support the need to understand determinants of acceptance of vaccines for HSV-2 and other STDs.

Adult↗

PubMed2001

Self-efficacy perceptions in oral health behavior.

The aim of this paper is to describe and understand people's views on dental self-efficacy and its formation. The qualitative data were collected by means of focused interviews with five patients selected on the basis of poor orientation to dental-care matters, measured using test scores from a previous questionnaire. The first stage of the analysis is a description of the background of the subjects from their own accounts; two proved to have internalized preventive dental beliefs and behavior deeply while two others had traumatic experiences as a reason for irregular dental appointments. One subject with poor oral health behavior seemed to have limited preventive action to his yearly dental appointment. The second stage of the analysis focuses on interpretation of the subjects' perception of self-efficacy and related comments. Among sources of self-efficacy that prove important in dental care are the cognitive, experiential, supportive and emotional dimensions, and beliefs and values learned in the family and at school. This qualitative research increases our understanding of the oral health behavior of patients and emphasizes the importance of patient-centered oral health education.

Adult↗

PubMed1998

Gender role orientation as a correlate of perceived health, health behavior, and qualitative well-being in older women.

This study investigated the relationships of gender role orientations (Feminine, Masculine, & Androgynous) with self-perceived health status, health behavior, and qualitative well-being experience in a simple random sample of community-dwelling older women (N = 70). Instruments used were The Bem Sex Role Inventory (Bem, 1974); The Seniors' Lifestyle Inventory (Schwirian, 1991); and The Integration Inventory (Ruffing-Rahal, 1991). Findings revealed the greatest number of significant positive correlations with the Feminine orientation; Androgyny was significantly linked with qualitative well-being and with a positive self-comparison in relation to peers and Masculinity was positively linked with health behavior. Findings are interpreted in light of successful aging issues for older women.

Aged↗

PubMed2005

The "lost boys of Sudan": functional and behavioral health of unaccompanied refugee minors re-settled in the United States.

OBJECTIVE: To assess the functional and behavioral health of unaccompanied Sudanese refugee minors approximately 1 year after resettlement in the United States. DESIGN: A descriptive survey. SETTING: Local refugee foster care programs affiliated with the US Unaccompanied Refugee Minors Program. PARTICIPANTS: A total of 304 Sudanese refugee minors enrolled in the US Unaccompanied Refugee Minors Program. MAIN OUTCOME MEASURES: Health outcomes were assessed using the Harvard Trauma Questionnaire and the Child Health Questionnaire. Outcomes included the diagnosis of posttraumatic stress disorder and scores on all Child Health Questionnaire subscales and global single-item assessments. RESULTS: Twenty percent of the minors had a diagnosis of posttraumatic stress disorder and were more likely to have lower (worse) scores on all the Child Health Questionnaire subscales. Low functional and behavioral health scores were seen mainly in functioning in the home and in subjective health ratings. Social isolation and history of personal injury were associated with posttraumatic stress disorder. CONCLUSIONS: Unaccompanied Sudanese minors have done well in general. The minors function well in school and in activities; however, behavioral and emotional problems manifest in their home lives and emotional states. The subset of children with traumatic symptoms had characteristics that may distinguish them from their peers and that may inform future resettlement services for unaccompanied minors in the United States.

Adolescent↗

PubMed1995

The effects of maternal health behaviors and other risk factors on immunization status among Mexican-American infants.

OBJECTIVE: Few studies have investigated the effect of maternal health behaviors on the utilization of childhood preventive care. We evaluated a sample of 788 Latino mother-infant pairs to determine whether, in addition to other characteristics, maternal health risk behaviors are associated with infant immunization status. METHODOLOGY: We conducted a cross-sectional survey of Mexican origin mothers of infants 8 to 16 months of age living in San Diego County, CA. In addition to sociodemographic and health care factors, we assessed maternal behaviors such as tobacco and alcohol consumption, safety precautions, and the organization of the home environment, and examined their relation to adequate childhood immunization status. RESULTS: When grouped together in a maternal health risk index, maternal health behaviors showed a dose-response relationship with inadequate immunization status. After controlling for confounders, each point increase on the health risk index was associated with a 20% increase in the likelihood of inadequate childhood immunizations. Marital status, parity, life stress, time lived in neighborhood, Spanish language, and child age were also important predictors. CONCLUSION: Early identification of children at risk for underimmunization may be aided by focusing on maternal health behaviors in addition to other sociodemographic characteristics.

California↗

PubMed2001

Time trends in oral health behaviors among Norwegian adolescents: 1985-97.

The purpose of this study was to investigate 1) the temporal changes in oral health behaviors and 2) the development of the distribution of oral health behaviors on the basis of socioeconomic factors among Norwegian adolescents from 1985 to 1997. Large-scale national surveys to assess smoking, intake of sweets, soft drink consumption, and toothbrushing among Norwegian adolescents were conducted in November 1985, 1989, 1993, and 1997. The surveys were part of the World Health Organisation (WHO) international study, Health Behaviour in School-aged Children. A total of 3955 (1985), 5037 (1989), 4952 (1993), and 5026 (1997) 11-, 13-, and 15-year-old students completed anonymous questionnaires at school. The response rates varied from 79% to 90%. The results showed a strong increase in the percentages reporting ever smoking and daily intake of soft drinks and sweets with age from 11 to 15 years in each survey year. In 1997, at the age of 15 years, most students reported toothbrushing more than once a day (94% boys, 97% girls) and ever smoking (39% boys, 36% girls), whereas moderate proportions confirmed daily intake of soft drinks (28% boys, 19% girls). Comparison of the results across the survey years, from 1985 to 1997, showed an overall decrease in ever smoking (boys, 59% versus 39%; girls, 52%, versus 36%) and toothbrushing more than once a day (boys, 95% versus 94%; girls, 99% versus 97%). Contemporary increases occurred with regard to daily soft drink consumption. Inequalities in ever smoking and daily soft drink consumption between socioeconomic status groups decreased and increased, respectively, from 1983 to 1997. The sex disparities observed in 1985, with boys being more likely than girls to report ever smoking and daily soft drink consumption, leveled off in 1997.

Adolescent↗

PubMed2005

Behavioral health: integrating research and application in support of exploration missions.

"Safe Passage: Astronaut Care for Exploration Missions," (Ball JR, Evans CH, eds. Washington, DC: National Academy Press; 2001) draws attention to behavioral health, an overarching topic that subsumes psychological, interpersonal, and cultural adaptation in space. On December 2-3, 2003, the University of California, Davis, was the site of a NASA-funded workshop entitled "New Directions in Behavioral Health: Integrating Research and Application." The purpose of the Workshop was to promote fruitful dialogue between researchers and operational personnel in the interests of expanding our understanding of behavioral health on Exploration missions including a return to the Moon and a voyage to Mars. This paper presents an overview of the rationale and findings of that workshop.

Adaptation, Physiological↗

PubMed1997

Relationships between health behavior, knowledge, and beliefs among Swedish blue-collar workers.

The main objective of this study was to assess the health behavior, risk awareness and beliefs concerning the importance of positive health practices among blue-collar workers, and to examine the relationships between behavior, knowledge and beliefs. Data were gathered from 1359 workers aged 18-65 years using a postal questionnaire to 2493 randomly selected members of two labor unions. A high prevalence of negative health practices was noted among the respondents. While no relationship was found between health behaviors and awareness of risks associated with such behaviors, there was a relationship between positive health practices and strong beliefs about the importance of those practices. Awareness of the influence of a positive behavior on disease risk was associated with a stronger belief concerning the importance of that behavior. Women were characterized by having more positive health behavior, a higher level of risk awareness and stronger beliefs concerning the importance of positive health practices. It was concluded that while relationships were found between behavior and beliefs, and between beliefs and risk awareness, further research to establish the direction of the relationships is warranted.

Adult↗