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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. - PowerPoint PPT Presentation
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Mary Jane Alexander, PhD.Deborah Layman, MA
Gary Haugland, MA
Nathan Kline Institute for Psychiatric Research
APHA 141st Annual Conference November 4, 2013
Mary Jane Alexander
No relationships to disclose
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
NYS Office of Temporary Disability Assistance
NYS Office of Mental Health MH078188 to Dr. Alexander
Why an MH screen – and why the MMS - in Local Social Service Settings?
MMS Study in NYS Local Social Service Departments
Policy considerations
• 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
Authors Lifetime (L) Current (C) Population
Kessler (2005) 46.4% 26.2% General Household Survey
Alexander & Haugland (2008) 43% Substance Use Treatment
Bassuk (1998)MD 44%; PTSD 35%
AFDC Single Moms
Cook (2009)61% (Any)53 % MH
TANF single Moms
Huan & Douglas (2004) 30%TANF single parents, 6 states
Shinn & Alexander(2003) 43%TANF new applicants
Current StudyAlexander, Layman, Haugland, Tang (2012)
64% (Any) 38% (Any) Current Study in NYS
52% (MH) 36% (MH)
MH Conditions among PA MH Conditions among PA recipientsrecipients
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.
1. Understand the extent of MH conditions and functioning among NYS beneficiaries
2. Validate the Modified Mini Screen (MMS) using the SCID
3. Develop decision rules for MH referrals
LSSDs: 5 counties volunteered to host the study
COUNTIES 7 of NY State’s 10 Largest Cities (excluding NYC)
Westchester Yonkers, Mt. Vernon, White Plains, Portchester
Monroe Rochester
Albany Albany
Erie Buffalo
Rensselaer
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
1) Brief, computer assisted interview:
MMS, background, health questions (N= 517)
2) Telephone interview:
SCID for DSM-IV (N= 476)
%
Female 74
Race & Ethnicity
Black 63
White 23
Hispanic 13
American Indian 5
Other 11
Education
No diploma 39
High School or similar 35
Some college/Advanced 27
Age (Mean and sd) 37 years (11)
%
Relationships & Parenting
Participant:
Is a Parent 88
Lives with Some Children 62
Has Ever Been Married/In Marriage-Like Relationship
30
Is Currently Married/In Marriage-Like Relationship
23
Case Type (n=490)
Family Assistance 34
Safety Net Families 25
Safety Net Individuals 41
MMS
Chronbach’s alpha .9
Test –retest .7 Mean (sd) T1 = 7 (6); T2 = 5 (5)
SCID
Inter-rater reliability
Any Lifetime Diagnosis 1.0
Any Current Diagnosis 0.91
Anxiety 0.91
Major Depression 0.83
PTSD 0.82
SCID Diagnosis StatusLifetime Current
n % n %
Any 313 (64%) 186 (38%)
Mental Health 255 (52%) 176 (36%)
Mood 201 (41%) 96 (20%)
Anxiety 178 (36%) 138 (28%)
Psychotic 20 (4%) 14 (3.0%)
Lifetime and Current Rates of Lifetime and Current Rates of MH ConditionsMH Conditions
Health and FunctionNo Current Diagnosis
MH CurrentDiagnosis
Mean (SD) Mean (SD)
MMS Average 5.4 (5.2) 12.9 (4.9)GAF 74.8 (9.8) 56.6 (10.5)
Physical Health 44.6(11.6) 40.7 (12.4)
Mental Health 48.6(11.5) 34.9 (10.0)
Unable to carry out usual activities (days)
5.8 (8.3) 11.7 (8.3)
In bed due to illness or injury (days)
3.2 (6.0) 6.8 (8.0)
Health and Functioning
FA n=166
SNIn=199
SNFn=125
TotalN=490
Mean SD Mean SD Mean SD Mean SD
MMS Score 6.9(5.8) 9.4(6.6) 7.4(6.0) 8.1(6.3)
GAF 70.6(12.3) 65.5(14.1) 69.7(12.5) 68.3(13.3)
Physical Health Measure
45.5 (11.5) 39.5 (12.3) 45.8 (11.1) 43.1 (12.0)
Mental Health Measure
44.1 (12.3) 42.2 (13.0) 45.4 (13.0) 43.7 (12.8)
Days unable to carry out usual activities
6.3 (7.8) 10 (9.6) 6.6 (8.0) 7.9 (8.2)
Days in bed due to illness or injury
3.5 (6.2) 5.9 (8) 3.6 (5.9) 4.5 (7.0)
Functioning by Case Type Functioning by Case Type
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
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
Treatment Histories
MH Lifetime (N=255)
MH Current (N=176)
N % N %
No Lifetime MH Treatment
57 22% 36 20%
No Current MH Treatment
91 36% 77 44%
Matrix of Accuracy With a cutoff of 7-9
MMS OF 7 OR MORE53% Referred
MMS OF 8 OR MORE48% Referred
MMS OF 9 OR MORE
43% Referred
True MH Diagnosis
No MH Diagnosis
True MH Diagnosis
No MH Diagnosis
True MH Diagnosis
No MH Diagnosis
# Above 7 162 97 # Above 8 151 83 # Above 9 142 71
# Below 7 14 217 # Below 8 25 231 # Below 9 34 243
Accuracy
True Positive
Rate
93%
False Positive
Rate
31%Accuracy
True Positive
Rate
86%
False Positive
Rate
26%Accuracy
True Positive
Rate
81%
False Positive
Rate
23%
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
NKI Center to Study Recovery in Social Contexts. Adapted from Sen