Characterising youth inpatient homelessness in Australian Public Mental Health

Keywords: Alcohol abuse; Comorbidity; mental health; substance use; emerging adulthood; adolescence

The systemic neglect of New York's young adults with mental illness.

Health Care Reform and Adolescents—An Agenda for the Lifespan: A Position Paper of the Society for Adolescent Medicine

Background: Increasing attention is being paid to understanding and addressing the financial consequences of cancer and cancer treatment; however, in addition to the direct and indirect costs of cancer care, survivors with few financial resources also face social needs such as food insecurity and housing instability. On average, young adults have fewer financial resources than older adults, placing them at risk for adverse financial outcomes due to cancer, including unmet social needs. The purpose of this study is to estimate associations between young adult age at diagnosis and prevalence of social needs among African American cancer survivors. Methods: We utilized data from 3,241 participants in the Detroit Research on Cancer Survivors (ROCS) cohort. African American adults were invited to participate if they were between the ages of 20-79 at diagnosis with breast, colorectal, lung, or prostate cancer since January 1, 2013; or diagnosed with endometrial cancer (ages 20-79) or any other cancer (ages 20-49) since January 1, 2016. Cases were identified through the Metropolitan Detroit Cancer Surveillance System, a population-based cancer registry. Participants self-reported several forms of unmet social needs, including food insecurity, recent utility shut-offs, housing instability, inability to get medical care due to lack of transportation, and whether they generally felt safe in their neighborhood. Modified Poisson models estimated prevalence ratios (PR) and 95% confidence intervals (CI) for social needs by age at diagnosis (20-39 vs. 65+) and tests for trend by 4-level age (20-39, 40-54, 55-64, 65+), controlling for demographic, socioeconomic, and cancer-related factors. Results: Overall, 32% of ROCS participants reported experiencing social needs, and prevalence was inversely associated with age at diagnosis such that 48% of survivors diagnosed as young adults reported any social needs compared with 22% of those diagnosed as older adults (PRadjusted: 2.3, 95% CI: 1.8-2.9; ptrend<0.001). Associations between young adult age at diagnosis and social needs were particularly high for utility shutoffs (PRadjusted: 4.7, 95% CI: 2.8-7.8) and food insecurity (PRadjusted: 3.4, 95% CI: 2.3-4.9) compared with those diagnosed as older adults. Young adults also reported substantially higher prevalence of not feeling safe in their neighborhood (PRadjusted: 2.8, 95% CI: 1.7, 4.6), housing instability (PRadjusted: 2.7, 95% CI: 1.7-4.5), and going without medical care due to lack of transportation (PRadjusted: 2.0, 95% CI: 1.2-3.3). There was an inverse association with age and all social needs examined (all ptrend<0.001). Conclusions: Each unmet social need considered was at least twice as common among African American cancer survivors diagnosed as young adults compared with those diagnosed when they were 65 or older. Young adults often have fewer financial resources compared older adults and should be prioritized in the development of interventions aimed at improving financial outcomes among cancer survivors. Citation Format: Theresa A. Hastert, Julie J Ruterbusch, Jean A. McDougall, Jamaica R.M. Robinson, Shaila M. Strayhorn, Andrew Abdallah, Gowri Chandrashekar, Ann G. Schwartz. Diagnosis in young adulthood as a risk factor for unmet social needs among African American cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-087.

PurposePatient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.Design/methodology/approachThis study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.FindingsThe findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.Originality/valuePrevious studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

This study explored follow-up after hospitalization and emergency room (ER) use for mental health among youths and young adults with private insurance. The IBM MarketScan commercial database (2013-2018) was used to identify people ages 12-27 with a mental health hospitalization (N=95,153) or ER use (N=108,576). Factors associated with outpatient mental health follow-up within 7 and 30 days of discharge were determined via logistic models with generalized estimating equations that accounted for state variation. Of those hospitalized, 42.7% received follow-up within 7 days (67.4% within 30 days). Of those with ER use, 28.6% received follow-up within 7 days (46.4% within 30 days). Type of established outpatient care predicted follow-up after hospitalization and ER use. Compared with people with no established care, the likelihood of receiving follow-up within 7 days was highest among those with mental health and primary care (hospitalization, adjusted odds ratio [AOR]=2.81, 95% confidence interval [CI]=2.68-2.94; ER use, AOR=4.06, 95% CI=3.72-4.42), followed by those with mental health care only (hospitalization, AOR=2.57, 95% CI=2.45-2.70; ER use, AOR=3.48, 95% CI=3.17-3.82) and those with primary care only (hospitalization, AOR=1.20, 95% CI=1.15-1.26; ER use, AOR=1.22, 95% CI=1.16-1.28). Similar trends were observed within 30 days of discharge. Follow-up rates after acute mental health service use among youths and young adults were suboptimal. Having established mental health care more strongly predicted receiving follow-up than did having established primary care. Improving engagement with outpatient mental health care providers may increase follow-up rates.

Objectives Adult child caregivers of older adults living with Alzheimer’s disease and related dementias are at risk of burnout due to competing caregiving demands from multiple generations. Yet, drawing from structural family theory, this study aims to examine the extent to which family dynamics, especially greater family cohesion and less family conflict, are associated with children’s mental and physical health. Method The present study was secondary data analysis of an observational study, in which 150 pairs of adult-child caregivers and parents with early-stage cognitive impairment self-reported their health, family relationships (cohesion, expressiveness, and conflict), and family conflict regarding caregiving. Results Findings indicate that family cohesion and expressiveness are significantly positively, and family conflict is significantly negatively, associated with children’s mental health. However, we did not find any significant association with physical health. Conclusion Supportive family relationships may buffer the mental health of adult-child caregivers whose parents are living with early-stage cognitive impairment. Tailored interventions focusing on family relationships and conflicts are crucial to support children in managing the challenges associated with caregiving.

Opportunities in mental health services research.

The Link Between Homeless Women's Mental Health and Service System Use

The Growing Strain of Mental Health Care on Emergency Departments: Few Solutions Offer Promise

ABSTRACTObjectiveWe sought to examine the associations between a social needs measure and physical, and mental health among cancer survivors in the United States.MethodsWe conducted a cross‐sectional analysis using the 2022 Behavioral Risk Factor Surveillance System survey involving 16,930 eligible cancer survivors. The primary outcomes of interest were self‐reported physical and mental health in the past 30 days. A social needs measure was our primary exposure of interest. Multivariate logistic regression was used to examine the associations of interest.ResultsOverall, 56% and 73% survivors with several days of poor physical and mental health, respectively, reported having two or more social needs. In multivariate analysis, those having at least one social need were more likely to report several days of poor physical (one need: OR, 1.62; 95% CI, 1.31–2.00, two or more needs: OR, 3.52; 95% CI, 2.84–4.35) and mental health (one need: OR, 3.07; 95% CI, 2.07–4.57, two or more needs: OR, 9.69; 95% CI, 6.83–13.74). Among survivors with two or more social needs, having exercised in the past 30 days were 41% and 59% less likely to experience poor physical and mental health, respectively (p‐value < 0.05). However, having at least one chronic disease was associated with several days of poor physical/mental health among those with two or more needs (p‐value < 0.05).ConclusionHaving social needs was associated with self‐reporting of several days of poor physical and mental health among cancer survivors. Integrated care should include mental/physical health management addressing cancer survivors' various social needs.

Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 - 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 - 0.98), inpatient visits (OR = 0.87, CI = 0.76 - 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 - 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs.

This study examined patient and healthcare provider (HCP) perspectives on the impact of unmet social needs on healthcare barriers for patients with vasculitis. Two surveys were developed to gather perspectives from patients with vasculitis, and HCPs specializing in vasculitis care. The patient survey also included a 20-question social needs assessment. The data were analyzed using descriptive statistics. One hundred patients and 31 HCPs completed the surveys between September 2022 and June 2023. Fifty-six percent of patients reported unmet social needs, with poor social and mental health (30%) being the most common. Sixty-three percent of patients with vasculitis perceived unmet social need(s) as barriers to healthcare access. Financial insecurity (30%), poor mental health (29%), and poor health knowledge (25%) were the most common barriers identified. Overall, HCPs perceived SDOH have a greater impact on healthcare access than the patients surveyed. Most patients (82%) and HCPs (90%) believed rheumatologists should help in the management of SDOH, specifically health knowledge and mental health. Few HCPs (10%) felt well-positioned to address patients' mental health. Suggested interventions that address social needs and improve healthcare access included referrals to community-based resources, providing educational materials, and virtual visits. Through patient and HCP perspectives, the impact of SDOH on healthcare access for patients with vasculitis was explored. Understanding the positive experiences and challenges faced by patients is crucial for developing targeted interventions to enhance healthcare access. These findings underscore the importance of ongoing efforts to improve the healthcare experience for patients with vasculitis. Key Points • The impact of unmet social needs on healthcare access for patients with vasculitis, illustrates the complex relationship between SDOH and healthcare outcomes. • Unmet social needs among patients with vasculitis, included poor social and mental health, financial and food insecurity, and a lack of health literacy, which may exacerbate challenges leading to poor health outcomes. • The differences in perspectives between patients and healthcare providers regarding the impact of certain SDOH on healthcare access, necessitates the importance of co-production in the development of interventions to improve healthcare delivery. • The importance of patient-centered care and tailored solutions was highlighted by the need for various interventions to address social needs and improve healthcare access, such as referrals to community-based resources, educational materials, and interprofessional collaboration.

PC-FACS

Older Homeless Adults: Can We Do More?