Journal of Behavioral Health Services & Research最新文献

This cross-sectional study aimed to assess the demographic and geographic variations in the visit rate for first-episode psychosis (FEP), identify trends and diagnostic patterns, and explore factors associated with FEP visits in Nebraska. Inpatient and emergency department data spanning 2017-2021 were collected by the Nebraska Hospital Association (NHA). The study focused on Nebraska residents aged 14-35 admitted for FEP, identified through specific ICD-10 codes. The sample was derived using a multi-step process, and the data included patient demographics, Behavioral Health Regions, rural vs. urban residency, and neighborhood characteristics. Mann-Kendall tests were used to test for significant trends over time. T-tests and chi-squared tests were used to assess differences in each of the measures between patients with and without psychotic disorders. The study findings revealed a significant increase in visits related to psychotic disorders from 2017 to 2021. In 2021, the FEP visit rate was 116 per 100,000 individuals, varying considerably by age, gender, and Behavioral Health Region. Schizoaffective disorder bipolar type was the most frequent psychotic disorder. Patients with psychotic disorders tended to be older, predominantly male, and treated in acute care settings. The rising trend underlines the need for continued investment in early intervention programs and highlights challenges in rural areas, necessitating targeted interventions. The findings provide valuable insights to inform planning, advocate for funding, and address the specific needs of diverse populations. Future research should explore additional influencing factors and extend the study period to understand FEP trends comprehensively.

Research demonstrates a positive impact of Peer Based Recovery Support Services (PBRSS) facilitated by peer recovery specialists (PRS), who are people in recovery from behavioral health conditions (e.g., substance use disorders [SUD] and mental health conditions). This study investigated PBRSS, their impact on client outcomes (e.g., substance use, health), and the factors (e.g., self-efficacy, perceived relationship with/helpfulness of PRS) mediating the relationship between services and outcomes while controlling for sociodemographic information (e.g., age). Data were collected across 58 sites within 25 agencies providing PBRSS in a state located in Northeastern USA. Cross-lagged panel models were used to examine 12 longitudinal mediational models in a sample of N = 412. Models were examined over two time periods (i.e., T1 and T2). After alpha correction (p = .00417), most results were nonsignificant. However, several findings indicated that constructs were significantly related across time in all models (e.g., self-efficacy at T1 significantly predicted self-efficacy at T2), while many point-in-time associations were also significant (e.g., number of services received was positively related to relationship/helpfulness of PRS at T1 and T2). Better PRS relationship/helpfulness at T1 significantly predicted a lower number of services received at T2, while receiving more services at T1 significantly predicted better PRS relationship/helpfulness at T2. Being older significantly predicted a worse overall health at T2 in some models. While no mediation was found, this study is important as it assists in building models with respect to the mechanisms by which PRS may effect change or not.

This study sought to understand how young adults (age 18-25) with histories of mental health disorders are coping with disrupted transitions to adulthood during the COVID-19 pandemic. A cross-sectional web survey was conducted in March-June 2021 of 967 US young adults with pre-pandemic psychiatric disability to assess their current psychiatric status, interrupted transitions, and associations with social determinants including income, community participation, and social context. Mental health was assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and PTSD Checklist-Civilian Version. Social determinants were identified with the Epidemic-Pandemic Impacts Inventory. Interrupted transitions were measured with the Young Adult Disrupted Transitions Assessment. Multivariable logistic regression models predicted four types of transition disruptions and associations with current mental health, social determinants, and demographic factors. Disruptions were reported by 81.1% including interrupted education completion (38.3%), employment careers (37.6%), residential independence (27.7%), and intimate partner relationships (22.9%). Many screened positive for major depressive disorder (81.7%), PTSD (85.5%), or GAD (58.6%). Disruption in establishing intimate partner relationships was associated with depression, anxiety, and PTSD. Interrupted residential independence was associated with anxiety. Interrupted education completion was associated with PTSD. Interrupted employment was associated with anxiety. Social determinants significant in these models included social connections, community participation, income, and racial/ethnic identification. Results illuminate ways that current mental health and social determinants affect transition interruptions during the pandemic. Findings suggest the need for interdisciplinary approaches, integrated models of care, and assistance accessing treatment, rehabilitation, and community support services from adult service systems.

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.

Rates of depression among youth and emergency department (ED) visits for un- or under-treated symptoms are on the rise. Early identification and treatment of depression is imperative at the patient, program, system, and population levels. This paper examines the individual and cumulative impact of Project ECHO and the inclusion of IBH services in pediatric primary care practices on mental health-related ED rates among youth diagnosed with depression for those practices. Twenty-eight practices participated and provided data on 5,388 patients diagnosed with depression who were seen between 2019 and 2022. A binominal mixed effect model was used to examine the impact of Project ECHO and IBH on mental health-related ED rates among youth diagnosed with depression per month within each practice. Compared to practices without an IBH program, those who implemented IBH had a significantly lower rate of mental health-related ED visits among this patient population (Incident Rate Ratio (IRR) = 0.80, p = .005, 95% Confidence Intervale (CI) = 0.68, 0.93). No significant differences were found between practices regardless of participation in Project ECHO, nor was there a significant interaction effect between practices that employed Project ECHO and IBH in combination. This study shows promising results with IBH having a positive impact on practice outcomes compared to treatment as usual, while Project ECHO in isolation or combined with IBH did not significantly affect rates of mental health-related ED visits.

The use of telehealth in behavioral healthcare increased significantly since the start of the COVID-19 pandemic and remains high even as a return to in-person care is now feasible. The use of telehealth is a promising strategy to increase access to behavioral healthcare for underserved and all populations. Identifying opportunities to improve the provision of telehealth is vital to ensuring access. An online survey about the current use of, and attitudes toward, telehealth was conducted by five Mental Health Technology Transfer Center (MHTTC) regional centers and the MHTTC Network Coordinating Office. The national MHTTC network provides training and technical assistance, to support the behavioral health workforce to implement evidence-based treatments. Three hundred and sixty-five respondents from 43 states and Puerto Rico participated. The majority of respondents were clinical providers (69.3%). Nearly all (n = 311) respondents reported providing at least one telehealth service at their organization, but the number and type of services varied substantially. Respondents had positive views of both video-based and phone-based services, but most had some preference for video-based telehealth services. Other services, including text message reminders, medication services, and mobile apps for treatment or recovery, were offered via telehealth by ~ 50% or fewer of respondents' organizations. Many organizations have areas where they could expand their telehealth use, allowing them to extend the reach of their services and increase access for populations that experience barriers to service access, though organizational barriers may still prevent this.

Peer support workers (PSW) improve outcomes for people with behavioral health needs, but integrating PSWs into routine behavioral healthcare has been challenging. Certified Community Health Centers (CCBHC), a new comprehensive care model, provides new opportunities to increase access to PSWs. The present study examines whether PSW utilization changed following one organization's transition to a CCBHC. Administrative data from a large behavioral health organization was used to examine changes in peer delivered services before and after CCBHC implementation. Chi-square analyses examined changes in the number of visits delivered by peers. Logistic regression examined differences in the likelihood of accessing PSW services during pre and post timepoints. Following CCHC implementation, the overall number of PSW visits delivered within substance use and transition age youth programs increased. In contrast, the number of PSW visits in community-based intensive case management program decreased. Clients with opioid use disorders were more likely to have accessed PSW services following CCBHC implementation. Results reflect that CCBHC designation generally increased the number of PSW visits within this organization; however, changes in peer service utilization were primarily concentrated among individuals with opioid use disorders and within substance use and transitional aged youth programs. This study provides novel insight into how PSWers are being integrated into the CCBHC model.

The opioid epidemic in the United States (US) has prompted innovative responses from law enforcement agencies including specialized units to refer overdose survivors to substance use treatment following an overdose. However, traditional law enforcement outreach does not address the multilevel barriers to treatment engagement that lead to repeat overdose-related calls for service. The current evaluation explored the process components and outcomes of a Comprehensive Opioid Abuse Program (COAP) initiative within a local law enforcement agency in the Southeast US. COAP funding supported a police-led recovery management team (RMT) to connect overdose survivors to substance use treatment. The RMT also utilized recovery management check-ups (RMCs) to provide sustained support to enhance substance use treatment engagement beyond the initial treatment referral. A mixed-methods approach was employed to examine participant demographic, substance use, mental health, treatment, and criminal justice characteristics (N = 65) and explore perceptions of programmatic strengths and potential areas for improvement (N = 15). The quantitative and qualitative analyses were informed by the Recovery Capital Model. Quantitative analysis revealed that the RMT connected many participants with various support services, notably including housing assistance and health insurance. Qualitative findings highlight program effectiveness in improving social, community, and personal recovery capital. These findings contribute to expanding research on police-led post-overdose initiatives and suggest that police-led RMCs can address multilevel barriers to treatment engagement and minimize law enforcement stigma.