Andrew Grogan-Kaylor

Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions Across Primary, Specialty, and Behavioral Health Care Settings: Systematic Review and Meta-Analysis

OBJECTIVE Collaborative chronic care models (CCMs) improve outcome in chronic medical illnesses and depression treated in primary care settings. The effect of such models across other treatment settings and mental health conditions has not been comprehensively assessed. The authors performed a systematic review and meta-analysis to assess the comparative effectiveness of CCMs for mental health conditions across disorders and treatment settings. METHOD Randomized controlled trials comparing CCMs with other care conditions, published or in press by August 15, 2011, were identified in a literature search and through contact with investigators. CCMs were defined a priori as interventions with at least three of the six components of the Improving Chronic Illness Care initiative (patient self-management support, clinical information systems, delivery system redesign, decision support, organizational support, and community resource linkages). Articles were included if the CCM effect on mental health symptoms or mental quality of life was reported. Data extraction included analyses of these outcomes plus social role function, physical and overall quality of life, and costs. Meta-analyses included comparisons using unadjusted continuous measures. RESULTS Seventy-eight articles yielded 161 analyses from 57 trials (depression, N=40; bipolar disorder, N=4; anxiety disorders, N=3; multiple/other disorders, N=10). The meta-analysis indicated significant effects across disorders and care settings for depression as well as for mental and physical quality of life and social role function (Cohens d values, 0.20-0.33). Total health care costs did not differ between CCMs and comparison models. A systematic review largely confirmed and extended these findings across conditions and outcome domains. CONCLUSIONS CCMs can improve mental and physical outcomes for individuals with mental disorders across a wide variety of care settings, and they provide a robust clinical and policy framework for care integration.

Spanking and child outcomes: Old controversies and new meta-analyses.

Whether spanking is helpful or harmful to children continues to be the source of considerable debate among both researchers and the public. This article addresses 2 persistent issues, namely whether effect sizes for spanking are distinct from those for physical abuse, and whether effect sizes for spanking are robust to study design differences. Meta-analyses focused specifically on spanking were conducted on a total of 111 unique effect sizes representing 160,927 children. Thirteen of 17 mean effect sizes were significantly different from zero and all indicated a link between spanking and increased risk for detrimental child outcomes. Effect sizes did not substantially differ between spanking and physical abuse or by study design characteristics. (PsycINFO Database Record

Corporal Punishment and the Growth Trajectory of Children's Antisocial Behavior

Despite considerable research, the relationship between corporal punishment and antisocial behavior is unclear. This analysis examined (a) the functional form of this relationship, (b) the correlation of initial antisocial behavior and changes in antisocial behavior, (c) differences in the relationship of corporal punishment and antisocial behavior by race, and (d) whether this relationship could be accounted for by unmeasured characteristics of children and their families. Data from 6,912 children in the National Longitudinal Survey of Youth were analyzed using hierarchical linear models. Findings suggested that corporal punishment has a relationship with children’s initial antisocial behavior and with changes in antisocial behavior. No evidence was found for differences in the effect of corporal punishment across racial groups. The relationship between corporal punishment and antisocial behavior persists even when accounting for unmeasured time invariant characteristics of children and families. The findings suggest that corporal punishment is not a preferable technique for disciplining children.

The effect of childhood maltreatment on adult criminality: a tobit regression analysis.

This article reports on the results of an analysis of a data set containing information on 667 nonmaltreated and 908 maltreated children. The data also contain information on whether the study subjects were arrested in early adulthood. Because adult arrests are an imperfect and censored measure of antisocial behavior, tobit regression analysis was used to examine the effect of the subjects’ experiences of child maltreatment on later arrests while controlling for those subjects’ demographic characteristics. The analysis finds that children’s age, race, and sex and experiences of child neglect all have an impact on subsequent adult arrests. However, physical abuse and sexual abuse do not emerge as statistically significant predictors of arrests in this model. The study also illustrates a method for the decomposition of tobit coefficients to extract more information from them.

Violence among men and women in substance use disorder treatment: A multi-level event-based analysis

BACKGROUND This study examined associations between acute alcohol and drug use and violence towards others in conflict incidents (overall, partner, and non-partner conflict incidents) by men and women recruited from substance use disorder (SUD) treatment. METHODS Semi-structured interviews were used to obtain details about interpersonal conflict incidents (substance use, whether specific conflicts were with intimate partners or non-partners) in the 180 days pre-treatment. Participants for this study were selected for screening positive for past-year violence (N=160; 77% men, 23% women). RESULTS Multi-level multinomial regression models showed that after adjusting for clustering within individual participants, the most consistent predictors of violence across models were acute cocaine use (significant for overall, intimate partner and non-partner models), acute heavy alcohol use (significant for overall and non-partner models), and male gender (significant in all models). CONCLUSIONS This study was the first to explicitly examine the role of acute alcohol and drug use across overall, partner and non-partner conflict incidents. Consistent with prior studies using a variety of methodologies, alcohol, cocaine use and male gender was most consistently and positively related to violence severity (e.g., resulting in injury). The results provide important and novel event-level information regarding the relationship between acute alcohol and specific drug use and the severity of violence in interpersonal conflict incidents.

Collaborative chronic care models for mental health conditions: cumulative meta-analysis and metaregression to guide future research and implementation.

Objective:Prior meta-analysis indicates that collaborative chronic care models (CCMs) improve mental and physical health outcomes for individuals with mental disorders. This study aimed to investigate the stability of evidence over time and identify patient and intervention factors associated with CCM effects to facilitate implementation and sustainability of CCMs in clinical practice. Methods:We reviewed 53 CCM trials that analyzed depression, mental quality of life (QOL), or physical QOL outcomes. Cumulative meta-analysis and metaregression were supplemented by descriptive investigations across and within trials. Results:Most trials targeted depression in the primary care setting, and cumulative meta-analysis indicated that effect sizes favoring CCM quickly achieved significance for depression outcomes, and more recently achieved significance for mental and physical QOL. Four of 6 CCM elements (patient self-management support, clinical information systems, system redesign, and provider decision support) were common among reviewed trials, whereas 2 elements (health care organization support and linkages to community resources) were rare. No single CCM element was statistically associated with the success of the model. Similarly, metaregression did not identify specific factors associated with CCM effectiveness. Nonetheless, results within individual trials suggest that increased illness severity predicts CCM outcomes. Conclusions:Significant CCM trials have been derived primarily from 4 original CCM elements. Nonetheless, implementing and sustaining this established model will require health care organization support. Although CCMs have typically been tested as population-based interventions, evidence supports stepped care application to more severely ill individuals. Future priorities include developing implementation strategies to support adoption and sustainability of the model in clinical settings while maximizing fit of this multicomponent framework to local contextual factors.

The Equivalence of the Behavior Problem Index Across U.S. Ethnic Groups

In this study, the authors examine the equivalence of the factor structure of a commonly used symptom checklist of behavioral and emotional problems—the Behavior Problem Index (BPI)—across African American, Hispanic, and White children in the United States. The sample is drawn from the 1998 data file of the Children of the National Longitudinal Survey of Youth, a U.S. data set. The results of the study suggest that the BPI is not equivalent across the three ethnic groups. These findings are consistent when equivalence is tested for a one-factor model, a two-factor model using the internalizing and externalizing dimensions of the BPI, and a six-factor model using the subscales of the BPI. Item-level analyses identify the statistically significant items that are associated with nonequivalence across ethnic groups. The implications of nonequivalent measures for cross-cultural research and practice with families and children are discussed.

Parental spanking of 1-year-old children and subsequent child protective services involvement.

The majority of U.S. parents spank their children, often beginning when their children are very young. We examined families (N=2,788) who participated in a longitudinal community-based study of new births in urban areas. Prospective analyses examined whether spanking by the childs mother, father, or mothers current partner when the child was 1-year-old was associated with household CPS involvement between age 1 and age 5. Results indicated that 30% of 1-year-olds were spanked at least once in the past month. Spanking at age 1 was associated with increased odds of subsequent CPS involvement (adjusted odds ratio=1.36, 95% CI [1.08, 1.71], p<.01). When compared to non-spanked children, there was a 33% greater probability of subsequent CPS involvement for children who were spanked at age 1. Given the undesirable consequences of spanking children and a lack of empirical evidence to suggest positive effects of physical punishment, professionals who work with families should counsel parents not to spank infants and toddlers. For optimal benefits, efforts to educate parents regarding alternative forms of discipline should begin during the childs first year of life.

Unpacking the impact of adverse childhood experiences on adult mental health

Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts.

Parenting and Youth Psychosocial Well-Being in South Korea using Fixed-Effects Models

The present study analyzed the relationship between various parenting practices and an array of adolescent psychosocial outcomes in South Korea, while controlling for demographic, family, school, and neighborhood factors. Analyses were based on five waves of the nationally representative Korea Youth Panel Survey using 3,263 youth (Person Years = 13,121). All parenting (warmth, monitoring, and hostility) and youth’s psychosocial (confidence, depressive symptoms, and aggressive behaviors) measures were reported by the youth. Within-person fixed-effects regression results indicated that parental warmth not only facilitated youth’s confidence, but also protected them against feelings of depression and aggression. Parental monitoring was a predictor of positive self-perception. As a parental measure with a preventive-orientation, monitoring exhibited a trend toward reducing aggressive behavior. On the other hand, hostile parenting was significantly associated with depressive symptoms and aggressive behaviors. Factors external to the family, such as school and neighborhoods were also associated with mental health outcomes among Korean youth.