Journal of Behavioral Health Services & Research最新文献

There are rising concerns over the availability of mental health services for children and youth. Recent evidence has shown reductions in the use of psychiatric inpatient, residential, and outpatient services among youths ages 0-17, with the COVID-19 pandemic and mental health workforce shortages identified as reasons for recent declines. The current study builds upon this evidence by exploring predictors of state-level changes in youth inpatient, residential, and outpatient service use from 2010 to 2022. This investigation involved secondary analysis of data collected from a Substance Abuse and Mental Health Services Administration (SAMHSA) annual survey of mental health treatment facilities across all 50 US states, D.C., and Puerto Rico, and publicly available data from the US Census Bureau and Kaiser Family Foundation. Results from longitudinal panel data models identified several state-level factors explaining variation in service use beyond reductions associated with COVID-19. Medicaid expansion, higher Federal Medical Assistance Percentage (FMAP), and more treatment facilities per capita were associated with higher utilization, and a greater percentage of youths from racial or ethnic minority backgrounds was associated with lower utilization. These findings suggest some actionable steps and service gaps needing further attention to help states improve service use in youth populations.

Team-based models of care delivery are increasingly utilized to address co-occurring mental health and/or substance use conditions. However, little is known about how team-based models function among primary care teams delivering treatment for opioid use disorder (OUD). The research team conducted qualitative interviews with a sample of multidisciplinary, primary care team members delivering OUD treatment using the collaborative care model (CoCM). Providers were recruited from 13 diverse United States (U.S.) clinics participating in a multisite hybrid effectiveness-implementation trial. Interviews were audio recorded and professionally transcribed. All transcripts were double-coded using a coding schema informed by relational coordination theory. Thirty-five team members completed an interview, including 14 primary care providers (PCPs), 13 behavioral health care managers (BHCM), and eight consulting psychiatric providers (CPP). Four themes emerged: (1) team-based work increases shared knowledge about patients; (2) team members leverage one another's relationships with patients to increase treatment engagement; (3) team collaboration is enhanced when BHCMs have opportunities and space to connect informally with PCPs; and (4) increased mutual respect between team members is needed to maximize patient engagement efforts. Team-based models may enhance patient engagement in OUD care by increasing the volume of patient contacts and augmenting therapeutic alliances.

Most youth in need of specialty anxiety treatment services do not receive it. Many families are lost between the time of initial outreach and attending a first therapy appointment. A retrospective administrative database review identified characteristics of families at risk of failing to connect with anxiety specialty services. Data included 563 records (2019-2023) from a specialty pediatric anxiety program embedded within a large community mental health setting. Variables of interest included client characteristics (age, gender, previous mental health diagnosis/history); household characteristics (insurance, parent/caregiver custody, distance from clinic); and a symptom screener. Descriptive statistics characterized documented non-response to appointment offers and failure to attend an initial scheduled appointment. The highest drop off occurred after families expressed initial interest in services; 113 (21%) families were non-responsive to outreach. Logistic regression analyses indicated that having insurance covered services (vs. self-pay) and living closer to the clinic (vs. farther) predicted increased odds of intake appointment scheduling (ps < .01). Clients with insurance covered services (vs. self-pay) also had higher odds of successful appointment attendance (ps < .01). Findings indicate that many families seeking specialty anxiety services for youth "fall off" after initial outreach (e.g., leaving a voicemail or completing an online inquiry form to learn about services). The results suggest the potential importance of streamlining initial contacts to make it easier for families to engage and suggest the potential for future work to examine whether strategies like direct intake booking can improve initial engagement rates.

The escalating mental health crisis in the USA has left over fifty percent of adults with a mental illness without mental health services. Federal mental health parity legislation addresses financial barriers to mental healthcare by requiring that insurance coverage for mental health services is equivalent to coverage for other medical services. Using data from the top ten and bottom ten states ranked by per capita State Mental Health Agency expenditures, this paper examines the impact of parity implementation and enforcement on three system-level access to care measures: (1) mental health workforce availability, (2) percent of state population living in a mental health shortage area, and (3) percent of total health expenditure spent on mental health by state agencies. As hypothesized, the top ten states had more comprehensive parity implementation and enforcement and a larger allocation of total health expenditures to mental health (p = 0.0002). The other two measures did not show a significant difference but trended in the direction of greater workforce availability (p = 0.11) and fewer residents living in mental health provider shortage areas (p = 0.054) among the top ten states compared to the bottom ten states. Using the scope of mental health parity alone, all three access-to-care measures were significantly better among states with comprehensive parity compared to states without comprehensive parity. These findings highlight the critical roles of financial investment, policy prioritization, and enhanced mental health infrastructure in addressing access to mental healthcare.

Child psychiatry access programs address the shortage of child and adolescent psychiatrists and other mental health professionals nationwide. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) provides telephone or email guidance to pediatric primary care providers treating mild to moderate psychiatric symptoms in patients. Statewide programs like the WI CPCP offer direct outreach meetings to primary care clinics, which, though resource-intensive, are hypothesized to increase program utilization. This study examined whether direct outreach meetings to primary care corresponded with subsequent increased primary care consultations with the WI CPCP. The authors hypothesized that direct outreach meetings would increase primary care consultations with the WI CPCP. WI CPCP consultations among 492 primary care providers were compared in the period 3 and 12 months before and after receiving a direct outreach meeting. These were also compared to 492 matched control providers who did not receive a direct outreach meeting. Results of generalized estimating equation analyses suggested that direct outreach meetings significantly increased primary care utilization of the WI CPCP (p < .01). Consultation numbers more than doubled when including consultations generated during direct outreach meetings themselves. Consultation numbers nearly doubled when examining consultations after direct outreach meetings. Results held for both the 3- and 12-month periods following a direct outreach meeting. Although direct outreach meetings may require additional time and resources for pediatric psychiatry access programs, they add value via increased primary care engagement for at least 1 year.

Complex concerns, such as tobacco use and risky drinking in patients with cardiovascular disease (CVD) who report not being ready to change, may require multi-dimensional approaches to intervention. In this Notes from the Field, an interdisciplinary, integrated conjoint appointment is described wherein primary care providers (PCPs) and behavioral health providers (BHPs) meet together briefly with the patient, bringing varying expertise in an effort to increase readiness to change and cessation of problem behaviors such as smoking. First, the protocol for this appointment, which is part of an intervention, which will be referred to as CARE-PACT (CardiovAscular Risk Education in Patient-Aligned Care Teams), will be described, including the evidence-informed components and choices made to increase feasibility and implementation of conjoint appointments across primary care clinics. Next, using an illustrative case example, the authors describe the flow, content, and logistics of CARE-PACT conjoint appointments, and the follow-up after the conjoint portion. CARE-PACT was examined as part of a small research pilot, and feasibility data, acceptability, satisfaction, and perception of usefulness was collected. Ten patient participants responded favorably to CARE-PACT, rating helpfulness and satisfaction a 4.1-4.7 on a 5-pt scale (5 signifying best). With the exception of some technological issues, qualitative data revealed patients found conjoint appointments were informative, patient-centered, and a good way to introduce a BHP. Altogether, this work supports the use of brief, interprofessional conjoint appointments in primary care in order to improve care processes for patients who have complex needs and who may need more than standard primary care interventions.

Young adulthood is a critical time for understanding mental health needs and young adults experience adverse symptoms at alarmingly increased rates. Following COVID-19, telehealth services came to the forefront of care for all ages. Despite increased use of telehealth services for behavioral health needs, a gap remains between service need and service use among young adults. Informed by Andersen's Behavioral Model of Health Care Utilization, the current study examined theoretically related factors for telehealth service utilization among young adults. Data were from the 2021 National Survey of Drug Use and Health. Participants were ages 18 to 25 years old (N = 13,979). Predictors included predisposing factors (sociodemographic characteristics), enabling factors (income, geographic location, insurance, and government assistance), and need factors (health, mental health, and substance use). A forward selection logistic regression was used to determine their impact on past-year telehealth use. Findings revealed factors associated with increased likelihood of telehealth use, including being female, being older, enrolled in school, being employed, earning over $75,000 per year, living in a metropolitan area, and having mental health, substance use, or health concerns. In contrast, identifying as non-white, being unemployed, earning between $20 k-$74 k, being on government assistance, or having insurance were associated with a decreased likelihood of telehealth use. Findings reveal important disparities and highlight the ongoing need to address structural and systemic barriers in telehealth access. Implications for practice and policy include expanding digital access, ensuring insurance flexibility that supports telehealth services, and investing in culturally responsive care models and training.

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.