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Browsing O'Neill School of Public and Environmental Affairs by Author "Aalsma, Matthew C."
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Item Healthcare utilization and mental health outcomes among nonfatal shooting assault victims(Elsevier, 2022-06) Magee, Lauren A.; Fortenberry, J. Dennis; Aalsma, Matthew C.; Gharbi, Sami; Wiehe, Sarah E.; School of Public and Environmental AffairsVictims of nonfatal shooting (NFS) assaults suffer from emotional and physical trauma; however, little is understood about clinical care utilization patterns among victims. This study examines the healthcare utilization and mental health outcomes before and after an index NFS victimization. A longitudinal dataset of police and clinical data were linked at the individual level to define a cohort of NFS victims with one or more clinical encounter in the 24-months preceding an index NFS injury (N = 2,681) in Indianapolis, Indiana between 2005 and 2018. Mental health was defined using ICD diagnosis codes from any emergency department, inpatient, or outpatient encounter and clinical care utilization was the number of unique encounters within the 24-months preceding and following an index NFS injury. Multivariable logistic regression was conducted to examine factors associated with a mental health diagnosis in the post injury period. Analyses were conducted in October 2021-March 2022. Overall clinical care utilization (Mean: pre = 277.7 (SD 235.3) vs. post = 333.9 (SD 255.1), p < 0.001) and mental health prevalence (14.4% pre vs. 18.8% post, p < 0.001) increased in the 24-months following an index NFS compared to the prior 24-months. Preinjury mental health utilization increased the odds of receiving a mental health diagnosis in the 24-months following an index NFS injury – particularly for Black victims (Odds Ratio 1.69, 95% CI 1.01, 2.85). The findings indicate missed opportunities within the healthcare system to connect NFS victims with needed mental health services, as well as the importance of premorbid connection to mental health care.Item Patterns of adolescent gun carrying and gun-related crime arrests in Indianapolis, Indiana over an 11-year time period(Elsevier, 2020-10) Magee, Lauren A.; Dir, Allyson L.; Clifton, Richelle L.; Wiehe, Sarah E.; Aalsma, Matthew C.; Pediatrics, School of MedicineAdolescent males are disproportionately affected by homicide as both victims and offenders. Indianapolis has seen increases in youth homicides over the past few years; gun carrying increases an individual's risk for involvement in firearm violence. It is unclear how often youth are arrested for gun carrying and gun-related crimes. Examining these patterns may identify an opportunity for intervention. This study is a descriptive epidemiology analysis that examines patterns of gun carrying and gun-related crime arrests among justice involved youth in Marion County (Indianapolis), Indiana. We accessed juvenile court records from January 1, 2006 to December 31, 2016 on all individuals arrested for a gun carrying offense (i.e., illegal possession of a firearm or gun; n = 711) and all individuals arrested for a gun-related crime (i.e., homicide, robbery, aggravated assault; n = 150). Data were analyzed in fall 2019. Proportions of juvenile arrests for both gun carrying (47.0 per 1000 arrests) and gun-related crime (25.4 per 1000 arrests) have substantially increased compared to ten-years ago (4.5 per 1000 arrests and 2.0 per 1000 arrests, respectively). Of those arrested, 27.7 per 100,000 population were arrested for a repeated gun-related offense; of which 21.5 per 100,000 were first arrested for gun carrying and 6.2 per 100,000 were arrested for a gun-related crime. The majority of gun-related repeat offenders were first arrested for gun carrying; therefore, these gun-carrying arrests may be an opportunity to intervene on an individual level by providing treatment, other needed resources, and discussing safe firearm storage with families and communities.Item Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth(Elsevier, 2020-11) Dir, Allyson L.; Clifton, Richelle L.; Magee, Lauren A.; Johnson-Kwochka, Annalee V.; Wiehe, Sarah E.; Aalsma, Matthew C.; Psychiatry, School of MedicineBackground Substance use is prevalent among justice-involved youth and given the risk of recidivism and other poor outcomes associated with substance use, justice systems have implemented efforts to improve substance use screening and connection to treatment. Although many justice systems use drug screening to monitor substance use, research on patterns of substance use based on drug screen records is lacking. The current study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. We also examined differences in these patterns of use and treatment referral and completion by race, ethnicity, and gender. Method We examined court records for N = 3440 youth with records of positive oral drug screen (ODS) between 2011 and 2016 to assess patterns of ODS results (e.g., number and of positive screens), court-ordered referrals to substance use treatment, and rates of treatment completion. Results Of 3440 youth with a positive ODS, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode; black youth ( OR = 0.54, p < .01) were less likely to have history of completing substance use treatment. Conclusion Our results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services. Additional research should identify barriers to substance use treatment completion among this population.Item A Solutions-Based Approach to Building Data-Sharing Partnerships(AcademyHealth, 2018) Wiehe, Sarah E.; Rosenman, Marc B.; Chartash, David; Lipscomb, Elaine R.; Nelson, Tammie L.; Magee, Lauren A.; Fortenberry, J. Dennis; Aalsma, Matthew C.; School of Public and Environmental AffairsIntroduction: Although researchers recognize that sharing disparate data can improve population health, barriers (technical, motivational, economic, political, legal, and ethical) limit progress. In this paper, we aim to enhance the van Panhuis et al. framework of barriers to data sharing; we present a complementary solutions-based data-sharing process in order to encourage both emerging and established researchers, whether or not in academia, to engage in data-sharing partnerships. Brief Description of Major Components: We enhance the van Panhuis et al. framework in three ways. First, we identify the appropriate stakeholder(s) within an organization (e.g., criminal justice agency) with whom to engage in addressing each category of barriers. Second, we provide a representative sample of specific challenges that we have faced in our data-sharing partnerships with criminal justice agencies, local clinical systems, and public health. Third, and most importantly, we suggest solutions we have found successful for each category of barriers. We grouped our solutions into five core areas that cut across the barriers as well as stakeholder groups: Preparation, Clear Communication, Funding/Support, Non-Monetary Benefits, and Regulatory Assurances. Our solutions-based process model is complementary to the enhanced framework. An important feature of the process model is the cyclical, iterative process that undergirds it. Usually, interactions with new data-sharing partner organizations begin with the leadership team and progress to both the data management and legal teams; however, the process is not always linear. Conclusions and Next Steps: Data sharing is a powerful tool in population health research, but significant barriers hinder such partnerships. Nevertheless, by aspiring to community-based participatory research principles, including partnership engagement, development, and maintenance, we have overcome barriers identified in the van Panhuis et al. framework and have achieved success with various data-sharing partnerships. In the future, systematically studying data-sharing partnerships to clarify which elements of a solutions-based approach are essential for successful partnerships may be helpful to academic and non-academic researchers. The organizational climate is certainly a factor worth studying also because it relates both to barriers and to the potential workability of solutions.Item Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees(BMC, 2021) Magee, Lauren A.; Fortenberry, J. Dennis; Rosenman, Marc; Aalsma, Matthew C.; Gharbi, Sami; Wiehe, Sarah E.; School of Public and Environmental AffairsBackground Individuals with mental illness and co-occurring substance use disorders often rapidly cycle through the justice system with multiple arrests. Therefore, is it imperative to examine the prevalence of mental health and substance use diagnoses among arrestees and repeat arrestees to identify opportunities for intervention. Methods We linked police arrest and clinical care data at the individual level to conduct a retrospective cohort study of all individuals arrested in 2016 in Indianapolis, Indiana. We classified arrestees into three levels: 1 arrest, 2 arrests, or 3 or more arrests. We included data on clinical diagnoses between January 1, 2014 and December 31, 2015 and classified mental health diagnoses and substance use disorder (SUD) based on DSM categories using ICD9/10 diagnoses codes. Results Of those arrested in 2016, 18,236 (79.5%) were arrested once, 3167 (13.8%) were arrested twice, and 1536 (6.7%) were arrested three or more times. In the 2 years before the arrest, nearly one-third (31.3%) of arrestees had a mental health diagnosis, and over a quarter (27.7%) of arrestees had an SUD diagnosis. Most of those with a mental health or SUD diagnosis had both (22.5% of all arrestees). Arrestees with multiple mental health (OR 2.68, 95% CI 2.23, 3.23), SUD diagnoses (OR 1.59, 95% CI 1.38, 1,82), or co-occurring conditions (1.72, 95% CI 1.48, 2.01) in the preceding 2 years had higher odds of repeat arrest. Conclusions Our findings show that linked clinical and criminal justice data systems identify individuals at risk of repeat arrest and inform opportunities for interventions aimed at low-level offenders with behavioral health needs.Item Youth Involved in the Justice System: Emergency Department Screening and Health Promotion(Elsevier, 2021-09) Magee, Lauren A.; Aalsma, Matthew C.; School of Public and Environmental Affairs