Journal of Behavioral Health Services & Research最新文献

Technology transfer centers (TTCs) facilitate the movement of evidence-based practices in behavioral healthcare from theory to practice. One of the largest such networks is the Substance Abuse and Mental Health Services Administration's (SAMHSA) TTC Network. This brief report shares findings from an organizational network analysis (ONA) of the network conducted as part of an external evaluation. For non-supervisory TTCs (n = 36) across three focus areas (addiction, prevention, and mental health), the authors computed network density, harmonic closeness, and non-null dyadic reciprocity for five types of interactions (e.g., "collaborated in workgroups"), then, for each interaction type, used Welch's T-test to compare mean harmonic closeness of standalone TTC grantees versus multiple-TTC grantees. ONA identified potentially isolated regional TTCs as well as mismatches between some centers' desired scope and their network centrality and enabled investigation of broader questions around behavioral health support systems. The approach appears useful for evaluating TTCs and similar support networks.

Southern HIV Service Organizations (SHSOs) are promising sites for the adoption and implementation of harm reduction as a means for addressing the HIV and opioid syndemic. However, little research to date has examined exactly how harm reduction is operationalized within and among SHSOs. Using program evaluation data (i.e., organizational assessment data and semi-structured qualitative group interview data with SHSO staff), this study aimed to characterize organizational implementation of harm reduction among SHSOs that sought harm reduction capacity-building assistance (i.e., training, coaching, funding) from the SUSTAIN Center. Authors utilized a convergent mixed methods design in which quantitative and qualitative approaches were employed in parallel to gain simultaneous insights into how harm reduction was operationalized in SHSOs and how the local context influenced implementation. Means and proportions of each organizational assessment domain were compared. Thematic analysis of group interview transcripts examined SHSO staff perceptions of harm reduction implementation in their respective communities. Quantitative results revealed that SHSOs most commonly operationalize harm reduction in the Outreach, Advocacy, and Principles domains but struggle to do so in terms of Services and Organizational Infrastructure. Qualitative results revealed that various factors in SHSOs' local context, such as the community's lack of knowledge and understanding of harm reduction, limited harm reduction services, and a challenging socio-political context, influence SHSOs implementation of harm reduction. Taken together, analyses reveal that (1) SHSOs expend significant effort conducting outreach activities because Southern communities are generally unaware of harm reduction, (2) SHSOs continually advocate for harm reduction in the midst of a challenging socio-political context, and (3) SHSOs offer fewer harm reduction services and integrate harm reduction into their organizational infrastructure to a lesser extent due to external, contextual factors. The combination of organizational-level data and SHSO staff insights provided by this mixed methods study have implications for policy advocacy, funding initiatives, and capacity-building efforts.

Federally Qualified Health Centers (FQHCs) provide comprehensive care to medically underserved populations whose access to behavioral health services may be limited. The goal of the current study was to examine referral patterns to specialty mental health and subsequent treatment initiation in an FQHC. In a 13-month period from March 2017 to March 2018, 1201 patients received a specialty mental healthcare referral. Of these patients, 37% reported scheduling an appointment with this referral, 44% refused the referral, 4% reported improvement in symptoms and not needing a referral, and 5% were not able to be reached due to a contact number being out of service. Common referral reasons among adults were depression, anxiety, and stress, and the most prevalent pediatric referral reasons were behavioral problems, depression, attention deficit hyperactivity disorder (ADHD), and anxiety. These data suggest that of the patients who received a specialty mental health referral, only one-third scheduled an appointment. The study also suggested that anxiety problems may be underrecognized in both adult and pediatric patients. Although significant attention has been put on increasing access to behavioral health services, there is still an unmet need. Universal mental health screening and increased coordination with specialty mental health providers in the community may better address this need.

This study examines whether the Affordable Care Act (ACA) Medicaid expansion (ME) was associated with changes in racial/ethnic disparities in insurance coverage, utilization, and quality of mental health care among low-income adults with probable mental illness using the National Survey on Drug Use and Health with state identifiers. This study employed difference-in-difference models to compare ME states to non-expansion states before (2010-2013) and after (2014-2017) expansion and triple difference models to examine these changes across non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Latino racial/ethnic subgroups. Insurance coverage increased significantly for all racial/ethnic groups in expansion states relative to non-expansion states (DD: 9.69; 95% CI: 5.17, 14.21). The proportion low-income adults that received treatment but still had unmet need decreased (DD: -3.06; 95% CI: -5.92, -0.21) and the proportion with unmet need and no mental health treatment increased (DD: 2.38; 95% CI: 0.03, 4.73). ME was not associated with reduced disparities.

The US fee-for-service payment system under-reimburses clinics offering access to comprehensive treatments for opioid use disorder (OUD). The funding shortfall limits a clinic's ability to expand and improve access, especially for socially marginalized patients with OUD. New payment models, however, should reflect the high variation in cost for using a clinic's clinical and voluntary psychosocial and recovery support services. The authors applied time-driven activity-based costing, a patient-level, micro-costing approach, to estimate the cost at an outpatient clinic that delivers medication for opiate used disorder (MOUD) and voluntary psychosocial and recovery support services. Much of the cost variation could be explained by classifying patients into three archetypes: (1) light touch (1-3 visits): no significant co-occurring psychiatric illness, stable housing, and easy to connect for ongoing OUD treatment in a traditional outpatient setting; (2) standard (average of 8 visits): initially requires an integrated team-based care model but soon stabilizes for transition to community-based outpatient care; (3) quad morbidity (> 20 visits): multiple co-occurring substance use disorders, unhoused, co-occurring medical and psychiatric complexity, and limited social supports. With the cost of the initial visit set at an indexed value of 100, an average light touch patient had a cost of 352, a standard patient was 718, and a quad morbidity patient was 1701. The cost structure revealed by this analysis provides the foundation for alternative payment models that would enable new MOUD clinics, staffed with multi-disciplinary care teams, and located for convenient access by high-risk patients, to be established and sustained.

Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.

Experiencing homelessness during young adulthood is associated with negative health outcomes and understanding housing trajectories of young adults experiencing homelessness may aid in the development of evidence-based public health programs designed to serve this at-risk age group. In the present study, the authors examined baseline predictors of 24-month trajectories of housing stability and unsheltered housing among a sample of 271 young adults aged 18 to 25 recruited from drop-in centers in Los Angeles. In multivariate models, the authors found that identifying as multi-racial/other and better friendship quality at baseline were associated with less steep increases in the likelihood of stable housing over time. Being employed at baseline was associated with a less steep decrease in the probability of being unsheltered over time, while illicit drug use days associated with a steeper decrease in the probability of being unsheltered over time. Continued research is needed to establish important factors determining young adults' long-term housing trajectories in the effort to promote greater access and engagement with housing services.

SBIRT is an effective process to target unhealthy alcohol and other substance use in medical settings, yet gaps persist on how best to integrate SBIRT into routine clinical practice. Utilizing a mixed-methods design, the current study examined a statewide SBIRT implementation effort to identify key components of successful implementation. Quantitative patient-level data (n = 61,121) were analyzed to assess characteristics associated with implementation, and key informant interviews were conducted with stakeholders to understand the implementation process. Findings demonstrated variation in intervention rates, and both site- and patient-level factors influenced SBIRT service delivery. Qualitative results highlighted critical factors shaping these differences, including staff perceptions, type of leadership, degree of flexibility, and the health reform context. Study findings illustrate the importance of a supportive outer context, key facilitators such as buy-in, dynamic leadership, and flexibility during implementation, and the impact of site and patient characteristics for the successful integration of SBIRT into medical settings.

Veterans with obsessive-compulsive disorder (OCD) often face barriers to receiving evidence-based treatments such as exposure and response prevention (ERP). Through retrospective review of electronic medical records, this study examined the rates of ERP delivery in a national sample of 554 veterans newly diagnosed with OCD in the Veterans Health Administration between 2016 and 2017. Results indicated that only 4% of veterans (n = 22) received any ERP treatment; and, of those, 16 veterans received "true ERP." Veterans who received any ERP were younger than those who did not. ERP was primarily delivered by psychologists in urban facilities along the East and West coasts of the USA. The findings from this study emphasize the need to train more providers to effectively deliver ERP in addition to providing telehealth services to increase access to care for veterans in rural areas.