Knowledge Corner

Adolescent Treatment Framework and Practice Guidelines

Sun, 11 Apr 2010 15:12:14 -0500

The Adolescent Treatment Framework and Practice Guidelines contains the core research and current knowledge that drives the work of Project Fresh Light. The extensive work completed to produce this document enables PFL to provide the most effective and up-to-date resources that are available in the area of adolescent treatment. This information will be useful to anyone working in or around the field of adolescent treatment - from providers, educators and counselors; to policy-makers and care-givers.

PLEASE CLICK BELOW TO SEE EACH SECTION:

Gap Analysis & Map

Sun, 11 Apr 2010 09:25:56 -0500

Adolescent Substance Abuse Treatment
Resources Gap Analysis

The attached Wisconsin map, table and graph have been compiled using the data complied in the 2009 Adolescent Substance Abuse Treatment Directory update.

The number of adolescents per county used is based on the adolescent county population 12-19 years of age. The prevalence information describes those adolescents who - per county - are in need of adolescent abuse and/or dependency treatment.

In 11 counties, there are no treatment provider agencies listed in the Directory for Adolescent in need of substance abuse treatment.

In 55 counties, there are between .5 to one- half of a treatment provider agency available for every 100 Adolescent in need of substance abuse treatment

In 6 counties, there are 1 -2 treatment providers listed in the Directory for every 100 Adolescent in need of substance abuse treatment.

Click below for supporting data:

GAP Analysis Data - SAMHSA

For further information, treatment provider updates or questions regarding this analysis, Please contact:

Susan Endres
Adolescent Treatment Coordinator
Bureau of Prevention, Treatment and Recovery
Department of Health Services

susan.endres@wisconsin.gov
or 608-266-2476

GAP Analysis data has been provided by:
Michael Quirke at BPTER, DMSAS

STUDY: Children with Special Health Care Needs

Fri, 5 Feb 2010 14:45:49 -0600

STUDY PRESENTS ESTIMATES ON THE PREVALENCE AND CORRELATES OF INTERNALIZING MENTAL HEALTH SYMPTOMS AMONG CSHCN

"Our findings on comorbidity [of internalizing mental health symptoms] with other physical and mental health conditions and symptoms extend what is known to a nationally representative sample of CSHCN [children with special health care needs]," state the authors of an article published in Pediatrics online (ahead of print) on January 18, 2010.

One-fifth to one-fourth of children in the United States experience a mental disorder before age 18. Mental conditions among children and adults have been associated with co-occurring or future health and behavior problems. To date, research on mental problems among CSHCN has focused primarily on those with specific conditions or used broad measures that do not distinguish between different types of symptoms.
The article provides estimates of internalizing mental health symptoms among CSHCN with a range of physical and mental health symptoms and mental conditions and identifies significant covariates of these symptoms.

As part of the 2005-2006 National Survey of Children with Special Health Care Needs, the researchers interviewed parents or guardians of CSHCN (ages 3-17) in all 50 states and the District of Columbia and used affirmative answers to either or both of the following items to identify CSHCN with internalizing mental health symptoms: (1) depression, anxiety, disordered eating, or other emotional problems at the time of the survey and (2) difficulty with feeling depressed or anxious, compared with other children of the same age. The analyses estimated the prevalence of internalizing mental health symptoms among CSHCN according to selected sociodemographic characteristics, examined the relationships between covariates of interest and internalizing mental health symptoms, and explored whether factors associated with internalizing mental health symptoms were consistent across age groups and among CSHCN with and without externalizing symptoms.

The authors found that:

* Almost one-third of CSHCN ages 3-17 experienced internalizing mental health symptoms.
* Girls were 16 percent more likely than boys to experience internalizing mental health symptoms.
* Compared with younger children (ages 3-5), older children were two to three times more likely to experience internalizing mental health symptoms.
* Children with behavioral problems were nearly six times more likely to experience internalizing mental health symptoms and those with attention deficit hyperactivity disorder (ADHD) nearly twice as likely to experience internalizing mental health symptoms, compared with those who had neither ADHD nor behavior problems. The next-strongest condition-related association was observed for autism spectrum disorder, followed by frequent headaches or migraines.
* CSHCN who were moderately affected by their conditions were 1.6 times more likely to experience internalizing mental health symptoms, and those whose daily activities were always or usually affected were more than twice as likely to experience internalizing mental health symptoms, compared with those who were never affected.
* CSHCN whose care caused financial problems for the family or whose condition caused a family member to stop or to cut back on work were at increased risk for internalizing mental health symptoms.

"The identification of sociodemographic and other correlates of internalizing symptoms, which may be underidentified in CSHCN, may help clinicians and families to focus screening and prevention efforts on high-risk subgroups of this heterogeneous population, including CSHCN with preexisting externalizing symptoms and conditions with a behavioral component," conclude the authors.

Ghandour RM, Kogan MD, Blumberg SJ, et al. 2010. Prevalence and correlates of internalizing mental health symptoms among CSHCN.

Pediatrics [published online ahead of print on January 18, 2010].
Abstract available at
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-0622v1?papetoc

Readers: More information is available from the following MCH Library resources:
- Children and Youth with Special Health Care Needs: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_CSHCN.html
- Mental Health Challenges in Children and Adolescents: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html

Mental Health Parity & Addiction Equity Act

Fri, 5 Feb 2010 14:08:29 -0600

BACKGROUND: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
In general, MHPAEA is effective for plan years beginning on or after October 3, 2009. For calendar year plans, the effective date is January 1, 2010. The regulation is effective on April 5, 2010, and applicable to plan years beginning on or after July 1, 2010.
MHPAEA applies to plans sponsored by private and public sector employers with more than 50 employees, including self-insured as well as fully insured arrangements.
MHPAEA also applies to health insurance issuers who sell coverage to employers with more than 50 employees.
Although MHPAEA provides significant new protections to participants in group health plans, it is important to note that MHPAEA does not mandate that a plan provide MH/SUD benefits. Rather, if a plan provides medical/surgical and MH/SUD benefits, it must comply with the MHPAEA’s parity provisions. Also, MHPAEA does not apply to issuers who sell health insurance policies to employers with 50 or fewer employees or who sell health insurance policies to individuals.
READ MORE: parity-act.pdf

Marijuana and Psychosis

Thu, 4 Feb 2010 23:27:22 -0600

Daily Pot Smoking May Hasten Onset of Psychosis

http://www.sciencedaily.com/releases/2009/12/091220144936.htm

ScienceDaily (Dec. 20, 2009) - Progression to daily marijuana use in adolescence may hasten the onset of symptoms leading up to psychosis, an Emory University study finds. The study was published in the November issue of the American Journal of Psychiatry.

The researchers analyzed data from 109 hospitalized patients who were experiencing their first psychotic episode. The results showed that patients who had a history of using marijuana, or cannabis, and increased to daily pot smoking experienced both psychotic and pre-psychotic symptoms at earlier ages.

"We were surprised that it wasn't just whether or not they used cannabis in adolescence that predicted the age of onset, rather it was how quickly they progressed to becoming a daily cannabis user that was the stronger predictor," said Michael Compton, lead author and assistant professor of psychiatry in the Emory School of Medicine.

The study also found a gender difference: The female subjects who progressed to daily pot smoking had a greater increased risk for the onset of psychosis than the males.

Marijuana is the most abused illicit substance among people with schizophrenia, the most extreme form of psychosis, and previous research has shown that smoking pot is likely a risk factor for the disease.

The Emory study also focused on what is known as the prodromal period, when a person has symptoms such as unusual sensory experiences, which are often precursors to frank hallucinations and delusions. Prodromal symptoms can occur months, or years, before a diagnosis of psychosis.
About 30 to 40 percent of prodomal teenagers will eventually develop schizophrenia or another psychotic disorder.

"The prodromal period is especially important because it's considered to be a critical time for preventive intervention," says Elaine Walker, a co-investigator of the study and professor of psychology and neuroscience at Emory.

The study also involved researchers from Emory's Rollins School of Public Health and Georgia State University. It was funded by the National Institute of Mental Health.

Journal Reference:

Compton et al. Association of Pre-Onset Cannabis, Alcohol, and Tobacco Use With Age at Onset of Prodrome and Age at Onset of Psychosis in First-Episode Patients. American Journal of Psychiatry, 2009; 166 (11):
1251-57
http://ajp.psychiatryonline.org/cgi/content/abstract/166/11/1251

OBJECTIVE: Several reports suggest that cannabis use is associated with an earlier age at onset of psychosis, although not all studies have operationalized cannabis use as occurring prior to onset of symptoms.
This study addressed whether pre-onset cannabis use, alcohol use, and tobacco use are associated with an earlier age at onset of prodromal and psychotic symptoms. Effects of the progression of frequency of use were examined through time-dependent covariates in survival analyses.

METHOD: First-episode patients (N=109) hospitalized in three public-sector inpatient psychiatric units underwent in-depth cross-sectional retrospective assessments. Prior substance use and ages at onset of prodromal and psychotic symptoms were determined by standardized methods, and analyses were conducted using Cox regression modeling.

RESULTS: Whereas classifying participants according to maximum frequency of use prior to onset (none, ever, weekly, or daily) revealed no significant effects of cannabis or tobacco use on risk of onset, analysis of change in frequency of use prior to onset indicated that progression to daily cannabis and tobacco use was associated with an increased risk of onset of psychotic symptoms. Similar or even stronger effects were observed when onset of illness or prodromal symptoms was the outcome. A gender-by-daily-cannabis-use interaction was observed; progression to daily use resulted in a much larger increased relative risk of onset of psychosis in females than in males.

CONCLUSIONS: Pre-onset cannabis use may hasten the onset of psychotic as well as prodromal symptoms. Age at onset is a key prognostic factor in schizophrenia, and discovering modifiable predictors of age at onset is crucial.