Journal of Behavioral Health Services & Research最新文献

Adolescence is a time of increased vulnerability to mental health conditions, which may necessitate hospitalization. This study sought to identify and characterize patterns of adolescent (re-)hospitalizations. The one-year (re-)hospitalization patterns of 233 adolescents were analyzed. The sequences of hospitalization and discharge was examined using cluster analyses. Results revealed five distinct (re-)hospitalization patterns or clusters: Cluster A represented brief hospitalizations with 56 cases (24.03%) averaging 7.71 days; cluster B consisted of repetitive short hospitalizations involving 97 cases (41.63%) with an average of 19.90 days; cluster C encompassed repetitive medium hospitalizations included 66 cases (28.33%) averaging 41.33 days; cluster D included long hospitalizations with 11 cases (4.72%) and an average of 99.36 days; cluster E depicted chronic hospitalizations, accounting for 3 cases (1.29%) with an average stay of 138.67 days. Despite no age-based differences across clusters, distinctions were noted in terms of sex, diagnoses, and severity of clinical and psychosocial difficulties. The study identified characteristics of both regular and atypical adolescent hospitalization users, emphasizing the distribution of hospitalization days and their associated clinical attributes. Such insights are pivotal for enhancing the organization of child and adolescent mental health services to cater to the growing care requirements of this age group.

There is a dose-response relationship between the incidence of psychiatric issues and poverty. To better understand disparities related to extreme poverty and inequality, this study aims to investigate whether there is a difference in mental health services between counties identified as persistent poverty counties and those not identified. Data from the National Survey on Substance Abuse and Mental Health Services and the U.S. Census American Community Survey were analyzed. A random-effects logit regression analysis was performed to determine the likelihood of access to various types of mental health facilities, behavioral health services, medical services, screening services, emergency services, and ancillary services. Adjusted regression results revealed that persistent poverty county status was associated with a lower likelihood of residential facility services (OR = 0.65, 95% CI 0.45, 0.96), a higher likelihood of medication use (OR = 1.58, 95% CI 1.20, 2.09), and a higher likelihood of ancillary services (OR = 1.10, 95% CI 1.05, 1.16), especially chronic disease management, housing, intensive case management, and peer support. Meanwhile, fewer trauma-related treatments were available in these counties. A subsample of rural counties showed similar results. Mental health providers in persistent poverty counties were less likely to offer residential and behavioral health services and more likely to provide medication and ancillary services. Implications for mental health policy and practitioners are discussed.

Depression, a prevalent health condition, substantially impacts both socioeconomic outcomes and individual wellbeing. Despite the availability of diagnostic tools, existing approaches for identifying depression severity often rely on single-indicator approaches, limiting accuracy. This retrospective study evaluates a multi-parameter analytics-enabled Identification and Stratification (IDS) framework designed to improve depression identification and severity stratification by leveraging health insurance claims and electronic health record data. For the evaluation, Highmark Health dataset was used, consisting of records for members aged 18 + with at least one healthcare encounter. The IDS framework identified 720,882 members with depression (16.6% of the population). The framework identified 258,206 more members (5.9% of the population) compared to using diagnoses alone. The stratification rules revealed variability in prevalence, with 5.0% mild, 8.5% moderate, 2.2% severe, with the remaining 0.9% in unknown, remission, or minimal. The IDS rules escalated 46% of mild and 19% of moderate cases to higher severity compared to single indicator assessments. Expenses for severe depression were, on average, 2.5 times higher than for minimal. The IDS framework demonstrated utility in identifying members with depression by linking fragmented data sources. Aligning multiple indicators provided a more comprehensive identification and a more nuanced severity evaluation compared to individual data elements. This enables targeting of cost-effective digital self-care tools to milder cases while reserving higher cost interventions for the most severely ill, potentially reducing costs while maintaining health outcomes. Implementation of this integrative platform can help focus efforts on those with the highest need and bridge the gap in treating depression.

People with mental health and substance use disorders (SUDs) experience worse outcomes, including increased mortality risk, compared to those with SUDs alone. Access to safe, stable housing, in conjunction with treatment, such as intensive outpatient programs (IOP), is vital in early recovery. Nevertheless, those with historically marginalized identities may experience increased disparities in accessing and utilizing services. The aim of this study was to examine disparities in the utilization of recovery residences among adults receiving treatment for mental health disorders and SUDs in an IOP. Participants (n = 2803) were recruited as part of an ongoing program evaluation at a large Midwestern treatment agency offering to cover some of the monthly cost of living in independently operated recovery residences while admitted to the IOP. Collected data included demographic information and outcome variables. Logistic regression models examined factors associated with recovery residence enrollment. Most participants (80.5%, n = 2258) lived in a recovery residence during IOP. People who were female, Black-only, multiracial, had less education, or a legal history were less likely to live in recovery residences. Those with a prior treatment history, recently unhoused, or with more days abstinent from substances were more likely to live in recovery residences. In short, even with reduced cost barriers, disparities persist in the utilization of recovery residences in conjunction with IOPs, particularly those from historically marginalized groups. Future research should prioritize understanding this utilization gap and developing effective strategies to support individuals in utilizing recovery residences alongside IOP for improved outcomes.

Adolescence is often identified as the period of time when individuals first begin to experience mental health needs, though a gap remains between need and mental health service use. With limited knowledge of continued impact of mental health service use on future services and mental health need, this study aims to examine the longitudinal, bidirectional relations between mental health service utilization and mental health symptoms across four time points. Data came from four waves of the National Longitudinal Study of Adolescent Health (Add Health; N = 7,902). We examined mental health service (MHS) utilization in the past 12 months and depressive symptoms. Cross-lagged panel analyses were conducted, adjusting for sociodemographic characteristics. Findings indicated that school MHS utilization at Tn increased the odds of using MHS at Tn+1 across all waves (OR = 1.34, 1.53, and 1.61, respectively). Second, depressive symptoms at Tn also predicted depressive symptoms at Tn+1 (β = .21, .30, .30, respectively). Third, as MHS use at Tn predicted depressive symptoms at Tn+1 (β = .14 (school), .27, .11, .18, respectively), depressive symptoms at Tn were significantly related to future mental health service use at Tn+1 (OR = 1.09, 1.15, 1.05 respectively). The current study extends the understanding of the reciprocal relationship between MHS use and depressive symptoms. The study suggests the critical importance of using school-based services in adolescence to promote mental health service use in adulthood, highlighting implications for adolescent mental health service providers across service settings.

The objective of this study was to describe the clinical experiences associated with billing for short-term residential care for substance use disorder (SUD) under a Medicaid managed care organization (MCO) payment structure requiring prior authorization. The authors conducted a qualitative analysis of focus group data collected from residential adult services (RAS) facilities staff in West Virginia between 2020 and 2022. These primary data were derived from 17 semi-structured focus groups across 11 distinct RAS facilities, which included 28 administrators, 23 clinicians, and 10 peer recovery support specialists, and were recorded and transcribed before being coded. A phenomenological thematic analysis was employed using data describing reported experiences of RAS staff members billing MCOs under the 1115 Medicaid SUD Waiver. Two main themes arose related to billing MCOs for residential treatment. First, providers felt powerless in their roles as their focus moved from clinical to administrative due to the administrative burden of prior authorizations. Second, providers felt that the shorter lengths of stay for patients that resulted from the prior authorization requirements reduced the quality of care they could provide and that the low quality of care increased the risk of relapse among patients. Thus, MCOs' utilization of prior authorization as a cost management tool may create barriers for providers to fulfill their clinical roles and provide high-quality care. More research is needed to investigate the prior authorization process from the perspective of MCOs and to quantify the effects of prior authorization on patient outcomes.

Mindful eating (ME) is becoming increasingly popular as a method of changing problematic eating behaviors, including orthorexic (ON) thoughts and behaviors. Simultaneously, the psychometric flaws of commonly used questionnaires for assessing ON thoughts and behaviors limit the potential of exploring their association with ME and diet quality. The study aimed to (a) assess the intensity of ON thoughts and behaviors; (b) evaluate the associations between ON thoughts and behaviors, ME, and diet quality; and (c) compare ORTO-R with ORTO-15 and its shortened versions and PL-DOS. Data were collected from a sample of 478 college students through a cross-sectional study conducted in 2021 across eighteen universities in Poland. Students completed the ORTO-R, ORTO-15, Düsseldorf Orthorexia Scale (PL-DOS), Mindful Eating Scale (MES), and Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN). ORTO-15 and its shortened versions correlated at least highly positively with each other for both sexes, as did ORTO-R and PL-DOS. Positive correlations were found between ORTO-15 and its shortened versions and such mindful eating behaviors as act with awareness as well as awareness for females and/or males. Meanwhile, ORTO-R correlated negatively with act with awareness and acceptance for females and/or males. In addition, PL-DOS correlated negatively with awareness and acceptance for females and/or males. An increase in the intensity of ON thoughts and behaviors measured by almost all questionnaires was associated with an increase in the intensity of beneficial dietary characteristics for health (higher the "Pro-Healthy Diet Index"-pHDI, and the "Diet Quality Index"-DQI) and a decrease in the intensity of harmful dietary characteristics for health (lower the "Non-Healthy Diet Index"-nHDI). Overall, ORTO-R and PL-DOS proved to be the most effective questionnaires for distinguishing eating behaviors in the context of orthorexic thoughts and behaviors, but only for ME. The results may suggest that ME practices may be associated with reduced ON thoughts and behaviors. However, limitations of the study, for example, a sample of college students, a non-randomly selected of sample, a cross-sectional design of the study, and an imbalanced biological sex ratio, make it much more difficult to generalize the results.

This study examined locus of control (LOC), coping, and professional quality of life in therapeutic service providers (TSPs; mental health clinicians with master's degrees or higher) to determine whether coping strategies either mediated or moderated the relationship between LOC and professional quality of life. One hundred seventy-two TSPs completed self-report measures used in these analyses. An exploratory factor analysis was conducted on the coping measure and yielded four coping subscales: adaptive, avoidant, religious, and substance use. The study used the PROCESS macro to examine whether coping strategies mediate the effect of LOC on professional quality of life. Regression analyses were used to examine moderation effects of LOC and coping strategies on professional quality of life. Results revealed that the relationships between both powerful others and chance with compassion satisfaction were negatively mediated by avoidant coping. Avoidant coping also negatively mediated the relationship between internal LOC and secondary traumatic stress. The relationship between chance and burnout was positively mediated by avoidant coping. Avoidant coping partially, negatively mediated the relationship between internal LOC and burnout. Lastly, the relationship between powerful others and burnout and internal LOC and compassion satisfaction was partially, positively mediated by avoidant coping. No coping strategies statistically moderated the relationship between LOC and professional quality of life. Findings suggested that avoidant coping plays an important role in the professional quality of life for TSPs and that internal LOC may have critical implications for a strong professional quality of life.

To address the behavioral health workforce crisis occurring in the United States, supporting students' interest in the behavioral health professions is urgent. Ongoing exploration of possible educational pathways into the behavioral health workforce is warranted, which can highlight opportunities to expand the number of adequately trained, culturally and linguistically representative, behavioral health providers. The purposes of the current study are to identify distinct educational pathways into graduate-level behavioral health professions and assess the extent to which varying pathways are associated with individual sociodemographic and employment characteristics. Leveraging an analytic sample of 1858 individuals from the 2021 National Survey of College Graduates (representative of a subpopulation of 847,095 individuals) who possessed a graduate degree and indicated being employed full time in a principal job related to behavioral health, latent class analysis is employed to identify distinct patterns with respect to the attainment of an associate degree, undergraduate field of study, and graduate field of study. Results favor a four-class solution featuring the following four general patterns: social work, psychology foundation and non-social work graduate degree, non-social work foundation and social work graduate degree, and non-psychology foundation and non-social work graduate degree. The educational pathways possess notable similarities in terms of gender identity, average salary, and job satisfaction; but also demonstrate important differences that could shape efforts to develop new programs and extend investments to support behavioral health workforce professional trajectories, with particular emphasis placed on financial support for educational pathways that efficiently increase the diversity of the graduate-level behavioral health workforce.