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PubMedDate not supplied

More evidence for the insurability of managed behavioral health care.

Debate continues about the cost and use of mental health services under managed care, as legislators consider various "parity" bills. This descriptive research replicates, broadens, and expands previously published case studies of single employers' data on cost and treatment prevalence in a large, diverse, national sample whose varied point-of-service benefits were provided by thirty employers representing multiple industries. Of those covered, 59,005 received treatment over the seven years studied. Of particular note is the pattern of increased use, increased care within the managed behavioral health organization network, and long-term cost reductions.

Behavior Therapy↗
PubMed1988

Abuse, feelings, and health behaviors in a student population.

Behavioral sequelae of child abuse are frequently cited, but there are few studies that examine the strength of association between behavioral effect and abuse for children in a nonclinical setting. Seven hundred twelve junior high school students (mean age, 13.5 years) were surveyed for self-report of personal experience with abuse, certain health behaviors, and self-esteem. Physical and/or sexual abuse was reported by 18.3% of students. Both types of abuse were associated with the following behaviors: running away; considering hurting oneself; suicide attempts; and the use of drugs, pot (marijuana), cigarettes, and laxatives. No clinically significant relationships were found between abuse and report of anger, sadness, or self-esteem. These data suggested that some feelings and behaviors were common among all adolescents sampled, while others were more common among abused adolescents. Recognition of strong associations should help direct clinical management. The results of this study confirm findings from some previous reports and indicate the need for further studies of children who are not in a clinical setting.

Adolescent↗
PubMed1999

An examination of body weight standards and the association between weight and health behaviors in the United States Air Force.

This study examined the weight standards used by the U.S. Air Force and tested whether Air Force personnel who exceed the maximum allowable weight standard are more likely to engage in health risk behaviors compared with individuals who do not exceed current Air Force weight standards. Participants were 32,144 individuals who completed basic military training from August 1995 to August 1996. Compared with body mass levels known to predict increased health risks, the Air Force maximum allowable weight standards were found to be more stringent for women than for men. Furthermore, exceeding the maximum allowable weight standard of the weight management programs did not consistently indicate that an individual engaged in a less healthy lifestyle than other airmen. Perhaps other risk factors, such as cigarette smoking, may be more closely linked to negative health consequences than body weight.

Adolescent↗
PubMed1992

Young women's antisocial behavior and the later emotional and behavioral health of their children.

OBJECTIVES: Antisocial and criminal behavior are increasing among US youth, especially among females. Thus, questions arise concerning whether youthful female deviant behavior eventually will have negative behavioral and emotional consequences for the later children of these women. METHODS: Associations between the severity of early female antisocial behavior (including both drug-related and non-drug related offenses) and the later behavioral and emotional health of the children of these women were examined among 1425 mother-child pairs of the National Longitudinal Survey of Youth. RESULTS: Multiple linear regression procedures indicated a significant positive relationship between the severity of the mothers' early non-drug-related offenses and the later severity of the children's scores on the Antisocial, Hyperactive, Anxious/Depressed, Headstrong, Peer Conflict/Social Withdrawal, Immature Dependency, and Total Problem subscales of the Behavior Problem Index. CONCLUSIONS: This study demonstrated an association between the antisocial behavior of female youth and the later behavioral and emotional problems of the children of these women. Future research needs to determine the mechanisms underlying the intergenerational transmission of these types of problems so that effective preventive and therapeutic public health practices may be designed and implemented.

Adolescent↗
PubMed2002

Current issues in continuing education for contemporary behavioral health practice.

The evolving health care system poses a number of challenges for the continuing development of the professional workforce. An overview of continuing education is provided, including typical objectives, format, content, and sponsors. Data are presented on continuing education requirements by discipline and by state. The forces of change that have driven the need for revised approaches to continued professional development are described, including research findings on the apparent lack of effectiveness of didactic learning activities. Current issues in continuing education are discussed, with a focus on educational content, financing, and the use of emerging technologies as a medium for these activities. The authors conclude with five recommendations for improving the process and content of continuing education for the professional behavioral health workforce.

Behavioral Sciences↗
PubMed1990

A program for health behavior change in a preventive cardiology center.

The Preventive Cardiology Center at the University of California, San Diego, was designed to conduct training, service activities, and research related to behavioral modification of cardiovascular disease (CVD) risk. A primary aim is to train medical students and other health care professionals in the application of scientifically established methods of behavior change. This training takes place in the context of a behavior-change program for patients with CVD risk factors. Participants at increased risk for CVD and their families are recruited to the Preventive Cardiology Center. A comprehensive assessment of physiological and behavioral risk factors leads to the development of dietary and/or exercise behavior-change targets. A five-session group intervention instructs participants how to change health behaviors. Behavioral techniques included in the program include self-monitoring, goal-setting, social support, self-reward, self-talk, and problem solving. Students and others are trained through readings, videotapes, and coleading of intervention groups.

Academic Medical Centers↗
PubMed2005

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.

Adult↗
PubMed2000

Developing a quality management system for behavioral health care: the Cambridge Health Alliance Experience.

The rapid pace of change in the health care system presents tremendous challenges for clinicians and managers charged with the delivery of mental health and substance abuse services. Declining reimbursement, new incentive structures, and increasing competition are placing unprecedented pressure on providers to deliver care efficiently. Regulatory scrutiny, consumer dissatisfaction, and a growing awareness of gaps between actual and ideal practice have led to intensifying pressure to improve quality. Yet system change has also presented new opportunities for managing cost and quality of care. Consolidation of facilities and practices into integrated networks, developments in information systems technology, and the emergence of models to facilitate change have led to the rise of "quality management," a framework for assessing and improving clinical, operational, and financial performance within a health care organization. This article reviews some of the precipitating factors and theoretical structures underlying quality management and then, through a case study of one organization's experience, describes the implementation of a quality management program in a behavioral health care delivery system. The case study emphasizes how theoretical frameworks were operationalized and how organizational structure and process were shaped to address challenges well known in quality management, such as authority, accountability, and follow-through. A multiphase model of quality management program development is formulated and used to provide context for this program's development.

Adolescent↗
PubMed2002

Differentiation of the health behavior patterns related to prostate cancer screening among African-American men in military settings.

The objectives of this study were to identify, describe, classify, and differentiate African-American men (AAM) in military settings according to the frequency with which they regularly, infrequently, or did not screen for prostate cancer using factors of the Health Belief Model. Participants in the study included 147 military health care beneficiaries who were AAM 40 years of age and older. Self-reporting questionnaires were used to collect data pertaining to the objectives. The results revealed that 85% of the men reported having screened for prostate cancer and more than 54% of them reported screening "annually." Discriminant analysis statistics revealed that age, education, and "perceived benefits" of the digital rectal examination and the prostate-specific antigen test best differentiated AAM who screened annually compared with nonscreeners. Educating AAM on the benefits and efficacy of the digital rectal examination and prostate-specific antigen tests may be helpful in increasing screening practices in this high-risk group.

Adult↗
PubMedDate not supplied

The primary prevention of heart disease in women through health behavior change promotion in primary care.

PURPOSE: To summarize recent evidence-based recommendations for physical activity promotion, dietary improvement, and tobacco cessation from the U.S. Preventive Services Task Force (USPSTF) and the Task Force on Community Preventive Services (CTF), and examine their applicability to the primary prevention of cardiovascular disease (CVD) in women through primary care interventions. METHODS: For the behaviors cited, USPSTF and CTF recommendations and their associated systematic evidence reviews (SERs) were retrieved. Individual articles from the USPSTF healthy diet and physical activity SERs that met our inclusion criteria were systematically examined to determine the applicability of this research to women. We supplemented findings from these sources with comprehensive federal research summaries and SERs from focused searches of systematic review databases relevant to primary CVD prevention in women through healthy behavior change. MAIN FINDINGS: The USPSTF strongly recommends primary care interventions for tobacco cessation. Strong CTF recommendations for multicomponent systems supports for clinicians, telephone support for quitters, and reduced patient costs for effective cessation therapies guide complementary approaches to assist clinicians. The USPSTF recommends intensive behavioral dietary counseling by specialists for high-risk CVD patients, but found insufficient evidence to recommend for routine healthy diet or physical activity promotion in primary care. The evidence base for these recommendations generally applies to women. Better reporting of gender and minority subgroup outcomes will assist more in-depth understanding of potential differences in either the processes or outcomes of behavior change interventions. CONCLUSIONS: Primary care clinicians, including obstetrician-gynecologists, can contribute to preventing CVD in women through implementing credible evidence-based recommendations for clinical interventions in tobacco and healthy diet. Researchers can further our understanding of gender-specific issues in healthy behavior interventions by reporting process and outcome data for gender and minority subgroups.

Diet↗
PubMed1995

Personal incentives as determinants of adolescent health behavior: the meaning of behavior.

It has been suggested that prevailing theories do not fully incorporate the less rational, more emotional elements of adolescent health and risk behavior. To address this limitation, the perceived incentives construct from Tappe's Model of Personal Investment is split into intrinsic and extrinsic incentives, with the intrinsic incentives representing personal meanings of adolescent health and risk behaviors. Intrinsic incentives were operationalized using transcripts from focus group interviews for three behavioral domains: sleeping habits, eating habits at lunch and eating habits after school. The ensuing questionnaire was completed by 416 Dutch secondary school students with a mean age of 14 years. Intrinsic incentives, or the personal meaning with which behavior is imbued, predicted health and risk behaviors well in all three behavioral domains. The implications of these results for further research and for the development of health education programs are discussed.

Adolescent↗
PubMed2004

Behavioral health outcomes associated with religious faith and media exposure about human genetics.

A number of scholars have speculated that religious people will be less likely than others to ascribe either fatalistic or deterministic powers to genes, opting instead to leave freedom as a choice for both God and humans. This research investigates the role of religious faith (RF) on behavioral health outcomes associated with information about genes and health, as well as its role as a gatekeeper to media information about genes and health. This research is based on the results of a survey of 858 members of the lay public, including northeastern and southeastern rural and urban participants. Findings are considered within frameworks of audience segmentation principles associated with RF.

Adolescent↗
PubMed1999

Use of the balanced scorecard to improve the quality of behavioral health care.

As the debate over managed care continues, measuring quality has increasingly become a focus in health care. One approach to measuring quality is the use of a scorecard, which summarizes a critical set of indicators that measure the quality of care. The author describes the Balanced Scorecard (BSC), a tool developed for use in businesses to implement strategic plans for meeting an organization's objectives, and shows how the BSC can be adapted for use in behavioral health care. The scorecard addresses quality of care at five levels: financial, customer, outcomes, internal processes, and learning and growth. No more than four or five realistic objectives are chosen at each level, and an indicator for the achievement of each objective is designed. The BSC integrates indicators at the five levels to help organizations guide implementation of strategic planning, report on critical outcomes, and offer a report card for payers and consumers to make informed choices.

Behavioral Medicine↗