Browsing by Author "Burns, Ashlyn"

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    A national overview of nonprofit hospital community benefit programs to address the social determinants of health
    (Oxford University Press, 2023-12-06) Franz, Berkeley; Burns, Ashlyn; Kueffner, Kristin; Bhardwaj, Meeta; Yeager, Valerie A.; Singh, Simone; Puro, Neeraj; Cronin, Cory E.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) identified SDOH as a top-5 health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients, while the remaining 56% of programs addressed SDOH at the community level. Hospitals that were major teaching organizations, those in the Western region of the United States, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients.
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    Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities
    (APA, 2023-09-01) Burns, Ashlyn; Menachemi, Nir; Yeager, Valerie A.; Vest, Joshua R.; Mazurenko, Olena; Health Policy and Management, School of Public Health
    Objective: The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) best practices guidelines. Methods: Secondary data from SAMHSA’s Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities’ organizational characteristics associated with adopting BHCC best practices. Results: Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). Conclusions: Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.
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    Availability of behavioral health crisis care and associated changes in emergency department utilization
    (Wiley, 2025) Burns, Ashlyn; Vest, Joshua R.; Menachemi, Nir; Mazurenko, Olena; Musey, Paul I., Jr.; Salyers, Michelle P.; Yeager, Valerie A.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: To determine whether availability of behavioral health crisis care services is associated with changes in emergency department (ED) utilization. Data sources and study setting: We used longitudinal panel data (2016-2021) on ED utilization from the Healthcare Cost and Utilization Project's State ED Databases and a novel dataset on crisis care services compiled using information from the Substance Abuse and Mental Health Services Administration's National Directories of Mental Health Treatment Facilities. A total of 1002 unique zip codes from Arizona, Florida, Kentucky, Maryland, and Wisconsin were included in our analyses. Study design: To estimate the effect of crisis care availability on ED utilization, we used a linear regression model with zip code and year fixed effects and standard errors accounting for clustering at the zip code-level. ED utilization related to mental, behavioral, and neurodevelopmental (MBD) disorders served as our primary outcome. We also examined pregnancy-related ED utilization as a nonequivalent dependent variable to assess residual bias in effect estimates. Data collection/extraction methods: We extracted data on crisis care services offered by mental health treatment facilities (n = 14,726 facility-years) from the National Directories. MBD-related ED utilization was assessed by applying the Clinical Classification Software Refined from the Healthcare Cost and Utilization Project to the primary ICD-10-CM diagnosis code on each ED encounter (n = 101,360,483). All data were aggregated to the zip code-level (n = 6012 zip-years). Principal findings: The overall rate of MBD-related ED visits between 2016 and 2021 was 1610 annual visits per 100,000 population. Walk-in crisis stabilization services were associated with reduced MBD-related ED utilization (coefficient = -0.028, p = 0.009), but were not significantly associated with changes in pregnancy-related ED utilization. Conclusions: Walk-in crisis stabilization services were associated with reductions in MBD-related ED utilization. Decision-makers looking to reduce MBD-related ED utilization should consider increasing access to this promising alternative model.
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    County characteristics associated with behavioral health emergency medical services calls
    (Oxford University Press, 2025-03-14) Burns, Ashlyn; Kampman, Haleigh; Menachemi, Nir; Psychiatry, School of Medicine
    A substantial portion of the 20 million calls that emergency medical services (EMS) personnel respond to each year are considered preventable, including more than 1.5 million behavioral health calls. Despite goals of preventing behavioral health crises and reducing the burden on patients and EMS personnel, little is known about how demographic and community characteristics influence behavioral health calls. Using nationwide 2021 EMS call data, we identified counties with high behavioral health calls and examined their demographic and community characteristics. Low-income and racially diverse counties had a higher incidence of behavioral health EMS calls, while politically conservative counties had a lower incidence of behavioral health EMS calls. To better meet the emergency behavioral health needs of communities, policy and decision-makers should consider strategies that increase access to and awareness of alternative behavioral health crisis services (eg, 988 Suicide and Crisis Lifeline).
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    Implementation and sustainability of systems change for mental health promotion and substance misuse prevention: a qualitative study
    (Springer Nature, 2024-11-27) Burns, Ashlyn; Kampman, Haleigh; Magee, Lauren; Blackburn, Justin; Alton, Madison; Pescosolido, Bernice; Psychiatry, School of Medicine
    Background: Social determinants of health have been shown to influence individual mental health and overall well-being. Additionally, populations that experience stigma and/or discrimination because of race, class, gender, or another identity group experience disproportionately higher rates of mental health disorders than populations that do not experience such marginalization. One way to address upstream social determinants that influence mental health is through systems change initiatives. In 2019, Indiana implemented a statewide Regional Prevention System (RPS) focused on systems change to promote mental health and prevent substance misuse. Methods: We developed a semi-structured interview guide to collect insights about the RPS implementation and sustainability. Potential participants were identified based on their role as an active regional coordinator (n = 9). We conducted qualitative interviews with all 9 regional coordinators in Indiana. Interview recordings were transcribed and coded using an a priori coding framework based on constructs from the Theory of Innovation Implementation and the Consolidated Framework for Implementation Research. Results: Insights about the RPS implementation process are presented across four domains: innovation, system-level, organization-level, and sustainability. In terms of implementation barriers, coordinators encountered hesitancy and distrust from community members, which they had to overcome to gain buy-in. They also described stigma, including community and individual social norms towards mental health and substance misuse, as barriers that challenged efforts to engage community members in the RPS. Facilitators of implementation included having established community infrastructure and external partnerships. In communities without existing infrastructure to support prevention efforts, particularly rural communities, the implementation process took longer but community members welcomed the additional support and valued the new communication platforms created by the RPS. On sustainability, coordinators provided examples of communities that were able to obtain grant funding in support of prevention initiatives launched through the RPS. Conclusion: The process of implementing and sustaining prevention efforts through the RPS varied across communities. Prioritizing the delivery of systems-change efforts in underserved communities that are ready for change, rather than statewide efforts, may offer a better strategy for addressing disparities in the social determinants of health that influence mental health and substance misuse.