Browsing by Subject "Behavioral health"
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Item 70400 Collaborative Care for Opioid Dependence And Pain (CCODAP): A Pilot Randomized Control Trial of an Opioid Tapering Intervention(Cambridge University Press, 2021) Bushey, Michael; Kroenke, Kurt; Medicine, School of MedicineABSTRACT IMPACT: If successful, this program can provide a scalable, patient-centered intervention to help patients taper off opioid medications in primary care settings. OBJECTIVES/GOALS: Tapering of chronic opioid therapy is often desirable but challenging in primary care and specialty clinics that lack behavioral health expertise. The objective of this pilot study is to determine the feasibility of testing a peer-delivered pain self-management program to assist primary care patients through an opioid taper. METHODS/STUDY POPULATION: To provide critical support to patients and providers during opioid medication tapering, we propose to conduct a 40 patient randomized controlled pilot of a 12-week telecare collaborative care program administered by a psychiatrist and peer recovery specialist team. The intervention will incorporate a validated positive psychology intervention for treating chronic pain. Additionally, participants will be invited to participate in semi-structured individual interviews to discuss their experience in the trial, what worked well, what could be improved, and potential strategies to bolster recruitment of additional patients in future studies. RESULTS/ANTICIPATED RESULTS: Our primary aim is to determine the effectiveness of our intervention in facilitating opioid medication weaning, with reduction in opioid dose as the primary outcome. Our secondary aims will be to assess pain outcomes, adherence to tapering, patient satisfaction, and barriers to adherence as described by patients. DISCUSSION/SIGNIFICANCE OF FINDINGS: This trial proposes a novel collaborative care approach for opioid weaning using proven, easy-to-deliver positive psychology tools for pain management that, if successful, could be implemented broadly in many clinics struggling to safely reduce opioid prescribing.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 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 HealthObjective: 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.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 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 MedicineA 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).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 Impact of learning health systems on cross-system collaboration between youth legal and community mental health systems: a type II hybrid effectiveness-implementation trial(Springer Nature, 2024-12-24) O’Reilly, Lauren; Sun, Dayu; Schwartz, Katherine; Gillenwater, Logan; Dir, Allyson; Monahan, Patrick; Aarons, Gregory A.; Saldana, Lisa; Adams, Zachary; Zapolski, Tamika; Hulvershorn, Leslie; Aalsma, Matthew C.; Pediatrics, School of MedicineBackground: Youth involved in the legal system have disproportionately higher rates of problematic substance use than non-involved youth. Identifying and connecting legal-involved youth to substance use intervention is critical and relies on the connection between legal and behavioral health agencies, which may be facilitated by learning health systems (LHS). We analyzed the impact of an LHS intervention on youth legal and behavioral health personnel ratings of their cross-system collaboration. We also examined organizational climate toward evidence-based practice (EBP) over and above the LHS intervention. Methods: Data were derived from a type II hybrid effectiveness trial implementing an LHS intervention with youth legal and community mental health centers (CMHCs) in eight Indiana counties. Using a stepped wedge design, counties were randomly assigned to one of three cohorts and stepped in at nine-month intervals. Counties were in the treatment phase for 18 months, after which they were in the maintenance phase. Youth legal system and CMHC personnel completed five waves of data collection (n=307 total respondents, ranging from 108-178 per wave). Cross-system collaboration was measured via the Cultural Exchange Inventory, organizational EBP climate via the Implementation Climate Scale and Implementation Citizenship Behavior Scale, and intervention via a dummy-coded indicator variable. We conducted linear mixed models to examine: 1) the treatment indicator, and 2) the treatment indicator and organizational EBP climate variables on cross-system collaboration. Results: The treatment indicator was not significantly associated with cross-system collaboration. When including the organizational EBP climate variables, the treatment indicator significantly predicted cross-system collaboration. Compared to the control phase, treatment (B=0.41, standard error [SE]=0.20) and maintenance (B=0.60, SE=0.29) phases were associated with greater cross-system collaboration output. Conclusions: The analysis may have been underpowered to detect an effect; third variables may have explained variance in cross-system collaboration, and, thus, the inclusion of important covariates may have reduced residual errors and increased the estimation precision. The LHS intervention may have affected cross-system collaboration perception and offers a promising avenue of research to determine how systems work together to improve legal-involved-youth substance use outcomes. Future research is needed to replicate results among a larger sample and examine youth-level outcomes.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.