Kathleen J. Pottick

Factors associated with inpatient and outpatient treatment for children and adolescents with serious mental illness

OBJECTIVE This study describes the distribution of children and adolescents in psychiatric inpatient and outpatient facilities and identifies factors associated with the selection of individuals into inpatient versus outpatient care. SAMPLE DATA: The data are from a 1986 nationally representative sample surveyed by the National Institute of Mental Health. RESULTS Results indicate that the vast majority of children and adolescents with psychiatric problems receive outpatient treatment rather than inpatient care. Factors that predict psychiatric hospitalization rather than outpatient care are (1) public or private insurance coverage versus no insurance; (2) previous hospitalization; (3) psychiatric diagnosis of affective or psychotic disorders versus conduct disorders, adjustment disorders, drug and alcohol abuse, and other disorders; and (4) age, with adolescents more likely to be hospitalized than children. CONCLUSIONS Further research is needed to explore the role of insurance in mental health sorting processes. Moreover, systematic, controlled research is needed to determine how different financing strategies affect mental health outcomes for children and adolescents.

Youths living away from families in the US mental health system

This study examines the clinical characteristics of youths who lived away from families at the time of admission to specialty mental health services, and investigates the association between type of nonfamily living situation and admission to residential versus outpatient programs. Of 3995 youths sampled from 1598 mental health programs in the United States, 14% lived away from their own families, either in foster care, group care settings, or correctional settings, or were emancipated. As a group, youths living away from families were more seriously emotionally disturbed and more likely to receive treatment in residential care programs. Youths who lived in foster care were more likely to be admitted to outpatient programs, while youths who lived in group care settings or correctional settings were more likely to be admitted to residential care programs, controlling on demographic and clinical characteristics. Targeting resources to enhance the availability and therapeutic capacity of foster care may facilitate community living, and decrease time spent in institutional settings.

Changing patterns of inpatient care for children and adolescents at the Menninger clinic, 1988-1994

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N = 784) at the Menninger Clinic from 1988 to 1994. During this period. median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents.

The lay concept of conduct disorder: do nonprofessionals use syndromal symptoms or internal dysfunction to distinguish disorder from delinquency?

Background: Conduct disorder (CD) must be distinguished from nondisordered delinquent behaviour to avoid false positives, especially when diagnosing youth from difficult environments. However, the nature of this distinction remains controversial. The DSM-IV observes that its own syndromal CD diagnostic criteria conflict with its definition of mental disorder, which requires that symptoms be considered a manifestation of internal dysfunction to warrant disorder diagnosis. Previous research indicates that professional judgments tend to be guided by the dysfunction requirement, not syndromal symptoms alone. However, there are almost no data on lay conceptualizations. Thus it remains unknown whether judgments about CD are anchored in a broadly shared understanding of mental disorder that provides a basis for professional–lay consensus. Objective: The present study tests which conception of CD, syndromal-symptoms or dysfunction-requirement, corresponds most closely to lay judgments of disorder or nondisorder and compares lay and professional judgments. We hypothesized that lay disorder judgments, like professional judgments, tend to presuppose the dysfunction requirement. Method: Three lay samples (nonclinical social workers, nonpsychiatric nurses, and undergraduates) rated their agreement that youths described in clinical vignettes have a mental disorder. All vignettes satisfied DSM-IV CD diagnostic criteria. Vignettes were varied to present syndromal symptoms only, symptoms suggesting internal dysfunction, and symptoms resulting from reactions to negative circumstances, without dysfunction. Results: All lay samples attributed disorder more often to youths whose symptoms suggested internal dysfunction than to youths with similar symptoms but without a likely dysfunction. Conclusions: The dysfunction requirement appears to reflect a widely shared lay and professional concept of disorder.

Clinical Characteristics and Outpatient Mental Health Service Use of Transition-Age Youth in the USA

This study examines diagnostic and service utilization patterns of transition-age youth in outpatient care derived from the 2007 nationally representative Client/Patient Sample Survey. Comparisons between 16–17, 18–21, and 22–25 year olds are highlighted. Among transition-age outpatients, the oldest youth had the highest rates of depression and bipolar disorder and co-occurring medical and substance use problems. Controlling for sociodemographic and clinical characteristics, 18–21 year olds were less likely to receive individual therapy than 16–17 year olds, but there were no age group differences in receipt of specialized therapy or psychotropic medication. Female gender and Hispanic ethnicity were positively associated with the number of services received and specialized service use, respectively; youth with private insurance were more likely than those with public insurance to receive psychotropic medication. Implications are discussed regarding access to and adequacy of services provided for young people in the critical transition to adulthood, especially with the implementation of the 2010 Affordable Care Act.

Clinical and Organizational Correlates of Medication for Youths in U.S. Mental Health Services

Organizational characteristics and payment sources are known to affect clinical decision making, but their influence in psychotropic medication practice is rarely studied. With data from nationally representative specialty mental health clinics, this article analyzes client and organizational predictors of psychotropic medication prescription to youths in outpatient programs. Findings suggest that factors beyond clinical profile predict medication receipt. These factors include payment source and program ownership (i.e., public, nonprofit, for‐profit). One implication of the results is that equally ill youths are treated differently depending on the organizational context. The implementation of best prescribing practices requires simultaneous attention to the incentives that promote equitable delivery of mental health services.

Influence of Social Workers’ Characteristics on the Perception of Mental Disorder in Youths

Modern versions of the Diagnostic and Statistical Manual are meant to reduce biases in judgment. This vignette‐based study of 250 student respondents in master of social work programs assesses the influence of their social characteristics on judgments of mental disorder among youths. Most respondents appropriately use contextual information to judge mental disorder. Minorities and women are less likely than nonminorities and men to judge that disorder is present, suggesting that they may be more sensitive than others to the consequences of labeling youths as having mental disorders. Diagnostic and Statistical Manual training removes differences between racial and ethnic groups.

The declining job satisfaction of white-collar women in sex-segregated and mixed-sex occupations

Abstract The declining job satisfaction of women white-collar workers reported by J. Veroff, E. Douvan, and R. A. Kulka (1981, The Inner American: A self-portrait from 1957 to 1976 , New York, Basic Books) is explored through secondary analyses of their data from two national cross-sectional surveys conducted in 1957 and 1976. Analyses were done using data from 258 women in 1957 and 372 women in 1976 in white-collar jobs. Multivariate contingency table analyses were used first to explore the separate effects of type of white-collar employment, whether or not the job was sex segregated, age, birth cohort, and education on job satisfaction declines. The decline in job satisfaction was found to be greater for women in sex-segregated occupations that in mixed-sex ones. In addition, while all white-collar women express increased dissatisfaction with ego-involving aspects of work, those in sex-segregated fields showed the greatest increases in job dissatisfactions in affiliative and achievement spheres. Neither type of white-collar employment nor birth cohort related to differential job satisfaction declines though age and education changes did. The final multivariate analysis demonstrated that the changing age and educational characteristics of job holders in sex-segregated fields accounted for the greater job satisfaction declines for these women, and that sex segregation did not appear to affect job satisfaction beyond changes related to these demographic factors.

Effects of Medication Management and Discharge Planning on Early Readmission of Psychiatrically Hospitalized Adolescents

This study examines the effect of clinical stabilization strategies—medication management and discharge planning—on early readmission of psychiatrically hospitalized adolescents. Controlling for demographic and clinical factors, results showed the risk of readmission was higher for youths who had medications added to an existing medication regimen, were placed in group homes, or discharged to partial hospitalization programs. Overall, findings indicate that stabilization strategies developed collaboratively between psychiatrists and social workers can reduce early readmission. However, improved medication monitoring upon discharge is needed, and the study results raise questions about the use of partial hospitalization to compensate for premature discharge.

Nourish and Publish: An Academic Women's Self-Help Effort

Affirmative action efforts have resulted in the recruitment of more women to junior faculty positions in schools of social work. However, the promotion and retention of women faculty members often depends on the womens ability to write for publication in addition to all the other heavy demands of their positions. This article reports on a self-help group to increase the scholarly output of its three women members. It describes the development of the group, its structure and process, its areas of conflict, and the factors that contributed to its success. Suggestions are made for adapting the effort to other settings.