Journal of Behavioral Health Services & Research最新文献

The evaluation of nine rural Oregon Certified Community Behavioral Health Clinics (CCBHCs) revealed lessons for delivering equitable behavioral health services to diverse populations from the perspectives of clinic leaders and other key partners, including those who receive services at CCBHCs. The Oregon CCBHC evaluation team employed a mixed methods data collection strategy from July to November 2022, including virtual interviews with clinic leaders, in-person focus groups with CCBHC clients at the CCBHCs, a virtual focus group with community-based organization representatives, and interviews with interested parties. Surveys of individuals who could not attend interviews or focus groups were conducted to supplement the findings. The results of this evaluation suggest the importance of four major themes to guide the equitable delivery of behavioral health services: challenges of addressing heath inequities, importance of fostering genuine community engagement, need for building capacity for innovation, and importance of integrating services and care. The experience of Oregon's CCBHCs provides insights into how rural clinics can improve equitable access to behavioral health services and encourage holistic, person-centered care by collaborating with state health authorities and other local community partners. The findings can inform clinicians and policymakers, highlighting the importance of strategic actions centered on equity for achieving better behavioral healthcare access in rural America.

U.S. service members transitioning from the military face formidable challenges to securing meaningful employment matching their preferences and qualifications. Despite diverse employment services, many veterans settle for dead-end jobs. This study examined personal characteristics predicting successful employment outcomes. In a secondary analysis of a controlled trial assessing 2-year employment outcomes for 205 transitioning veterans with service-connected disabilities participating in a career coaching program, multivariate regression analyses were conducted to identify personal characteristics associated with employment outcomes, including characteristics differentiating who benefits more from a career coaching program, compared to usual services. Two employment outcomes were examined: job acquisition and employment earnings. The single best predictor of job acquisition was assignment to the career coaching intervention. Among 18 demographic, military service, and health and well-being measures, the only predictor of job acquisition was gender (91% of men and 79% of women worked during follow-up). Twelve personal characteristics were associated with mean monthly earnings from employment, including four demographic measures, three military service measures, and five measures of health and well-being. Disability ratings did not predict employment outcomes. Overall, career coaching helped veterans gain employment, regardless of their personal characteristics. Three personal characteristics differentiated veterans who benefited more from career coaching. Veterans reporting alcohol use and those who had a longer period of military service benefited more, as did veterans who were not depressed. The authors conclude that most veterans obtain civilian employment soon after separation from the military, but personal characteristics strongly influence their employment earnings.

People experiencing housing insecurity and homelessness are diagnosed with mental health and substance use-related conditions at higher rates than their stably housed peers and often engage with systems including housing and homelessness systems such as eviction prevention, emergency shelters, homeless outreach services, and transitional housing, health systems including emergency departments and criminal legal systems including police interaction and incarceration. This qualitative study's aims are (1) to understand how people experiencing housing insecurity and homelessness access behavioral health services, including mental health and substance use-related care and (2) examine the role of social support, systems involvement, and previous treatment experiences in accessing or using these services. Thirty interviews were conducted with people experiencing homelessness or housing insecurity to learn about their experiences accessing and using mental health or substance use-related services, including the role of other service systems and social supports. A framework approach was used for analysis. The researchers identified five key themes related to use or non-use of services including personal networks as a conduit; housing situations as directly related to use of services; siloed systems; policies and procedures create barriers; and using services when there was a need. This study contributes to the literature by providing a more nuanced and in-depth understanding of factors related to use or non-use of mental health and substance use-related services among people experiencing housing insecurity and highlights the role that systems and social supports play, in addition to individual-level factors.

The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission.

Up to 33% of American adults will experience a diagnosable anxiety disorder in their lifetime. Approximately one-third of anxiety diagnoses assigned by mental health providers in outpatient settings are unspecified. The tendency of many providers to use an unspecified anxiety diagnosis may negatively impact the provision of evidence-based treatments for specific anxiety disorders. This study examines the perspectives of mental health providers working in an integrated and stepped health care system, asking how their roles and responsibilities shape their practices related to diagnosing specific anxiety disorders. The authors conducted semi-structured interviews with 32 Veteran Health Administration (VHA) mental health providers to understand their perspectives on diagnosing anxiety disorders. Matrix analysis was used to identify different roles and responsibilities articulated. Thematic analysis was used to highlight themes across providers' discussion of their roles in diagnosing and treating patients. The results show that, for most providers, assigning a specific diagnosis is a component of duties but rarely their focus. Second, it is unclear in which clinic setting a specific anxiety diagnosis should be made. Finally, among different types of mental health professionals, there is no clear designation on who should be providing a specific anxiety diagnosis. Altogether, results indicate that many providers feel making a specific diagnosis for anxiety is the responsibility of others-either those in other clinic settings or with other credentials. Findings call for clearer guidelines that specify individual clinician accountability for obtaining a specific anxiety diagnosis in a team-based environment.

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.

Session planning is a core activity for implementing evidence-based practices (EBPs), yet it is unknown whether public mental health settings provide the support for therapists to session plan. This two-part study conducted in collaboration with EBP leaders in Philadelphia's public mental health system deployed mixed methods to examine therapists' session planning practices and preferences. In Study 1, 61 public mental health therapists completed an online survey to identify session planning barriers and facilitators, current practices, and desired planning supports. In Study 2, nine therapists who ranked a session planning tool as a top choice support in Study 1 participated in two focus groups to elaborate on their survey responses and provide feedback on three session planning tool prototypes. Study 1 survey respondents cited multi-level barriers and facilitators to session planning. In both closed- and open-ended responses, analyzed descriptively and via content analysis respectively, therapists described wanting more time, lower caseloads, financial incentives for session planning, and additional clinical resources and guidance from trainings, peers, and supervisors to support session planning. Study 2 focus group participants, whose responses were analyzed using content analysis, reiterated the need for these multi-level supports and expressed the need for a "one-stop" database of session planning tools that would be free, easily searchable, and modifiable for varied clinical needs. All three session planning tool prototypes reviewed were acceptable; two were also considered feasible and appropriate. This investigation of an under-studied aspect of the EBP implementation process reveals the need for multi-level session planning supports.

Substance use disorder (SUD) is increasing among primary Spanish-speaking populations, and treatment use is disproportionately low. Patient-provider Spanish language concordance is associated with SUD treatment initiation and better outcomes. Recent geographic shifts within primary Spanish-speaking populations are important considerations in identifying gaps in SUD service delivery in Spanish. This national epidemiologic study used the Mental Health and Addiction Treatment Tracking Repository (2022; N = 9336 facilities) and US census data to pinpoint the location of SUD treatment facilities that offer services in Spanish, and used multilevel models to determine whether access to Spanish services is keeping up with the influx of primary Spanish-speaking populations in new areas that have not historically had a large Spanish language presence. Twenty-two percent of SUD treatment facilities provided services in Spanish. For every 10% increase in the percentage of a census tract speaking Spanish, the odds of SUD treatment facilities offering services in Spanish increased by 30% (aOR = 1.03, 95% CI = 1.02-1.04, p < 0.0001), indicating that Spanish language services were more common in places where people who speak Spanish already live. In contrast, the study team identified no association between the availability of Spanish services and increases in community-level Spanish between 2010 and 2022 (aOR = 1.00, 95% CI = 0.99-1.01, p = 0.87), indicating that access to services is not keeping up with demand as populations move and the Spanish language grows in new areas. SUD treatment services are lagging behind as the location of where primary Spanish-speaking families choose to live changes. Local health policies and ambitious interventions are needed that target the unique needs of SUD treatment clients who speak Spanish.

Primary care has been proposed as an ideal setting for the management of alcohol use disorder (AUD); however, there is limited research on the diagnosis and prescribing patterns of medications for alcohol use disorder (MAUD) within primary care. This retrospective study aims to determine whether primary care engagement is associated with the likelihood of an AUD diagnosis or prescription of MAUD. Analyzing administrative claims data from a statewide cohort of 10,138 Medicaid enrollees, only 5.9% of patients diagnosed with AUD were prescribed MAUD (including naltrexone, acamprosate, disulfiram, and topiramate). Patients with higher levels of primary care visit frequency were significantly more likely to carry an AUD diagnosis (p < .0001); however, primary care visit frequency was not associated with prescription of MAUD. This study highlights the underutilization of MAUD within primary care, and the need for research identifying successful strategies to address barriers to prescribing MAUD in this setting.

Mental health disorders, including depression and anxiety, are common comorbidities in individuals with type 2 diabetes mellitus (T2DM), contributing to increased healthcare resource utilization (HCRU) and the financial burden of the disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are commonly used for T2DM management, and emerging evidence suggests they may help alleviate mental health symptoms. This study examined the association between GLP-1RA (versus DPP-4 inhibitor [DPP-4i]) initiation and mental health-related HCRU in T2DM patients. Using data from the Komodo Healthcare Map, a national database of pharmacy and medical claims, this study conducted a retrospective cohort analysis with 774,968 adults who initiated GLP-1RAs or DPP-4i between January 2019 and March 2022. Patients were followed for 12 months, and mental health-related HCRU (emergency department, inpatient, outpatient hospital, and office visits) for depression and anxiety was assessed. A difference-in-differences analysis compared HCRU before and after medication initiation, adjusting for sociodemographic and clinical variables. GLP-1RA use was associated with significant reductions in outpatient hospital visits (IRR: 0.96; 95% CI: 0.95-0.98) for depression, and office visits for depression (IRR: 0.87; 95% CI: 0.82-0.92) and anxiety (IRR: 0.85; 95% CI: 0.81-0.90) compared to DPP-4i. However, no significant changes were observed in emergency or inpatient visits. Reductions were more pronounced with semaglutide, liraglutide, and dulaglutide. These findings suggest that GLP-1RAs may help reduce depression- and anxiety-related HCRU in patients with T2DM, indicating potential benefits beyond glycemic control. Further research is needed to explore long-term outcomes and the cost-effectiveness of GLP-1RAs for managing mental health comorbidities.