JAMA Health Forum最新文献

Importance: Asian language speakers with limited English proficiency (LEP) face significant barriers to accessing adequate mental health care. Despite worsening mental health outcomes for this population, there is limited research examining the availability of Asian language mental health treatment in the US.

Objective: To quantify trends and analyze disparities in the geographic availability of Asian language mental health treatment from 2015 to 2024.

Design, setting, and participants: This cross-sectional study of US mental health facilities from April 30, 2015, to December 9, 2024, used longitudinal data from the nationally representative Mental Health and Addiction Treatment Tracking Repository linked with county-level demographic data from the 2023 American Community Survey. Facilities were included if they completed the National Mental Health Services Survey or the National Substance Use and Mental Health Services Survey.

Main outcomes and measures: Primary outcomes included the annual proportion of mental health facilities offering Asian language services and the proportion of counties with at least 1 such facility. For 2024, facility-level characteristics associated with Asian language services were assessed and geographic mismatches between service availability and the proportion of Asian language-speaking individuals with LEP were mapped.

Results: The study included 3847 mental health facilities. Of these, 214 facilities (5.6%) offered services in at least 1 Asian language in 2024 (including Arabic, Chinese, Farsi, Hindi, Hmong, Japanese, Korean, Tagolog, and Vietnamese). The proportion peaked at 265 facilities (6.9%) in 2021, then declined from 2022 to 2024. The number of counties with at least 1 facility with Asian language services was 98 (6.3%) in 2024. Facilities offering Asian language services were concentrated in metropolitan areas (208 [97.2%]), particularly in California (57 [26.6%]) and the Northeast (52 [24.3%]). Rural areas lacked such services (3 of 485 rural facilities [0.6%] in 2024), even in counties with substantial populations of Asian language-speaking individuals with LEP (0 of 5 facilities).

Conclusions and relevance: This cross-sectional study found a persistent geographic mismatch between the mental health needs of Asian language-speaking individuals with LEP and the availability of appropriate linguistic services. The gap was pronounced in rural areas. The findings suggest that policies aimed at expanding the behavioral health workforce and increasing access to culturally and linguistically competent services to reduce ongoing disparities in mental health outcomes and access to care are urgently needed.

Importance: Enrollment in public benefits is associated with improved health outcomes, yet many eligible individuals do not claim them. Public benefit programs are important policy tools to address health-related social needs. Health systems have developed new partnerships with community organizations to assist patients with enrollment in benefits.

Objective: To determine whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department.

Design, setting, and participants: This 2-arm, nonblinded, randomized clinical trial was conducted from November 2023 to April 2024 at 2 academic hospital emergency departments in Philadelphia, Pennsylvania, and included adult individuals in stable condition with Medicaid or Medicare insurance who were discharged from the emergency department and eligible for at least 1 of 10 public benefit programs. Individuals were excluded if they were unable to read English or did not have access to a mobile phone. Data were analyzed from May 2024 to November 2024.

Interventions: Eligible participants were randomized in a 1:1 ratio. Participants allocated to the intervention received a series of 4 automated text messages over 14 days that prompted them to contact a benefits navigator telephone line operated by a community partner; those allocated to the control group received a paper flyer.

Main outcomes and measures: The primary outcome was whether study participants called benefits navigators within 14 days. Secondary outcomes included whether study participants submitted any benefits application within 14 days.

Results: Of 1778 patients screened, there were 160 participants enrolled. Participants' mean (SD) age was 44 (17) years; 94 (59%) were women, 145 (91%) were non-Hispanic Black, and 11 (7%) were non-Hispanic White. In the intervention group, 20 participants (25%) contacted benefits navigators vs 0 in the control group (difference, 25 percentage points; 95% CI, 16%-35%). In the intervention group, 11 participants (14%) submitted at least 1 application for public benefits compared with 0 in the control group (difference, 14 percentage points; 95% CI, 6-22).

Conclusions and relevance: The trial results suggest that text messages were more effective than paper referrals to help eligible emergency department patients seek assistance with public benefits applications. Text messages may offer a tool to allow health systems, in collaboration with community partners, to address health-related social needs.

Trial registration: ClinicalTrials.gov Identifier: NCT05654220.