Stay up to date with Mental Health Weekly

  • Learn about the latest trends in the field
  • Hear from leading clinical practitioners and field leaders
  • Stay up to date with regulatory and policy changes
  • Glean strategies for delivering quality services
  • Get expert advice on budget issues
Order with discount code MHW5 and SAVE 50%! SUBSCRIBE NOW!

Other Products of Interest

Alcoholism and Drug Abuse Weekly
an indispensable resource for managers and directors in addiction treatment centers, federal and state policy makers, researchers, and healthcare consultants. Read More
Child and Adolescent Psycho-
pharmacology Update

Stay current with the most successful approaches to treating common childhood disorders. This newsletter covers the latest research findings, off-label prescribing practices, case reports, adverse events, and more to keep you informed. Read More
11/19/2015 12:00 AM

A National Alliance on Mental Illness affiliate’s program that intensifies the approach taken by traditional education and support initiatives is earning recognition for making inroads with a high-need group: public housing residents with largely unaddressed mental health challenges.

A National Alliance on Mental Illness (NAMI) affiliate’s program that intensifies the approach taken by traditional education and support initiatives is earning recognition for making inroads with a high-need group: public housing residents with largely unaddressed mental health challenges.

The individuals targeted in NAMI Greater Cleveland’s Mental Health Workshops program are those who face the threat of eviction from public housing — and significant prospects for homelessness as a result — because of disruptive behavior in the housing community. Unlike some NAMI programs that use peer-led groups only, this NAMI Greater Cleveland initiative is built on a team approach that includes two group facilitators from the professional ranks (one a psychologist and one a social worker).

The program, which originated from an idea advanced by a NAMI Greater Cleveland multicultural outreach coordinator, was honored last month as a recipient of a 2015 Connect 4 Mental Health Community Innovation Award in the category of continuity of care. The innovation awards, co-sponsored by the National Council for Behavioral Health, NAMI, and pharmaceutical companies Otsuka Pharmaceutical Development & Commercialization Inc. and Lundbeck, honor organizations that deliver community-driven, solutions-based approaches for people with serious mental illness.

“The program works in public housing communities where access to services is limited, people are leery of the system, and finances and transportation are an issue for people,” NAMI Greater Cleveland Executive Director Michael Baskin told MHW. “Many of these individuals have not previously been identified with a diagnosis.”

Group support model

The NAMI Greater Cleveland program operates in two public housing communities in the city. Baskin says these sites see an intersection of many difficulties, including poverty, unaddressed health needs and the potential for violence.

“In some communities, there are drugs and alcohol, and some prostitution,” said Baskin. “Even tangentially being near enough to this activity means there is more likelihood of becoming involved.”

The individuals targeted in the Mental Health Workshops program may have already had a dispute with a neighbor, for example. Unaddressed mental health needs might make them a candidate for a pattern of destructive behaviors that would place them at risk for eviction. The program offers these public housing residents (mostly women) a series of twice-monthly workshops over 18 weeks, averaging 10 participants per group. Baskin says the sessions as a whole resemble a slowed-down version of group therapy, but “we don’t call it that, because it’s education and support.”

He says participants come to learn more about what might be triggering any problematic behaviors. The goal involves helping these individuals to develop coping, communication and self-management skills to improve their physical and mental wellness.

“As in most NAMI programs, the expert is not a mental health professional,” Baskin said. “We emphasize the power of the group. The voices of the group share their hopes, their strengths and their history, and how they have survived that history.”

The NAMI Greater Cleveland team includes the clinical professionals who serve as the group facilitators, a wellness coach, interns and a service coordinator. Baskin says the service coordinator is essentially a peer who helps the group facilitators connect group participants to appropriate community-based services for mental and physical health.

Group participants rate their mood on a 1-to-10 scale at the start and finish of each workshop session they attend. Those who have scores below 6 are referred to the wellness coach and/or the interns for follow-up.

NAMI Greater Cleveland generally structures the desired outcomes of its initiatives around the Substance Abuse and Mental Health Services Administration’s National Outcome Measures, which also have become the standard for Ohio’s state mental health agency. Key outcome areas for the initiative in the public housing communities include:

  • Increased awareness of signs and symptoms of mental illness, and treatment options. The NAMI chapter states that 95 percent of participants achieved this in 2014.
  • Improved compliance in mental health treatment and medication management.
  • Increased awareness of the importance of communicating one’s needs to family members, fellow residents and treating professionals.
  • A general understanding of the importance of supportive relationships in furthering recovery.
  • Improved mood levels and fewer incidents of disruptive behavior and eviction. NAMI Greater Cleveland reported that among participants last year, only one incident of disruptive behavior occurred.

Baskin said the program is being funded through a combination of monies from the Cleveland-based Mt. Sinai Health Care Foundation and funding from the county alcohol, drug and mental health services board overseeing the Cleveland area.

Potential expansions

The participants in the Mental Health Workshops initiative in the two Cleveland public housing communities are primarily black. Many are in their 30s and 40s, and some have been separated from their children, Baskin said.

He believes this model will prove applicable to other underserved populations. “We’re looking to use the model in senior housing, and in the Hispanic community,” he said.

The Greater Cleveland chapter’s inroads with minority populations constituted one of the contributing factors toward the affiliate also being named NAMI’s outstanding affiliate for 2014. The national organization stated that the affiliate’s programming mirrors NAMI’s dedication to multicultural action through its highlighting of diversity and inclusion in programming.

Baskin emphasized that making inroads in environments such as public housing takes a concerted, long-term effort. “It takes time to develop relationships in any community, and in particular a minority community and in housing projects,” he said. “You have to work with management, as it’s critical to get their buy-in, so that they see NAMI as an ally.”

Bottom Line…

Using a somewhat more intensive approach than what is seen in most education and support initiatives, NAMI Greater Cleveland is working to improve the lives of public housing residents through a program that has gained national recognition.

11/5/2015 12:00 AM

New research in JAMA Psychiatry points to a number of risk factors that contribute to high mortality rates in people with schizophrenia — most notably, smoking. The integration of tobacco cessation into clinical practices is one of the key strategies to addressing the premature mortality in the schizophrenia population, says the director of clinical improvement for the National Council for Behavioral Health.

New research in JAMA Psychiatry points to a number of risk factors that contribute to high mortality rates in people with schizophrenia — most notably, smoking. The integration of tobacco cessation into clinical practices is one of the key strategies to addressing the premature mortality in the schizophrenia population, says the director of clinical improvement for the National Council for Behavioral Health.

The research findings are not surprising, Shelina D. Foderingham, MPH, MSW, told MHW. “Many community mental health and addiction providers are not asking about tobacco use,” she said. “It’s not a standard [part] of practice.” Even up until a few years ago it was not a standard of care and was not included as part of the intake process, said Foderingham.

The culture is shifting, Foderingham said. “It’s about whole health and wellness,” she said. “We’re starting to think holistically about treatment. We’re also treating unhealthy behaviors.” Physical health care and nutrition should be part of mental health providers’ scope of practice, noted Foderingham. Providers should also be able to refer people to necessary resources within the community, she said.

Enforcement is critical when developing programs, said Foderingham. “Provider organizations need to get buy-in from staff and clients when they’re drafting smoking cessation policies,” she said. “Even before you draft policies, it’s important to have conversations with providers and clients.”


“One of the key pieces we heard from organizations is that in order to implement a tobacco-free policy in your organization, you need to do more than draft such a policy,” she said. “It’s about asking that person if he or she wants help and linking them to that help,” Foderingham said. “It’s also about communicating with your staff and helping them understand why you’re deciding to go this way and how you can be successful together in making a tobacco-free program work.”

One of the challenges in implementing tobacco-free policy is that staff members sometimes smoke with their clients at intake settings or they may take breaks with their clients and feel that it’s a good way of developing rapport, said Foderingham.

“One of the misconceptions is [providers may say] ‘Our clients can’t quit or it’s too hard. It might jeopardize their recovery,’” she said. “Most clients want to quit. Up until now providers weren’t asking them if they smoke.” Foderingham pointed to a 2010 study in the Annual Review of Public Health that found that people with mental illness or addiction disorder want to quit smoking.

The study authors wrote, “Despite opinions to the contrary, the smoking cessation rates of persons with mental illnesses and substance abuse disorders who desire to quit are comparable to the general population. Several studies have found that 77 percent to 79 percent of these individuals intend to quit, many in the next month.”

Programs, resources

The National Council meanwhile is embarking on a number of initiatives around tobacco cessation. “We’re helping organizations integrate tobacco screening, and providing resources on nicotine replacement therapy, along with counseling services and referrals to community resources,” said Foderingham.

Earlier this year, the National Council wrapped up its webinar program “Implementing Tobacco-Free Policies in Community Behavioral Health Organizations.” The National Behavioral Health Network for Tobacco & Cancer Care co-hosted the series. Foderingham is the network’s project director.

The National Council also operated a Learning Community in partnership with Pfizer on smoking cessation to help addiction providers implement programs in their agencies, she said.

Every state has a Tobacco Control Program that offers free training for health care professionals and free individual and group counseling, she said. “Mental health providers may not be aware of or tapping into resources that states provide,” Foderingham said, adding that many programs do vary by state.

The National Council’s annual conference in 2016 will feature tobacco cessation workshops and one-on-ones with national tobacco control and wellness experts, said Foderingham. The two sessions are “Get the 4-1-1: Integrating Cancer and Tobacco Control and Prevention into Your Organization” and “Tobacco & Addictions: Building Partnerships to Reduce Tobacco Use Among People with Addictions.”

For more information, visit www.bhthechange.org/about.

10/1/2015 12:00 AM

Poverty is on the rise, as is the number of children with mental disorders, although many of the children with these disorders who may qualify for federal benefits aren’t receiving them, according to a new report released by the Institute of Medicine (IOM). The IOM report, released September 9, compares national trends in the number of children with mental disorders under 18 to trends in the Supplemental Security Income childhood disability population.

Poverty is on the rise, as is the number of children with mental disorders, although many of the children with these disorders who may qualify for federal benefits aren’t receiving them, according to a new report released by the Institute of Medicine (IOM). The IOM report, released September 9, compares national trends in the number of children with mental disorders under 18 to trends in the Supplemental Security Income (SSI) childhood disability population.

Since 1975, the Social Security Administration (SSA) has paid benefits to poor children through the SSI program. In 2013, approximately 1.3 million children received SSI benefits. Approximately 50 percent of those recipients had disabilities primarily due to a mental disorder.

According to the report, “Mental Disorders and Disabilities Among Low-Income Children,” an increase in the number of children who were recipients of SSI benefits due to mental disorders has been observed from 1985 to 2010. Less than 1 percent of children in the United States are recipients of SSI benefits for a mental disorder.

“There has been an increase in the number of children who receive Supplemental Security Income from the Social Security Administration,” Amy Houtrow, M.D., Ph.D., MPH, associate professor and vice chair in the Department of Physical Medicine and Rehabilitation Division for Pediatric Rehabilitation Medicine at the University of Pittsburgh School of Medicine, told MHW. The study was conducted to determine the reason for the increase, said Houtrow, IOM committee member and coauthor of the report.

“One of the reasons the report happened is because Congress was questioning the appropriateness of the SSI program,” said Houtrow. “It’s important to identify children who are disabled and need support and financial assistance to help lift them out of poverty. It tells the value of the program.”

The IOM committee selected to conduct the report looked at 10 years of data for mental health and reviewed national trends and trending using Medicaid data. They also  reviewed trends in childhood disability attributed to10 major mental disorders: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disability (ID), mood disorders (depression and bipolar disorder), learning disorder, organic mental disorders, oppositional defiant disorders, conduct disorders, anxiety-related disorders and borderline intellectual function.

While the number of children allowed  SSI benefits for mental disorders has fluctuated from year to year between 2004 and 2013, over the 10-year period, the percentage of poor children who are allowed SSI benefits for mental disorders has decreased, according to the study.

“There is likely a large group of children who would qualify for benefits but are not receiving them,” said Houtrow. “Lots of families in poverty might not have access to health care services or have knowledge about SSI benefits.”

The study found that in 2013, approximately 1.8 percent of U.S. children (ages 0–18) were recipients of SSI benefits — an increase from 1.3 percent in 2004. The percentage of all U.S. children who were recipients of SSI disability benefits for the 10 major mental disorders grew from 0.74 percent in 2004 to 0.89 percent in 2013.

The proportion of children whose applications were allowed annually for the 10 major mental disorders out of all allowances for children did not increase. Approximately one-half of all allowances for child disability benefits were for the 10 major mental disorders.

According to the study, trends in the number and proportion of allowances and recipients varied by type of mental disorder. Some diagnoses, such as ASD, showed substantial increases over the period. Some, such as ID, showed considerable decreases. For each year from 2004 to 2013, the ADHD category was largest in terms of numbers and proportions of child SSI disability allowances and recipients.

The trend in child poverty was a major factor affecting trends observed in the SSI program for children with mental disorders during the study period. Increases in the numbers of children applying for and receiving SSI benefits on the basis of mental health diagnoses are strongly tied to increasing rates of childhood poverty because more children with mental health disorders become financially eligible for the program when poverty rates increase.

The committee concluded that better data about diagnoses, comorbidities, severity of impairment and treatment, with a focus on trends in these characteristics, is necessary to inform improvement to the SSI program for children.

Identifying children

“There is a large reservoir of children who would likely qualify for benefits and who are not receiving the benefit,” Houtrow said. “We know that poverty is on the rise among children. We know that disabilities are on the rise among children. The big message is to help identify children who may be eligible so parents can apply for the benefit.”

She noted that one-half of children who receive SSI get pulled out of poverty. “That’s a huge thing,” Houtrow said. “It allows parents to provide for the care and well-being of their child with a disability. They receive cash assistance, which can help mitigate food insecurity, for example. It’s important to their well-being and growth.”

Receiving the SSI benefit gives children an opportunity to receive Medicaid, providing them with much better access to mental health services, said Houtrow. For the children who didn’t have insurance before, Medicaid is a big benefit, she said. The children will also get referred to another benefit: their state Title V program, targeted toward children with special needs.

“The job of the whole system is to try to help families make the first step toward the application process if they might be eligible,” said Houtrow. From a policy perspective, it’s important to continue to acknowledge the benefits of the program for children and families.

Provider information

Some mental health conditions are severe enough to negatively impact children in their day-to-day functioning, said Houtrow. “Providers should recognize this and attempt to manage it but also understand that for children living in poverty who have mental health conditions associated with poor functioning, those children may be eligible for SSI,” she said.

For poor children with severe mental health problems associated with disabilities, providers should alert parents of the possibility of benefits, Houtrow said. “This is because there are a lot of benefits from being lifted out of poverty,” she said, noting that not all children who apply will receive the benefit. “It’s hard to qualify, and there’s a strict set of criteria,” she said.

Health care providers, including case managers, social workers, pediatricians and mental health providers may lack the knowledge for helping families know where to look and to point them in the right direction. “Lots of health care providers may not even know about the SSI program,” Houtrow said.

The determination process includes the review of medical records and the gathering of information from schools, clinics and hospitals, said Houtrow. “Making sure you document thoroughly how the child’s life is impacted and what conditions the child has will help with the determination process,” she said.

Only the primary code is used when reviewing SSI data because only the primary code must be filled in on the forms. Therefore, although a lot of children have a primary code of ADHD, they might also have other problems that are not coded.

Children with mental retardation (now referred to as intellectually disabled) are very likely to qualify for SSI if they also meet the income eligibility criteria, said Houtrow. More than 90 percent qualify, she said. “Autism and intellectual disability nearly all qualify for financing,” she added. “Autism and ID are associated with significant disabilities most of the time, so more of those kids qualify.”

The report doesn’t point out why children who may qualify aren’t applying for the benefit, she explained. The next thing for the health care system to do is determine what it can do to help identify children in need of the benefits and ensure they receive services, said Houtrow.

For a copy of “Mental Disorders and Disabilities Among Low-Income Children,” visit http://iom.nationalacademies.org.

Bottom Line…

Mental health providers can help identify children in need of benefits and ensure they receive services.


Quality diagnosis essential in identifying children for federal benefits

“If a parent doesn’t leave the doctor’s office feeling sad, they probably haven’t given the doctors enough information about the extent of the child’s disability,” Bob Klaehn, M.D., who is on the faculty of the Maricopa Integrated Health System Child Psychiatry Fellowship Program in Mesa, Arizona, where he ensures that child psychiatrists in training have experience in diagnosing autism, told MHW.

“They have to talk about things that are very painful,” said Klaehn, who is not affiliated with the IOM’s “Mental Disorders and Disabilities Among Low-Income Children” report. “In order to get a full picture of the disability, it takes time. Not all doctors even have the time or ability to do that.”

The lack of expertise in the diagnosis of autism in most communities prevents many children with this diagnosis from getting SSI benefits, said Klaehn. “That’s one of the biggest barriers I’m aware of from my experience in state government,” he said. For example, the training requirements for child psychiatrists in the diagnosis of autism and other developmental disabilities is quite limited, said Klaehn “It’s surprising to me given the increasing prevalence of autism,” he said.

There has to be an easy way for busy doctors to provide information, said Klaehn, who said he hasn’t conducted SSI paperwork in years — which was a paper-and-pencil process back then that was often considered laborious. “We live in an age of electronic health records. By now the SSI process should be more electronically friendly. If you make it more user-friendly, more doctors would be able to complete the paperwork,” he said.

“It’s all based on access to diagnostic services,” said Klaehn. “There are still some inequities in terms of diagnoses in children.”

From the Field
9/26/2013 12:00 AM
8/7/2013 12:00 AM
In Case
7/11/2013 12:00 AM

    Username: Password:
  • Content Directory

    MHW subscribers can now log in to browse all articles online!
    Browse Content
    Free Content
  • Free E-Alerts

    Sign up to receive exclusive content and special offers in the areas that interest you.
  • Subscription Formats

  • Meet the Editor

    Valarie Canady
    Managing Editor

    Valerie Canady, managing editor of Mental Health Weekly, knows the mental health field inside and out. She uncovers the essential stories and gets the scoop directly from leaders and advocates in the field.
Copyright © 2000-2015 by John Wiley & Sons, Inc. or related companies. All rights reserved.