Therapists’ Perceptions of School-based Mental Health Services: A Qualitative Evaluation of two Behavioral Health Models

Therapists’ perceptions of school-based mental health programs are considered to be an important factor in determining the effectiveness of a school based behavioral health model. This qualitative evaluation summarizes the perceptions of participant therapists on two different behavioral health models called Full Service Schools (FSS) and Full-Service Schools (FSS) Plus model that are currently being implemented in a large school district in Florida. FSS therapists provide therapy at a hub location whereas FSS Plus therapists work at one particular school. The study utilizes therapists’ views of their respective programs to compare and contrast the effectiveness of each of the behavioral health models. Five focus groups involving 24 therapists from both models were held at five separate locations. Nvivo version 10 was used to conduct a thematic analysis of collected data. Study findings revealed better results for the FSS Plus model as compared to the FSS model in terms of successful elimination of barriers such as transportation and lack of physical space to provide therapy. This study suggests that improved and effective behavioral health services can be provided to students by assigning a designated therapist at each school

Auditing the AUDIT:A systematic review of cut-off scores for the Alcohol Use Disorders Identification Test (AUDIT) in low- and middle-income countries

INTRODUCTION: The World Health Organization's (WHO) Alcohol Use Disorders Identification Test (AUDIT) is used extensively across the world, with cut-off scores recommended by the WHO. We reviewed the use and validity of AUDIT cut-off scores in low- and middle-income countries as cultural contexts are expected to influence the detection of alcohol use disorders. MATERIALS AND METHODS: The systematic review was guided by an a priori defined protocol consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We searched Cochrane library, Medline, EMBASE, PsycINFO, CINAHL, Indmed, LILACS, and AJOL databases using appropriate search terms. We conducted a narrative synthesis of the data. RESULTS: We identified 54 distinct studies that used AUDIT cut-off scores which were not in alignment with those recommended by the WHO. India (n = 10), Nigeria (n = 9), and Brazil (n = 9) produced most of these included studies. Most of the studies (n = 42) did not conduct psychometric evaluations of AUDIT cut-off scores. Of the twelve studies which did report psychometric results, a wide range of cut-off scores performed well. In these studies the cut-off scores to detect hazardous drinking ranged from >3 to >5, for harmful drinking from >5 to >16, and for dependent drinking from >7 to >24. DISCUSSION: AUDIT is being widely used in LMICs and non-recommended cut-off scores are considered to be appropriate in these countries. It is important to systematically evaluate the psychometric properties of those cut-off scores to ensure the internal validity of the studies in which they are used

The systematic development of a mobile phone–delivered brief intervention for hazardous drinking in India

Background: The treatment gap for alcohol use disorders (AUD) in India is the highest among all mental health and substance use disorders. Despite evidence of the cost effectiveness of brief interventions (BIs) for hazardous drinking, implementation in low- and middle-income countries (LMICs) is rare due to several human resource–related barriers. This paper describes the processes and outputs of a study aimed at systematically developing a mobile phone–delivered BI to overcome such barriers. Methods: This is a mixed methods study with four steps: (1) Review of existing relevant evidence base by extracting data from studies cited in two recent, relevant and high-quality systematic reviews; (2) In-depth interviews (IDIs) with 11 national experts in addictions research and practice, and 22 hazardous drinkers; (3) Delphi survey (2 rounds) to identify components for the intervention package through consensus building; and (4) Content and intervention development workshops with a range of stakeholders to develop the intervention package. Results: The research team sourced 72 journal articles from two selected systematic reviews. Key content areas extracted from the studies included facts and statistics about health related to drinking behavior, self-reflection, goal-setting messages, motivational messages, and skills to manage risky situations. The IDIs with experts and hazardous drinkers endorsed most of these content areas as well. The Delphi survey achieved consensus on 19 content areas, which included targeted recommendations, personalized feedback and information, goal management, and coping skills. The content and intervention development workshops resulted in an intervention package delivered over 8 weeks, with the following seven themes guiding the content of the weekly messages: safe drinking/health education, alcohol reduction, drinking and risk management, drinking alternatives, situational content, urge management, and maintenance and relapse prevention. Conclusion: The research team designed this study to consider contextual factors while developing the intervention, which is important to ensure acceptability and feasibility of the intervention. Interestingly, the contextually informed intervention components had several commonalities with BIs developed and tested in high-income countries.</p

Teachers\u27 Perceptions of Student Mental Health: The Role of School-Based Mental Health Services Delivery Model

Authors examined teachers\u27 perceptions of student mental health in the context of two school-based mental health (SBMH) services delivery models. Study participants included teachers (N = 468) involved in two different models of SBMH programs (on-site therapists versus community-based therapists) in a large school district in Southeast United States. Differences regarding the two models\u27 effects on teachers\u27 perceived awareness, knowledge, and comfort related to student mental health were compared. The authors also compared mental health training received by teachers and their satisfaction with the respective models. There were statistically significant differences between the two models in teachers\u27 perceived awareness, knowledge, mental health training received, and satisfaction. However, teachers with in-school therapists were only comfortable accessing services for students with mental health issues and not necessarily talking with students about mental health. An SBMH services delivery model that has a dedicated therapist within the school increases the likelihood that teachers will be more aware and knowledgeable of student mental health, but more tailored trainings may be needed to better equip teachers with direct student management of mental health issues

Integrating assisted tele-psychiatry into primary healthcare in Goa, India: a feasibility study

BACKGROUND: Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. METHODS: Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. RESULTS: The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92–39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61–25.57, p = 0.008)]. CONCLUSION: Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings