Journal of Behavioral Health Services & Research最新文献

Adverse childhood experiences (ACEs) have been linked to food insecurity, poor health outcomes, and socioeconomic challenges. Despite this, there is a dearth of studies connecting ACEs to use of safety net programs in the United States (U.S). This study examines the prevalence and association between ACEs and parent-reported use of SNAP benefits in U.S. households. Data were obtained from the parent-reported 2022 National Survey of Children's Health ( N = 52,521 children). Descriptive statistics were used to estimate prevalence rates, and six logistic regression models were used to determine the significant association between ACEs and parent-reported SNAP benefits use during the past 12 months. An estimated 57.5% of children with one or more ACEs had parent-reported SNAP benefits use in their households during the past 12 months. Children's individual ACE exposure such as  experiencing economic hardships (AOR = 2.29) and being discriminated due to health conditions (AOR = 1.69) were associated with higher likelihood of parent-reported SNAP benefits use in households during the past 12 months. However, living with a family member with mental illness was associated with lower likelihood of parent-reported SNAP benefits use in households during the past 12 months (AOR = 0.70). Additionally, children's exposure to at least one ACE (AOR = 1.60), two ACEs (AOR = 2.27), three ACEs (AOR = 2.88), and four or more ACEs (AOR = 2.80) were associated with higher likelihood of parent-reported SNAP benefits use in households during the past 12 months. This study underscores the need for comprehensive interventions to address children's ACEs and strengthen public welfare policies for continuous use of SNAP benefits for families with limited resources in U.S households. Detailed implications for behavioral health, practice, and policy are further discussed.

Transitioning foster care children from fee-for-service (FFS) Medicaid to Medicaid managed care (MMC) plans is increasingly common, yet research on the impact of such transitions is limited. This systematic review addresses this gap by synthesizing evidence on the effects of transitioning foster care children from FFS to MMC on healthcare utilization and costs. Eligibility criteria included peer-reviewed articles on youth in foster care in the United States, aged 0-18 years, comparing selected outcomes under FFS vs. MMC. The outcomes of interest included behavioral, dental, vision, and well-child care. The databases searched were MEDLINE (PubMed), Cochrane Library (Wiley), APA PsycINFO (Ebsco), Social Services Abstracts (ProQuest), and Web of Science (Clarivate). A qualitative synthesis of articles meeting the inclusion criteria was performed. Five articles met the inclusion criteria. Three articles yielded mixed findings regarding behavioral healthcare, which was evaluated as having low certainty of evidence. Two articles on well-child visits indicate significant changes when transitioning youth from FFS to MMC coverage, with varied impacts based on how well-child visits were defined and rated moderate certainty of evidence. No articles examined dental or vision outcomes. Results suggest a shortage of empirical evidence on the effects of transitioning from FFS to MMC for children in foster care. Future research should describe insurance benefits packages in greater detail, as not all FFS or MMC programs are the same and continue to study the impacts of such transitions on healthcare utilization and outcomes for this vulnerable group.

Evidence-based practices (EBPs) are most effective when they are delivered with a high degree of fidelity, or as they are intended to be delivered. Because clinicians often deviate from fidelity, it is important to monitor EBP fidelity over time to guide corrective actions. However, little is known about current fidelity monitoring practices in community behavioral health care. The current study used a mixed methods approach to characterize current fidelity monitoring practices, as well as barriers and facilitators to fidelity monitoring, in community behavioral health care agencies. Therapists, supervisors, recovery coaches, executive leaders, and agency leaders (N = 191) from multiple agencies in a Midwestern state completed a survey measuring current fidelity monitoring methods at their agency and perceived acceptability and feasibility of potential fidelity monitoring methods and strategies. Additionally, agency leaders, supervisors, and therapists (N = 10) within the state and leaders of intermediary organizations (N = 11) across the United States participated in individual qualitative interviews asking about facilitators, barriers, and priorities related to ongoing fidelity monitoring. Most respondents indicated their agency currently monitors what practices are being delivered, with self-report and chart review the most frequently reported methods used and session recordings and role-play assessment the least-frequently endorsed. Mixed methods results revealed common barriers to and potential strategies for facilitating fidelity monitoring efforts at the clinician-, agency-, and system-level. Findings highlight the need for scalable and sustainable methods for monitoring fidelity and the need for multi-level approaches to support EBP fidelity monitoring in community behavioral health settings.

Chronic pelvic pain (CPP) is a medically complex, multifaceted gynecological condition associated with psychological comorbidities and sexual trauma among women. Low rates of positive treatment outcomes underscore the need to better understand complex relationships between CPP, trauma exposure, and the psychosocial context of patients' lives. We conducted a secondary analysis of English and Spanish qualitative interviews with female-identity patients (N = 48) about CPP's impact on psychosocial well-being. Interviews were coded and analyzed in accordance with reflexive thematic analysis. We generated 4 themes regarding CPP and psychosocial well-being: navigating pain-filled relationships, multiple burdens of mental health challenges and marginalization, sexual trauma exposure embedded in illness experience, and harnessing hope in healing and dealing with CPP. We used insights from these findings to generate a list of treatment recommendations for trauma-informed, CPP-specific integrated care. Patients described the importance of social support and how psychological comorbidities and trauma exposure contributed to CPP's psychosocial toll. Findings provide insight into the burden of CPP-related minority stress and the role of hope on patients' well-being. Patients with CPP endorse the integration of psychosocial support into their CPP treatment plans. The authors encourage the incorporation of behavioral health providers into integrated care teams to deliver trauma-informed, culturally responsive methods for engaging patients with CPP in psychosocial interventions addressing multiple domains of well-being.

Model adherence indicates the degree to which a program or intervention is delivered as intended. In integrated primary care, where mental health services are embedded into primary care clinics, appraisal of model adherence provides insight into whether these services align with key features of this unique practice environment (e.g., brief, interdisciplinary care). To date, such evaluations have emphasized system and provider factors. This study is a preliminary evaluation of whether a novel patient-facing measure, the Primary Care Behavioral Health Provider Adherence Questionnaire-Patient Version (PPAQ-Patient), can provide insight into adherence to the Primary Care Behavioral Health (PCBH) model of integrated primary care. Survey data were collected from 281 veterans who received PCBH care. Exploratory factor analyses evaluated the data structure. Results suggest that 19 items spanning three temporally-referenced subscales may feasibly capture patient perspectives on PCBH adherence at various stages of treatment. Future work is needed to refine the measure.

This study examines older adults' perspectives on patient-centered care and engagement in a short-term behavioral health intervention, addressing persistent barriers to mental health access in aging populations. Guided by the NIH Stage Model (Stage 1), the goal was to refine the intervention by integrating participant feedback to enhance recruitment, retention, and overall program acceptability. Data were drawn from focus groups with residents of The Villages® community, alongside program participation and survey records. The 12-week intervention enrolled 183 participants; 115 (62.8%) completed all 10 sessions and both intake and exit surveys. Most completers were female (75.7%) and white (92.2%), with anxiety (60.9%) and depression (54.8%) as the most common treatment reasons. While completion rates were moderate, 37.2% dropped out, and only 33.8% of non-completers responded to follow-up inquiries, underscoring ongoing retention challenges. Findings highlight the potential of embedding behavioral health services within primary care to reduce stigma, improve accessibility, and leverage trust in existing provider relationships. Older adults valued clear communication, early demonstration of benefits, and interventions tailored to their preferences and cultural context. However, early discontinuation-often after perceived improvement-suggests a need for strategies that encourage sustained engagement, such as rapport-building, booster sessions, or follow-up reminders. From a systems perspective, integrating behavioral health into primary care can promote equity, reduce logistical barriers, and support more holistic care delivery. These insights can guide providers, policymakers, and researchers in designing responsive, patient-centered interventions that improve both engagement and outcomes for older adults.

This qualitative study explores what factors influence teaming in behavioral health settings, from the perspective of behavioral health providers. Twenty-four participants from a range of behavioral health professions engaged in semi-structured interviews. Using a grounded theory approach, data were analyzed, and a "prism" model was developed to capture the complexities of behavioral health providers' perceptions of factors influencing teaming in various mental health and/or substance use disorder treatment programs. Specific model components included: behavioral health context, individual factors, navigating disciplinary-specific approaches, workplace structures, communication as a "throughline," and varied perceptions of teaming. The prism model is dynamic, acknowledging the role of the individual in the system while also recognizing that participant perceptions of teaming are shaped by environmental and contextual forces. Each pathway is singular, with a variety of interacting factors. A key finding is that while teaming was viewed positively, there was no shared understanding of what teaming meant or whether it was occurring. The article concludes with implications for behavioral health education and practice, including support for new models of behavioral health care that incentivize teaming, expand community supports and peer workforce, prioritize the goals of recovery and wellness, and provide opportunities for more flexible financing.