Adapting TeamSTEPPS for school mental health teams: a pilot study

Background School mental health care often is provided by teams contracted from community mental health agencies. The team members that provide this care, however, do not typically receive training in how to work effectively in a team-based context. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) provides a promising, evidence-based strategy for improving communication and climate in school-based teams. Methods In collaboration with stakeholders, we adapted and piloted TeamSTEPPS for use with school mental health teams. Teams in six schools were randomized to receive the adapted TeamSTEPPS approach or usual supports. The main outcomes of interest were feasibility and acceptability of the adapted TeamSTEPPS strategy. Results Results indicated that team member burnout was significantly higher at follow-up than pretreatment for both control and intervention teams. TeamSTEPPS was feasible and acceptable to implement, and leadership emerged as an important facilitator. Barriers to implementation success included staff turnover, lack of resources, and challenges in the school mental health team relationship. Additional supports to implement TeamSTEPPS were suggested, including ongoing consultation and booster training to address high staff turnover. Conclusions Results suggest that TeamSTEPPS is promising for school mental health teams but additional modifications are likely needed.

MEDICARE IS THE LAST HOLDOUT: EXAMINING THE IMPACT OF MEDICARE POLICY ON OLDER ADULTS’ ACCESS TO MENTAL HEALTH CARE

Medicare is the primary insurance provider for approximately 59 million Americans, and the number of beneficiaries is expected to surpass 80 million by 2030. Currently, Medicare regulations allow psychiatrists, psychologists, clinical social workers, and psychiatric nurses to provide mental health services. These providers were last updated in 1989 with passage of the Omnibus Budget Reconciliation Act of 1989. Since that time, the mental health marketplace has changed dramatically, and Medicare beneficiaries are unable to access care from approximately 200,000 graduate-level mental health professionals with similar training to eligible Medicare providers. There is evidence that this Medicare mental health coverage gap (MMHCG) impacts both providers and beneficiaries. For example, some beneficiaries may begin treatment only to have services interrupted, or stopped altogether, once the provider is no longer able to be reimbursed by Medicare. We surveyed 6,550 members of the American Counseling Association, including 3,815 who identified themselves as practicing counselors. These individuals work in diverse contexts (e.g., community mental health agencies, private practice, and integrated care settings). Survey results indicated that a significant number of practicing counselors turn away or refer Medicare beneficiaries who seek mental health care due to the MMHCG. In-depth interviews were also completed with eight licensed mental health professionals who detailed the challenges they and their clients experienced. Participants perceived a discrepancy between Medicare’s intended aims to promote health and provider restrictions that were confusing and frustrating to navigate. Participants concluded that the MMHCG has a negative impact on older adult clients.

STEPPS in The Netherlands

This chapter describes the introduction and implementation of STEPPS (and STAIRWAYS) in The Netherlands, starting in 1998. The program was translated into the Dutch language (VERS I and VERS II) and has been gradually implemented nationwide. Apart from the United States, The Netherlands has the largest number of STEPPS programs. Research conducted in The Netherlands on STEPPS is reviewed, including controlled and uncontrolled studies. Several STEPPS-based training formats have been developed, including those for adolescents, family members of patients, and patients who are parents. The basic VERS I program has also been implemented as a part of assertive community treatment for patients with psychotic disorders and comorbid personality problems, and it is used in community mental health agencies, forensic facilities, and addiction clinics. A brief version of STEPPS has also been developed.

Identifying Male Victims of Partner Abuse: A Review and Critique of Screening Instruments

Accurate identification of partner abuse (PA) victims and perpetrators is essential to secondary prevention of such violence. Important progress has been made regarding identification of female victims of PA but significantly less scholarly attention has been given to screening instruments that capture men’s PA experiences. The purpose of this article is to briefly review the history of PA screening methods/instruments used and to provide an organized critique of screening tools used with men today. A gender-inclusive approach was used to critique 8 PA screening tools along the following themes: theoretical/paradigmatic approach, language, abuse type, severity and frequency, format, and psychometric data. Strengths of the instruments included (a) use of gender-neutral language in item wording, (b) screening for multiple forms of PA, (c) assessment of frequency of violent acts, and (d) collection of psychometric data with men. Recommendations for future practice include a list of questions for clinicians to use when selecting a screening tool. These questions will assist clinicians and scholars to consider the strengths and limitations of each tool and make more informed choices about the instruments they are using to screen men. Future research recommendations included (a) a call to the field to use a gender-inclusive framework in developing PA screening tools, (b) for developers to clearly label and outline theories or paradigms used to develop instruments, and (c) to obtain psychometric data for diverse groups of men, across various settings (e.g., community mental health agencies, private practice, college campuses).