Sharon Green-Hennessy

An economic and clinical rationale for changing utilization review practices for outpatient psychotherapy

The growth of managed care has led to greater cost consciousness in the financing and delivery of mental health and substnace abuse services. The authors examine whether pressures to reduce the costs associated with mental health and substance abuse treatment have led to the overapplication of a popular managed care strategy, utilization review (UR), to the management of outpatient psychotherpay benefits. Several arguments are presented highlighting why changing outpatient psychotherapy UR practices would be in the best economic and clinical interests of all involved parties, including payers, managed care organizatios, (MCOs), mental health consumers, and providers. A number of alternatives to the aggressive management of outpatient psychotherapy benefits are outlined and discussed.

Homeschooled adolescents in the United States: developmental outcomes.

The mission of schools has broadened beyond academics to address risk behaviors such as substance use, delinquency, and socialization problems. With an estimated 3.4% of all U.S. youth being homeschooled, this study examines how U.S. homeschoolers fare on these outcomes given their lack of access to these school services. Adolescents (ages 12-17) from the 2002 through 2011 National Surveys of Drug Use and Health (NSDUH) were divided based on school status (home vs. traditional schooling) and religious affiliation (stronger vs. weaker). Controlling for demographic differences, homeschoolers with weaker religious ties were three times more likely to report being behind their expected grade level and two and a half times more likely to report no extracurricular activities in the prior year than their traditionally schooled counterparts. This group was also more likely to report lax parental attitudes toward substance use. Findings suggest homeschoolers with weaker religious ties represent an at-risk group.

A Review of Mental Health Interventions in SAMHSA's National Registry of Evidence-Based Programs and Practices

OBJECTIVE This study identified and examined characteristics of mental health interventions listed in a registry of evidence-based behavioral health programs and practices. METHODS Data were from the National Registry of Evidence-Based Programs and Practices (NREPP), which is sponsored by the Substance Abuse and Mental Health Services Administration. All mental health interventions posted as of May 2010 were reviewed. RESULTS A total of 91 interventions were assessed. Over half (57%) focused on promoting mental health rather than on treating mental illness. The implementation materials and trainings for most interventions (52%) were proprietary. Analysis of NREPPs rated dimensions revealed that quality-of-research scores were significantly lower for interventions with exclusively proprietary materials, whereas readiness-for-dissemination scores were significantly lower for interventions with exclusively publicly available materials. CONCLUSIONS NREPP represents a practical tool for organizations seeking to initiate or expand their use of evidence-based services. Periodic studies of listed interventions may help to identify programmatic gaps in NREPP.

Datapoints: Reported Mental Health Specialty Care in the 2010 HealthStyles Survey

O measure of progress in reducing negative attitudes toward people with mental illness is the extent to which members of the general public who report having a mental health condition seek specialist care. To examine this issue more closely, we analyzed adult responses to the 2010 edition of the HealthStyles Survey. The survey is a large, private proprietary, national mail panel marketing survey conducted annually to assess attitudes and beliefs about chronic and infectious disease and behaviors, exposure to health information and to health communication campaigns, and self-reported symptoms, risk factors, diseases, and disorders (1). The survey is designed to be representative of the U.S. population, and the 2010 survey data were weighted to match the 2009 Current Population Survey estimates for age, sex, marital status, education, and race-ethnicity. The 2010 survey was mailed to 6,255 respondents; the response rate was 67% (4,184 individuals age 18 and over). Most respondents agreed with statements that a person with mental illness would improve if given treatment and support (68%) and that treatment can help people with mental illness lead a normal life (65%). A subset of respondents (24%) self-reported having one or more of eight listed mental health conditions in the past year. Among those with a self-reported mental health condition, approximately 42% reported having more than one mental health condition. For those with either a single condition or multiple conditions, depression and anxiety were the most prevalent, accounting for almost 80% of all conditions in both groups. Figure 1 presents data about respondents with one or more self-reported mental health conditions who reported visiting a mental health specialty provider in the previous year and the extent of these visits. Only 17% of those with one self-reported condition and 46% of those with multiple self-reported conditions saw a mental health provider during the previous year. Further, among those who visited a mental health provider, most made fewer than six visits. Among those with a single condition who sought treatment, 79% reported six or fewer visits. Among those with multiple conditions, 58% reported six or fewer visits. Reported Mental Health Specialty Care in the 2010 HealthStyles Survey

Coverage of mental health and substance misuse topics in the Cochrane review system.

Aims. To assess the breadth of mental and substance coverage in the Cochrane review system. Methods. All mental health and substance entries were identified from the 2005 to April 2012 Cochrane Database of Systematic Reviews. Results. A total of 1019 entries focused on mental health or substance misuse, with 698 (68.5%) being completed reviews. One out of every five entries focused on serious mental illness/psychosis. Systematic reviews addressing unipolar depression, dementia and certain substance disorders also appeared well-represented. In contrast, a number of impairing disorders frequently seen in practice received less attention, with bipolar disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and autism spectrum disorders each accounting for less than 2% of the entries. The majority of interventions reviewed involved medication (57.1%), although this was not the case for a number of childhood-onset disorders. Some diagnostic areas (sleep, anxiety, mood and substance) were addressed by multiple Cochrane review groups (CRGs). Conclusions. The Cochrane Collaboration is well poised to be a strong guiding influence to those seeking to employ evidence-based mental health care. Broadening its diagnostic coverage and diversifying types of intervention reviewed would probably further maximize its impact. A more centralized and directed approach of prioritizing topics could help ensure more comprehensive coverage.

Suspension of the National Registry of Evidence-Based Programs and Practices: the importance of adhering to the evidence

Recently the United States Assistant Secretary of Mental Health and Substance Use disclosed having suspended the National Registry of Evidence-Based Programs and Practices, stating it was so deficient in both rigor and breadth that it must be replaced. However, a closer examination of her claims about the Registry indicates many of them to be inaccurate. Contrary to her assertions, the Registry is not devoid of medication-assisted treatments for opioid use; nor does it contain but a scant few interventions related to schizophrenia and psychosis. Moreover, many of her criticisms regarding rigor pertain to reviews completed since late 2015, when the Substance Abuse and Mental Health Services Administration altered key aspects of the Registry. In contrast to reviews generated under the 2007 rules, these newer reviews rely on fewer references, incorporate less expert input, are more likely to be based exclusively on gray literature, and are no longer required either to provide dissemination readiness information or meet certain minimum research quality standards. However, only 123 (25.7%) of the 479 Registry interventions have been reviewed solely using the problematic 2015 criteria, with the remaining 356 interventions having a review which use the 2007 guidelines. Yet, rather than address the agency’s recent missteps and expand the Registry’s content coverage, the agency appears to have decided to invest considerable resources into replacing it, relying heavily on expert consensus versus empirical data in its initial attempt to do so. This raises questions about the agency’s current commitment to evidence-based practice.