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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.

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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, MAGary Haugland, MA

Nathan Kline Institute for Psychiatric Research

APHA 141st Annual Conference

November 4, 2013

presenter disclosures
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

funding
Funding

NYS Office of Temporary Disability Assistance

NYS Office of Mental Health

MH078188 to Dr. Alexander

outline
OUTLINE

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

MMS Study in NYS Local Social Service Departments

Policy considerations

why screen for mh in local social service settings
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
why the mms
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.

validation study goals
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
site sample
Site Sample

LSSDs: 5 counties volunteered to host the study

client sample
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

two part study procedure
Two part Study Procedure

1) Brief, computer assisted interview:

MMS, background, health questions (N= 517)

2) Telephone interview:

SCID for DSM-IV (N= 476)

what did we learn about mh
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

what did we learn about mh1
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

policy implications
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

human rights implications the capabilities framework
Human Rights Implications: The Capabilities Framework

NKI Center to Study Recovery in Social Contexts. Adapted from Sen