Welcome | Networking
| Long Range Plan | Links
| Membership
Application
Issue:
A comprehensive program of epidemiological and services research
is needed to plan for and to evaluate the effectiveness of
services.
Status:
Being Developed
Discussion:
With medications, there is a well defined
process for testing the medication's safety and effectiveness. Once
the Food and Drug Administration approves a new medication, the
pharmaceutical companies have strong economic incentives to make
information available and to promote its use. With services, however,
the processes are poorly defined.
Since the mid-1980s, NIMH has promoted the use of
multidisciplinary research centers to integrate the research, and to
get away from the confusion caused by the 230 theories about the
causes and treatments of mental disorders that prevailed at that
time.
For nearly ten years advocacy groups have been
urging the state to use the available National Institute of Mental
Health grant programs, as well as other funding sources, to develop a
comprehensive epidemiological and services research program in
Alaska. Why? Here are needs identified by family
advocates:
- To adequately plan for services, the planning agencies need to
know by community how many children need help.
The national studies show that from birth to age 18, 20 percent
of the children have a mental disorder that needs treatment and
that 9 percent meet the Center for Mental Health Services
definition of seriously emotionally disturbed. According to the
"1993 Alaska Youth Mental Health Needs Assessment," by Norman
Dingus, Ph.D., University of Alaska Fairbanks, this is probably a
conservative estimate for Alaska, and the rates of serious
emotional disturbance for Alaska Native youth may be 25 percent.
This type of information is particularly important in Alaska,
because state policies encourage people to live in remote
communities where physical and mental health and social services
are scarce.
- An outcome-oriented quality-assurance program needs answers to
a number of researchable questions:
• how many infants, toddlers, children and youth need help
in a community,
• how many have been identified,
• how many have been diagnosed and treated by professionals
trained to treat childhood mental disorders,
• how well are various cultural groups accessing services and
how well do the services fit their needs, and
• whether or not the services are achieving desirable
outcomes in a cost-effective manner.
- Preventive intervention programs need to know more about
modifiable risk factors.
Both the NIH Publication No. 96-4093 "A Plan for Prevention
Research for the National Institute of Mental Health," and the
Institute of Medicine's, "Reducing Risks for Mental Disorders,"
National Academy Press, 1994, point out the need to adopt a public
health form of risk-reduction. The Center for Disease Control's
suicide prevention programs also stress the need to identify
risks.
In this context preventive intervention programs include early
identification and treatment programs. Where they are in use,
these programs are reducing the incidence of mental disorders and
reducing the disabilities cause by these disorders.
- Innovative programs need to be assessed for
cost-effectiveness, and successful ones need to be replicated.
For example, the state has a small Healthy Families
Alaska program and a federally funded Early Head Start
program that need to be evaluated. Hawaii's Healthy Families
program has been statewide since 1985, and their program
dramatically reduce child abuse, increase infant immunization
rates, and reduce alcohol consumption among enrolled at-risk
families. This type of program can also be used to aid families
with other risk factors, and help identify infants and toddlers
with psychiatric disorders. In Hawaii the child abuse rates among
high risk families has been dramatically reduced at one-half the
cost of the old style law enforcement approach used in Alaska.
Evaluations in other states show that these "home-visit" programs
can be cost-effective, but they need adequate support from other
provider agencies.
Another example is the innovative program that the Division of
Family and Youth Services had in Barrow in the early 1990s. There
the Youth Home staff anticipated family crisis, and they were able
to greatly reduce the use of their youth home. Currently the staff
and program has been moved to another community, Kotzebue I
believe. The program needs a review from an outcome standpoint,
and if it is as successful as reported it should be
replicated.
Another example is the program in Anchorage to manage
cognitively impaired sex offenders, which should be evaluated and
possibly replicated. On the other hand, in 1998 the state passed a
civil commitment law for violent sexual predators, although
similar laws in the state of Washington have been evaluated and
found to be unscientific and ineffective (click
here). The services under the new law need to be evaluated so
that we are not wasting scarce public resources on ineffective
programs.
- Cultural differences: Native, Asian American, Pacific
Islanders.
- Outcome studies: what is working for whom and under what
circumstances. "What Works in Children's Mental Health Services,"
by Kutash and Rivera, Paul H. Brookes Publishing, 1996.
Since the 1980s the National Institute of Mental Health has funded
epidemiological and services research. Alaska, however, has not
participated in these research programs.
There are a number of research announcements that
could help plan a better program of services and help with the
evaluation of effectiveness. Advocacy groups have been working on
these issues for over a decade (see history
of this issue).
The NIMH web
page lists a host of announcements; you will have to browse
through them, but a number are important to people in Alaska. For a
sample look at the excerpts from several of the grant
announcements:
Prepared by: Dick Wilson
Strategies:
- Planned Action steps:
Contact the Alaska Native Health Board
Return to Issues master Page
Email us webmaster
Date Last Modified:
5/7/01