Browsing by Subject "Behavioral health"
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Item A health research agenda guided by migratory and seasonal farmworkers and the providers who serve them(Patient-Centered Outcomes Research Institute (PCORI), 2018-11) Holmes, Cheryl; Levy, Michelle; Mariscal, E. SusanaThis document shares the results of an almost two-year process to create a health research agenda specific to migratory and seasonal farmworkers. The purpose was to better understand what health outcomes are important to farmworkers in two Midwestern states and identify research and information gaps. A key strategy in accomplishing this work was not only to engage farmworkers in addition to providers, researchers and various other administrators but to do so in an active, direct and frequent manner, thus highlighting and elevating their voices and perspectives. This document is organized in that spirit.Item Addressing Disparities through TCOM Strategies(2016-11) Walton, Betty A.; Harrold, WendyWhile America is rapidly become more diverse, the human service workforce is changing more slowly. Behavioral health disparities in accessing appropriate services and in outcomes are well documented. Can TCOM strategies be leveraged to address these issues? Combining existing information (insurance claim and workforce data) with TCOM information clarifies local challenges and provides a framework to monitor progress. Moving beyond considerations of gender and age, possible access issues and lower or disrupted service use may be reflected in differences in service utilization by language, race, and ethnicity. Exploring available information can identify access and/or engagement and systematic reporting issues. Implementing recommended TCOM reports provides tools to help identify disparities in behavioral health outcomes for programs and services by geography and demographics. In reviewing outcome management reports for teenagers and transition age youth, questions arise about the significance of observed differences. In response, a predictive analysis using ANSA data asks if age, gender, race, ethnicity, current personal recovery factors (strengths and recreation), or the identification of cultural or linguistic challenges predict resolving actionable needs over time. Routinely monitoring differences in access and outcomes is recommended as a TCOM quality improvement process.Item Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems(Springer Nature, 2022-03-04) Lawson, Spencer G.; Lowder, Evan M.; Ray, Bradley; School of Public and Environmental AffairsBackground: Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations. Methods: We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects. Results: Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant. Conclusions: Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.Item Healthcare Resource Use and Costs Among Individuals with Vitiligo and Psychosocial Comorbidities: Retrospective Analysis of an Insured US Population(Dove Press, 2024-08-08) Lofland, Jennifer H.; Darbha, Samyuktha; Naim, Ahmad B.; Rosmarin, David; Dermatology, School of MedicinePurpose: This study aimed to describe healthcare resource utilization and costs among individuals with vitiligo who were diagnosed with ≥1 psychosocial comorbidity, using data from US claims databases. Patients and methods: A retrospective, observational cohort analysis of the IBM MarketScan Commercial and Medicare supplemental claims databases for US individuals with vitiligo aged ≥12 years and a first vitiligo claim between January 1 and December 31, 2018, was undertaken to assess psychosocial burden, including mental and behavioral health comorbidities. Results: Of the 12,427 individuals included in the analysis, nearly 1 in 4 (23.5%) who had vitiligo were also diagnosed with ≥1 psychosocial comorbidity. A greater percentage of these individuals versus those who were not diagnosed with a psychosocial comorbidity had a vitiligo-related prescription claim (50.2% vs 45.4%; P<0.0001), especially for oral corticosteroids (25.4% vs 16.6%; P<0.0001) and low-potency topical corticosteroids (9.0% vs 7.6%; P<0.05). Total vitiligo-related healthcare resource utilization and costs were consistent among individuals with and without psychosocial comorbidity despite significantly (P<0.05) higher vitiligo-related ER visit utilization and expenditure among those with psychosocial comorbidity. Furthermore, individuals diagnosed with vitiligo and ≥1 psychosocial comorbidity had significantly (P<0.0001) greater utilization of all-cause mean prescription claims (25.0 vs 12.8), outpatient services (other than physician and ER visits: 19.5 vs 11.3), outpatient physician visits (10.1 vs 6.4), inpatient stays (0.6 vs 0.1), and ER visits (0.4 vs 0.2) and incurred significantly higher mean (SD) direct medical expenditures ($18,804 [$46,621] vs $9833 [$29,094] per patient per year; P<0.0001). Conclusion: Individuals with vitiligo who were diagnosed with ≥1 psychosocial comorbidity incurred greater total all-cause but not vitiligo-related healthcare resource utilization and expenditures than those without diagnosis of psychosocial comorbidities. Identification of psychosocial comorbidities in individuals with vitiligo may be important for multidisciplinary management of vitiligo to reduce overall burden for individuals with vitiligo.Item Management of youth with suicidal ideation: Challenges and best practices for emergency departments(Wiley, 2024-04-03) Santillanes, Genevieve; Foster, Ashley A.; Ishimine, Paul; Berg, Kathleen; Cheng, Tabitha; Deitrich, Ann; Heniff, Melanie; Hooley, Gwen; Pulcini, Christian; Ruttan, Timothy; Sorrentino, Annalise; Waseem, Muhammad; Saidinejad, Mohsen; Emergency Medicine, School of MedicineSuicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self‐harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self‐harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home‐ and community‐based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on‐site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community‐ and home‐based services, pediatric‐receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.Item Race/Ethnicity, and Behavioral Health Status: First Arrest and Outcomes in a Large Sample of Juvenile Offenders(Springer Nature, 2018-04) Lau, Katherine S.L.; Rosenman, Marc B.; Wiehe, Sarah E.; Tu, Wanzhu; Aalsma, Matthew C.; Pediatrics, School of MedicineThe objective of this study was to assess the simultaneous effects of gender, race/ethnicity, and pre-arrest behavioral health (BH) service-use on age at first arrest, and first arrest outcomes. Between January 2004 and December 2011, arrest and medical records were collected on a retrospective longitudinal cohort of 12,476 first-time offenders, ages 8-18 years. Black youth were arrested at younger ages than white or Hispanic youth. Youth with psychiatric problems were arrested at younger ages than youth with substance-use, dual-diagnoses, or no BH problems. Compared to white males, black males had lower odds of detention and BH referrals. Compared to white females, black females had higher odds of release and lower odds of probation, detention, and BH referrals. A significant gender-by-BH problem interaction revealed males and females with previous psychiatric problems were arrested at younger ages than youth with substance, dual-diagnosis, or no prior problems. Implications are discussed.Item Study protocol and stakeholder perceptions of a randomized controlled trial of a co-response police-mental health team(Springer, 2023) Bailey, Katie; Hofer, Meret; Sightes, Emily; Lowder, Evan Marie; Grommon, Eric; Ray, BradleyItem Supportive Transition Planning for Adolescents Transitioning From Psychiatric Hospitalization to School: A Systematic Literature Review and Framework of Practices(Ubiquity Press, 2023-01-30) Midura, Sara; Fodstad, Jill C.; White, Benjamin; Turner, Angela J.; Menner, Scott; Psychiatry, School of MedicineSchool-aged youth with behavioral health needs often struggle in the academic environment. When admitted to acute psychiatric hospital settings, the student’s difficulties and needs increase upon discharge and return to the school setting. While the literature describes systemic issues in transitioning from an acute psychiatric hospital to the school setting, limited resources exist for practitioners to plan for and support the successful reintegration of affected students. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the purpose of the current systematic review was to collect and synthesize evidence from the literature (N = 20) in the areas of barriers, challenges, and significance of the need for a formal transition planning framework. Four major key factors emerged as important to assist in creating a transition planning framework for acute psychiatric hospitals to school-based settings: (a) Stakeholder Voice (Student, Caregiver, Hospital/Treatment Team, or School Team Voice); (b) Establishing a Point Person for Transition (Medical or School Point Person); (c) Recommendations/Accommodations (Formal or Informal Supports); and (d) Having a Transition Meeting. Other common factors are discussed, and recommendations are provided to aid practitioners in increasing the likelihood that school-age youth succeed in the school environment post-discharge from acute psychiatric settings. Finally, gaps in the literature are identified as areas for further research.Item Synthesizing Adaptive Digital Bioethics to Guide the Use of Interactive Communication Technologies in Adolescent Behavioral Medicine: A Systematic Configurative Review(Elsevier, 2022-08-01) Skeen, Simone J.; Shaw Green, Sara K.; Knopf, Amelia S.; School of NursingDespite the continuing integration of digital outreach tools into adolescent preventive services, adaptive guidance for their ethical use remains limited. In this configurative review, we synthesize the ad hoc, applied digital bioethics developed in adolescent human immunodeficiency virus prevention science. By focusing on generalizable technological affordances, while balancing privacy and autonomy, we offer strategies for identifying potential technologically mediated harms that can transcend specific platforms, tools, or the knowledge levels of individual clinicians. Clinical vignettes illustrate the application of these strategies.