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Validating the MMS: An MH referral screen for public assistance recipients in NYS

Validating the MMS: An MH referral screen for public assistance recipients in NYS. Mary Jane Alexander, PhD. Deborah Layman, MA Gary Haugland, MA Nathan Kline Institute for Psychiatric Research. APHA 141 st Annual Conference November 4, 2013. Presenter Disclosures. Mary Jane Alexander.

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Validating the MMS: An MH referral screen for public assistance recipients in NYS

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  1. Validating the MMS: An MH referral screen for public assistance recipients in NYS Mary Jane Alexander, PhD.Deborah Layman, MAGary Haugland, MA Nathan Kline Institute for Psychiatric Research APHA 141st Annual Conference November 4, 2013

  2. Presenter Disclosures Mary Jane Alexander The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

  3. Funding NYS Office of Temporary Disability Assistance NYS Office of Mental Health MH078188 to Dr. Alexander

  4. OUTLINE Why an MH screen – and why the MMS - in Local Social Service Settings? MMS Study in NYS Local Social Service Departments Policy considerations

  5. Why an MH screen – and why the MMS - in Local Social Service Settings?

  6. Why screen for MH in Local Social Service Settings? • Full and diverse community participation is a human rights principle and a public policy goal • Increased % of public assistance benefit recipients with complicating conditions that affect quality of life • Presence of MH Conditions in LSSDs is around 50% • About 40% of those who met criteria for any MH condition in 2011 did not receive services • Some evidence for supported approaches to Employment

  7. MH Conditions among PA recipients

  8. Why the MMS? Free Brief (22 items) Easy to use and score Computer based administration and scoring available Comprehensive (mood, anxiety, and psychosis) Excludes substance use (already screened by OTDA) Validated in NYS in Chemical Dependency OP & residential settings, street outreach programs, jails and shelters and now in local social service departments.

  9. MMS Study in NYS Local Social Service Departments

  10. Validation Study: Goals • Understand the extent of MH conditions and functioning among NYS beneficiaries • Validate the Modified Mini Screen (MMS) using the SCID • Develop decision rules for MH referrals

  11. Site Sample LSSDs: 5 counties volunteered to host the study

  12. Client sample In each site all clients appearing to recertify public assistance benefits were invited to participate Informed consent was obtained from people who were interested in participating Participants were compensated $25 for completing the screen and $50 for completing the telephone diagnostic interview

  13. Two part Study Procedure 1) Brief, computer assisted interview: MMS, background, health questions (N= 517) 2) Telephone interview: SCID for DSM-IV (N= 476)

  14. Study Sample (N = 476)

  15. Study Sample (continued)

  16. Reliabilities

  17. What we learned about Mental Health, Health & Functioning

  18. Lifetime and Current Rates of MH Conditions

  19. Functioning by MH Diagnosis

  20. Functioning by Case Type

  21. What did we learn about MH? Over 1/3rd of our sample met criteria for Current MH condition Over 60% of our sample met criteria for Lifetime MH condition All participants reported lower levels of functioning than the general population Participants with a Current MH condition reported poorer health and functioning than participants with No MH condition Safety Net Individuals and older participants reported poorer health and functioning and higher rates of all MH conditions than TANF and Safety Net Families

  22. What did we learn about MH? Over a lifetime, mood disorders were most common (41% of all participants) In the past month, anxiety disorders were the most common (28% of all participants) 269 (55%) participants experienced a traumatic event in their lifetime 65 (13%) percent met criteria for PTSD in their lifetime

  23. Treatment Gap

  24. Decision Rules

  25. Policy considerations

  26. Policy Implications The MMS is a reliable and accurate screen for use in Local Social Service Departments Best “statistical” balance between true and false positives occurs between MMS scores 7-9 Decision rules should be based on local capacity Screen should be optional for localities Screen should be optional for individuals

  27. Human Rights Implications: The Capabilities Framework NKI Center to Study Recovery in Social Contexts. Adapted from Sen

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