Predicting initial client engagement with community mental health services by routinely measured data

Engagement is a determinant of how well a person will respond to professional input. This study investigates whether, in practice, routinely measured data predict initial client engagement with community mental health services. Engagement, problem severity, client characteristics, and duration before the first contact were measured at team entrance with clients (n = 529) of three community mental health teams. Regression analysis was used to predict engagement. Gender, age, referrer, having children, having a partner, and ethnicity showed a minor relationship with engagement. Higher problem severity measured by the team members with the Health of the Nation Outcome Scales, being referred for having psychiatric problems and/or causing severe and long-lasting trouble (as ‘assessed’ by the often non-professional referrer), and a longer duration between enrollment and the first conversation with a client, were indicative for a lower engagement. The final model explained 19.2 % of the variance in engagement. It can be concluded that initial client engagement with community mental health services can be predicted, in part, by routinely measured data. The findings can be used by community mental healthcare teams to create an awareness system

Ethical considerations for alcohol researchers in their relation towards policy makers

Alcohol policy research all over the world is often funded by national or local governments. Researchers involved may be confronted with several ethical questions. These questions can have quite a different character. Ethical questions may have a severe character that can be quite “clear” for the researchers involved. Miller et al. [1] for instance recently studied interference of funders, like governments or industrial and charitable organizations, in addiction research. Results show that activities occur such as censorship of research outputs, interference with the wording in reports and articles and interventions in when and how findings are released. Governments funding policy research may interfere in a way as described by Miller et al. [1]. but also less obvious ethical issues may occur: What if the research question is formulated in a “questionable” or “suggestive” way? What if policy makers deliberately ignore results of scientific research? The purpose of this contribution is to elaborate on these less obvious ethical issues, not primarily to give clear-cut answers but to raise consciousness and stimulate reflection and debate among researchers and policy makers

Adolescents and alcohol:An explorative audience segmentation analysis

Background So far, audience segmentation of adolescents with respect to alcohol has been carried out mainly on the basis of socio-demographic characteristics. In this study we examined whether it is possible to segment adolescents according to their values and attitudes towards alcohol to use as guidance for prevention programmes. Methods A random sample of 7,000 adolescents aged 12 to 18 was drawn from the Municipal Basic Administration (MBA) of 29 Local Authorities in the province North-Brabant in the Netherlands. By means of an online questionnaire data were gathered on values and attitudes towards alcohol, alcohol consumption and socio-demographic characteristics. Results We were able to distinguish a total of five segments on the basis of five attitude factors. Moreover, the five segments also differed in drinking behavior independently of socio-demographic variables. Conclusions Our investigation was a first step in the search for possibilities of segmenting by factors other than socio-demographic characteristics. Further research is necessary in order to understand these results for alcohol prevention policy in concrete terms

Extensive medical absenteeism among secondary school students:An observational study on their health condition from a biopsychosocial perspective

An adequate approach to reducing school absenteeism should focus on medical absenteeism as this is the most prevalent form of school absenteeism. The objective of this study is to explore the health condition of pre-vocational secondary students with extensive medical absenteeism from a biopsychosocial perspective. Data were obtained from medical assessments and Strengths and Difficulties Questionnaires (SDQs) of students with medical absence above threshold criteria (i.e. reported sick four times in 12 school weeks or more than six consecutive school days) who were referred to a youth health care physician. The results showed that the students had a mean absence rate of 14% in 12 school weeks. Of all students, 43.5% had a diagnosed disease and 81.5% had problems such as physical complaints not yet diagnosed, psychosocial problems, lifestyle problems and sleeping difficulties. Four groups could be distinguished: 13.4% with a diagnosed disease and no problem, 30.1% with a diagnosed disease and a problem, 51.5% with a problem and no diagnosed disease and 5.1% without a diagnosed disease or problem. Significantly higher scores of the Total difficulties-scale on the SDQ were found (mean 10.5; SD 5.8) in the study group, compared to a reference group (mean 9.1; SD 4.9). In conclusion, this study shows that when using the aforementioned criteria for extensive medical absenteeism to intervene with the absence, students with a mean absence rate of 14% in 12 school weeks are identified. If there was a diagnosed disease, it was accompanied by problems about twice as often. More than half of the students’ absence was caused by problems rather than a disease. The great diversity of these problems calls for a personalized approach. A broad perspective, including medical expertise, is needed to distinguish between emerging mental and physical diseases, psychosocial and lifestyle problems. Keywords: Adolescent Health, Preventive Pediatric Primary Care, School Absenteeism, Public Health, Psychosocial Problem

Addressing medical absenteeism in pre-vocational secondary students:Effectiveness of a public health intervention, using a quasi-experimental design

Background Students’ health and school absenteeism affect educational level, with adverse effects on their future health. This interdependence is reflected in medical absenteeism. In the Netherlands, a public health intervention has been developed to address medical absenteeism in pre-vocational secondary education. This study aims to investigate the effectiveness of this intervention on students’ medical absenteeism, compared to “medical absenteeism policy as usual”. Methods A quasi-experimental design with an intervention group (493 students) and a control group (445 students) was applied. Multilevel analysis was used to study differences in the development of the level of a student’s medical absence over time (after 3 and 12 months). Results In the intervention group, the level of absenteeism decreased from 8.5 days reported sick in 12 school weeks to 5.7 days after 3 months, and to 4.9 days after 12 months. The number of absence periods fell from 3.9 in 12 school weeks to 2.5 after 3 months, and to 2.2 after 12 months. In the control group, the absence days initially decreased from 9.9 days reported sick in 12 school weeks to 8.4 days after 3 months, after which an increase to 8.9 days was measured. The number of absence periods initially decreased from 4.5 in 12 school weeks to 3.5, after which an increase to 3.7 was measured. The number of absence days per period remained about the same in both groups. Conclusions The study provides first indications for the intervention to be effective for Dutch pre-vocational secondary students with increased medical absence rates. The intervention, which consists of personalised management of medical absenteeism by systematic identification of students with extensive medical absenteeism and consistent referral to youth health care physicians, appears to reduce the absence rates more effectively than “medical absenteeism policy as usual”. The effectiveness of the intervention is shown primarily by a decrease in the number of periods reported sick