Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733−0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research

Co-occurring Substance Use and Mental Health Needs: Enhancing the Adult Needs and Strengths Assessment (ANSA) to Manage Services

Substance use disorders (SUD) are common, affecting one in 25 adolescents (ages 12 -17), one in seven young adults (ages 18 to 25), and one in 16 adults (ages 26 and older) during 2017. 1 While 16.7% of adults without SUD experienced mental health (MH) disorders, 45.6% of adults with SUD experienced co-occurring MH disorders.1 Related research found much higher rates of adults with MH or SUD disorders (50-75%) have co-occurring disorders. 2, 3, 4, 5 Co-occurring MH and SUD make treatment more difficult, increase use of health resources, and interfere with individuals’ life functioning.2, 3, 4 In response to the opioid crisis, SUD treatment funding and services are expanding. Effective treatment requires identification of co-occurring disorders (COD). The goal of this study was to examine how well practitioners assess and identify COD in practice

ANSA: Becoming a Recovery Focused Tool

poster abstractThe Adult Needs and Strength Assessment (ANSA, Lyons, 2009) has been used across public mental health and addiction services in Indiana to help develop intervention plans and to monitor client progress. ANSA consists of six core domains (Life Functioning, Behavioral Health Needs, Risk Behaviors, Strengths, Acculturation, and Caregiver). Domain items are rated on a four-point scale to describe the degree to which a need interferes with functioning or a useful strength is present. Despite statewide implementation, literature related to the ANSA is scarce. The study evaluates the psychometric properties of ANSA and its role as an outcome performance measure. Adults for whom the ANSA had been rated at four points between 2008 and 2010 were included (N=6320). Internal consistency reliability was measured for each ANSA domain and outcome measure. Reliable change indices (RCI) for each domain were used to calculate significant change. At each point of assessment and across time, the Cronbach’s alphas for all domains, except Risk Behaviors, are in the acceptable to high ranges (0.71 to 0.92), indicating good internal consistency and stability. For outcome performance measures, a more realistic timeframe for assessments (12 months) was required to document reliable improvement in at least one ANSA domain for individuals with serious mental health needs. The Residential Stability outcome measure has the low internal consistency and stability. From the recovery perspective, a new Community Integration measure was proposed as an alternative outcome measure and proved to be reliable (α = .90). Study findings helped enhance the ANSA tool, create a new outcome measure, and inform state policy. Specifically, bridging research to practice, findings resulted in restructuring the ANSA Risk Domain and modifying how outcomes are measured for adults in recovery focused behavioral health services

Mental Health Service Access: Use of Existing Data

Background and Purpose. Although about 20% of children (ages 3 to 17) experience mental health disorders, only one in five youth receive specialized treatment. Without intervention, youth experience long lasting adverse effects. Barriers to service access include stigma, poverty, race/ethnicity, gender, and geography. Routine utilization of existing data could inform program and policy planning and monitor progress, but such information is seldom available. This study explored the use of administrative data to examine service utilization and to identify and address disparities in a midwestern state. Methods. Access to mental health (MH) services was defined as utilizing publically funded mental health. Two types of existing data were evaluated: mental health block grant (MHBG) and Medicaid claims. Uniform Reporting System (URS) Client Level Data for transition age youth (TAY, ages 18-20) 2004-2016 trends were compared by gender and race/ethnicity. Child Medicaid behavioral health service utilization in 2014 was contrasted by age, gender, race/ethnicity, and language. Relationships among language, identification of MH needs, and service utilization were also explored. Results. According to URS data, TAY youth’s utilization of MHBG funded services doubled then plateaued between 2013 and 2016. A pattern of more young women (55%) receiving services than men remained constant over time, although the 2015 census population estimates were similar. Disportionate access between white and non-white TAY decreased during a home and community based service grant (2008-2012). Based on SFY14 Medicaid claims, MH needs were most frequently identified for 12-14 year old boys, but service intensity peaked for adolescents between ages 15 and 17. In contrast to MHBG data, more young men, ages 18-25, utilized MH services. After age 25, women more frequently utilized services. However, boys and men consistently received more MH services. MH service utilization by youth of color was lower than by Caucasian youth. A limitation of using administrative date emerged as language was missing for foster youth who had the highest level of Medicaid MH service utilization. Most young Medicaid members (90%) lived in English speaking households; other households primarily spoke Spanish (5%), Burmese, or other languages. Children in English speaking homes received more than twice the amount services compared to children in Spanish speaking homes. MH health needs for children were less often identified in the four largest urban counties than in smaller communities. In contrast to research, the intensity of MH services varied across urban and rural settings. Conclusions and Implications. Consistent with research, this examination of administrative data found disproportionate identification of behavioral health needs and utilization of services by age, gender, race and ethnicity. Routine monitoring of existing data could help monitor MH service utilization and the impact of policy or programs on access to care. Gender differences between MHBG and Medicaid MH service utilization require further exploration. Additional research is needed regarding factors affecting geographic differences and the effectiveness of routinely using existing data to manage programs and inform policy.Indiana Family & Social Services Administration, Division of Mental Health & Addictio

Preference Reversals in Decision Making Under Risk Are Accompanied by Changes in Attention to Different Attributes

Recent work has shown that visual fixations reflect and influence trial-to-trial variability in people’s preferences between goods. Here we extend this principle to attribute weights during decision making under risk. We measured eye movements while people chose between two risky gambles or bid on a single gamble. Consistent with previous work, we found that people exhibited systematic preference reversals between choices and bids. For two gambles matched in expected value, people systematically chose the higher probability option but provided a higher bid for the option that offered the greater amount to win. This effect was accompanied by a shift in fixations of the two attributes, with people fixating on probabilities more during choices and on amounts more during bids. Our results suggest that the construction of value during decision making under risk depends on task context partly because the task differentially directs attention at probabilities vs. amounts. Since recent work demonstrates that neural correlates of value vary with visual fixations, our results also suggest testable hypotheses regarding how task context modulates the neural computation of value to generate preference reversals

Normalization of microarray expression data using within-pedigree pool and its effect on linkage analysis

"Genetical genomics", the study of natural genetic variation combining data from genetic marker-based studies with gene expression analyses, has exploded with the recent development of advanced microarray technologies. To account for systematic variation known to exist in microarray data, it is critical to properly normalize gene expression traits before performing genetic linkage analyses. However, imposing equal means and variances across pedigrees can over-correct for the true biological variation by ignoring familial correlations in expression values. We applied the robust multiarray average (RMA) method to gene expression trait data from 14 Centre d'Etude du Polymorphisme Humain (CEPH) Utah pedigrees provided by GAW15 (Genetic Analysis Workshop 15). We compared the RMA normalization method using within-pedigree pools to RMA normalization using all individuals in a single pool, which ignores pedigree membership, and investigated the effects of these different methods on 18 gene expression traits previously found to be linked to regions containing the corresponding structural locus. Familial correlation coefficients of the expressed traits were stronger when traits were normalized within pedigrees. Surprisingly, the linkage plots for these traits were similar, suggesting that although heritability increases when traits are normalized within pedigrees, the strength of linkage evidence does not necessarily change substantially

Planting the Seeds of College and Career Readiness in Preschool

Many jobs require some type of post-secondary degree or specialized training beyond high school, therefore addressing college and career readiness concepts at an early age may influence young children’s future success. This mixed-methods authentic case study explores the implementation and challenges of introducing a structured framework to enhance the culture of universal achievement at one non-profit preschool in a rural hub city. The research site is non-profit preschool accredited by the National Association for the Education of Young Children (NAEYC) which serves predominantly low-income families. The purpose of the study was to discover how the core beliefs of the No Excuses University (NEU) program have influenced awareness of post-secondary opportunities and prospects for educational achievement. Participants included 18 preschool faculty/staff members, 37 parents of preschool students, and 31 preschool students. Adult participants answered online survey questions, while preschool students responded to face-to-face interview questions. Analysis of the collected data revealed that fostering a culture of universal achievement in a preschool setting can enhance young students’ and their families’ awareness of future educational opportunities, increase communication regarding long-term post-secondary goals, and support the development of a positive future story. Conclusions drawn from this study indicate that implementing a structured framework that addresses a variety of educational opportunities can positively influence the child, their parents, members of the school faculty, and the local community. Strategies and effective approaches executed by the preschool include the use of powerful symbolism and multi-faceted collaboration. Some untold challenges to program implementation are discussed. The implications from this research study on early exposure to college and career readiness concepts are applicable to many fields of study

Cancer immunotherapy based on MUSIC platform and STING activation in brain cancer cells

https://openworks.mdanderson.org/sumexp23/1008/thumbnail.jp

Nogo-66 Receptor Prevents Raphespinal and Rubrospinal Axon Regeneration and Limits Functional Recovery from Spinal Cord Injury

AbstractAxon regeneration after injury to the adult mammalian CNS is limited in part by three inhibitory proteins in CNS myelin: Nogo-A, MAG, and OMgp. All three of these proteins bind to a Nogo-66 receptor (NgR) to inhibit axonal outgrowth in vitro. To explore the necessity of NgR for responses to myelin inhibitors and for restriction of axonal growth in the adult CNS, we generated ngr−/− mice. Mice lacking NgR are viable but display hypoactivity and motor impairment. DRG neurons lacking NgR do not bind Nogo-66, and their growth cones are not collapsed by Nogo-66. Recovery of motor function after dorsal hemisection or complete transection of the spinal cord is improved in the ngr−/− mice. While corticospinal fibers do not regenerate in mice lacking NgR, regeneration of some raphespinal and rubrospinal fibers does occur. Thus, NgR is partially responsible for limiting the regeneration of certain fiber systems in the adult CNS