Behavioral Health Challenges Research Articles

Impact of Behavioral Health Consultation on Hepatitis C Treatment Outcomes at a Federally Qualified Health Center; Philadelphia, PA.

Hepatitis C virus (HCV) infection is a public health issue that claims the lives of 350,000 individuals globally every year. Primary care providers are increasingly prescribing HCV medications with more modern, simplified administrations. Individuals with HCV are disproportionately affected by behavioral health challenges and substance use disorders. Integrated behavioral health providers can work in concert with their patients' primary care teams to provide innovative treatment programs to help support the needs of HCV care. We used simple and multivariable logistic regression to determine the association between receipt of behavioral health consultation and two outcomes on the care continuum: insurance approval for treatment and initiated HCV treatment regimen. These models were fitted using theoretically hypothesized variables and multivariable regression models included age, sex, and race/ethnicity as potential confounders. From January 2015 to May 2017, 189 patients at health centers were referred for onsite HCV primary care treatment. Of these, 142 were approved for participation, and 132 started treatment. Simple regression revealed a significant association between behavioral health consultation and treatment approval; however, behavioral health consultation was non-significant in the multivariable model for treatment approval. For initiating HCV treatment, onsite behavioral health consultation was significantly associated in both the unadjusted and adjusted regression models. Integrating behavioral health services for patients seeking HCV treatment may improve movement across the care continuum, optimizing patient's HCV health outcomes. Behavioral health consultation in primary care settings should be studied further to improve HCV treatment outcomes for patients with behavioral health and substance use disorders.

Is There a Geriatric Mental Health Specialist in the House?

Is There a Geriatric Mental Health Specialist in the House?

Impact of pediatric hypophosphatasia on behavioral health and quality of life

BackgroundHypophosphatasia (HPP) is a rare genetic disorder caused by loss-of-function mutations in the ALPL gene encoding tissue nonspecific alkaline phosphatase. It is characterized by defective bone mineralization associated with low alkaline phosphatase activity. Clinical features of pediatric HPP are highly variable, and can include premature loss of teeth, musculoskeletal problems, and impaired mobility. The effects of pediatric HPP on sleep, mood, regulation of attention and behavior, and other aspects of behavioral health have not been comprehensively studied.MethodsParents of 30 children with HPP (14 females, 16 males) between the ages of 3 and 16 years (mean age = 8.0 years) enrolled in this cross-sectional survey-based study. Molecular genetic and biochemical testing as well as clinical records were reviewed to verify diagnosis of HPP. The cohort included 15 patients with a more clinically severe presentation of HPP who had received treatment with enzyme replacement therapy (asfotase alfa) and 15 children with less severe HPP who were treatment-naïve. Parents provided information regarding psychopathological comorbidity, emotional and behavioral well-being, and quality of life.ResultsClinically significant behavioral health challenges were evident in 67% of children with HPP. The most common behavioral findings included sleep disturbance and symptoms of attention deficit hyperactivity disorder (ADHD), each of which were observed ≥ 50% of individuals. Sleep disturbance, pain interference, poor behavioral regulation, and mood/anxiety symptoms were associated with reduced physical and psychosocial quality of life. Behavioral concerns were evident among children with HPP receiving asfotase alfa treatment as well as among children with clinically less severe disease who had not initiated therapy. Although most children in the cohort (77%) had age-typical development of adaptive skills, emotional and behavioral challenges were associated with weaker adaptive function.ConclusionsChildren with HPP are at increased risk for ADHD symptoms and other behavioral health challenges. There is likely an under-recognition of these findings in clinical practice.

RCA is hiring

Recovery Centers of America (RCA), based in King of Prussia, Pennsylvania, is looking for nurses, therapists, and counselors, as well as recovery support specialists. In an announcement last week, Brian O'Neill, CEO of RCA, said that the “COVID‐19 pandemic has been devastating for all of us but it is particularly severe for those with addiction and behavioral health challenges.”

Virtual interview training for autistic transition age youth: A randomized controlled feasibility and effectiveness trial.

Autistic transition age youth struggle with obtaining employment, and interviewing is a critical barrier to getting a job. We adapted an efficacious virtual reality job interview intervention to meet the needs of autistic transition age youth, called the Virtual Interview Training for Transition Age Youth. This study evaluated whether Virtual Interview Training for Transition Age Youth can be feasibly delivered in high school special education settings and whether Virtual Interview Training for Transition Age Youth improves job interview skills, job interview self-efficacy, job interview anxiety, and access to employment. Forty-eight autistic transition age youth received school-based pre-employment services as usual with Virtual Interview Training for Transition Age Youth, while 23 autistic transition age youth received services as usual only. Local teachers trained and supervised autistic transition age youth using Virtual Interview Training for Transition Age Youth. Participants reported Virtual Interview Training for Transition Age Youth was highly acceptable. Participants receiving services as usual and Virtual Interview Training for Transition Age Youth, compared to participants receiving services as usual only, had better job interview skills and lower job interview anxiety as well as greater access to jobs. Overall, Virtual Interview Training for Transition Age Youth appears to be effective at teaching job interview skills that are associated with accessing competitive jobs. Moreover, youth enjoyed Virtual Interview Training for Transition Age Youth and teachers feasibly implemented the tool within special education pre-employment transition services. Future research needs to better understand how autistic transition age youth from culturally diverse backgrounds and different social, behavioral, or mental health challenges may respond to Virtual Interview Training for Transition Age Youth.

Challenges to Admitting Residents: Perspectives from Rural Nursing Home Administrators and Staff.

Rural residents are older, on average, than urban residents, with more underlying health conditions and higher rates of disability. Rural nursing homes face unique challenges admitting medically-complex patients and meeting their needs throughout their stay. These challenges may be amplified for certain health conditions. Greater geographic distances also strain transitional care coordination practices with health system referral hubs in urban areas. In this study, we assess perceptions of difficulty rural nursing homes encounter in admitting and serving individuals with dementia, obesity, mental and behavioral health conditions, and medically complex conditions. Using a survey of nursing home administrators located in non-metropolitan counties across the U.S. (n = 209), we assessed the self-reported degree of difficulty identified in serving each of the 4 type of conditions, coupled with qualitative analysis of open-ended questions identifying specific challenges. Rural nursing homes have capacity constraints owing to lower population density, limited financial resources, and unique challenges recruiting and retaining workforce to rural areas. Nursing home administrators reported the most challenges to providing high-quality care to residents with mental and behavioral health challenges, followed by obesity. For specific challenges, administrators focused primarily on staffing concerns, as well as space and equipment needs. Rural nursing home administrators identified challenges related to specific conditions and capacity constraints. To ensure appropriate and high-quality nursing home placement for rural residents, and to minimize the disruption of transitions into nursing home settings, more attention is needed on addressing the constraints identified by rural nursing home administrators in this study.

Infant mental health in intensive care: Laying a foundation for social, emotional and mental health outcomes through regulation, relationships and reflection

Infants and their families who begin their lives in intensive care often experience short and long term behavioral, socioemotional and mental health challenges that often follow them into adulthood. Utilization of evidence-based infant mental health principles, approaches and strategies in the neonatal intensive care unit can contribute to the promotion of optimal outcomes for babies and their parents. In order to integrate mental health best practices into intensive care settings, an emphasis on infant and family regulation, optimal nurturing relationships and reflective practice is offered. Using a parallel process, similar strategies in support of intensive care professionals in their provision of appropriate mental health supports to babies and families is essential.

The challenge of change fatigue on workplace mental health

PurposeChange and “change fatigue” were contributing to a spectrum of workplace issues – from extreme stress and burnout – to rising mental health issues even before the impact of COVID-19. This paper aims to examine why identifying mental and behavioral health issues had become a top priority for some employers and explore the negative impacts mental health issues present to organizations.Design/methodology/approachTo gain this additional insight and data, meQuilibrium partnered with Employer Health Innovation Roundtable (EHIR) to hold a series of four workshops and focus groups, in the Fall of 2019 with 37 participating EHIR members representing large employers. The authors also gathered data through a short survey instrument. The discussions and the survey focused on the current mental and behavioral health challenges being faced by their organizations and what innovations are being put in place or will need to be put in place as part of a future integrated workforce strategy.FindingsA key, and foundational, finding was that among these human resource (HR) leaders there was a view shared by 97% of survey respondents that the workplace was facing a greater mental health challenge than previously. Hundred per cent of participants agreed that the success of a workplace mental health solution will now require highly personalized, whole-person care across the full range of problems from mild to severe and will need to include not just the employee but also their spouse/partner and children.Originality/valueWhile identifying mental and behavioral health issues had become a top priority for some employers even before the pandemic, meQuilibrium believed there was a need for more clarity as to how the HR professionals were viewing the urgency of the situation. This study examines key stakeholders in their organizations, the effectiveness of their current solutions and what new approaches to employee mental health they were considering. This paper includes original data compiled through workshops and focus groups.

In Case You Haven't Heard…

The Carter Center, a global leader in mental health, announced July 15 the eight U.S. recipients of the 2020–21 Rosalynn Carter Fellowships for Mental Health Journalism. The group includes a nonprofit news leader, local reporters, freelance journalists and the inaugural Benjamin von Sternenfels Rosenthal Grantee for Mental Health Investigative Journalism. Beginning in September, fellows will pursue innovative mental health journalism projects during the yearlong, nonresidential fellowship, a news release stated. The projects tackle some of society's biggest behavioral health challenges and seek to strengthen reporting, drive change in their communities and help reduce stigma through storytelling. The fellowships challenge recipients to delve deeper into learning about a mental health issue to ensure the public gets reliable information about mental illnesses. “The Carter Center has worked for more than two decades to develop a cohort of journalists who can have a significant impact on the public's understanding of mental illnesses,” said former First Lady and Carter Center co‐founder Rosalynn Carter. “These journalists are making important contributions to lifting some of the stigma associated with mental health issues.”

Evaluation of an Urban School-Based Social, Emotional, and Behavioral Health Professional Development and Consultation Model

AbstractSocial, emotional, and behavioral health challenges pose significant barriers to students’ academic success, yet teachers report that they do not feel equipped with the knowledge and skills needed to address these challenges in their classrooms. This article presents findings associated with the effectiveness of an innovative school-based behavioral health professional development and consultation model designed to address this need for urban educators. Program evaluation results from school-based team members from five pilot schools over a two-year partnership period indicate that this model is highly used and valued by school staff, as well as perceived by school staff as effective in building the knowledge, skills, and self-efficacy to implement strategies and build systems in schools to address students’ social, emotional, and behavioral health needs. Progress monitoring data suggests that this learning is translating to actual systemic change in schools based on school-based team members’ reports of progress toward goals specific to the behavioral health systems, procedures, and protocols at their schools. The findings highlight the implications for school-based consultants and practitioners based on the promise of this model.

Nursing facility social work with family behavioral health challenges

ABSTRACT Nursing facility social workers play a prominent role in promoting behavioral health among family members with compromised responses to their loved one’s residing in a skilled care nursing facility. Familial behaviors in nursing home settings and social workers’ responses to them have not been systematically investigated. This study addresses the issue through quantitative and qualitative analyzes of face to face, in-depth interviews with 20 BSW/MSW licensed nursing facility social workers averaging 8.8 years of experience. The analysis conducted by a five-member research team yielded six recurring categories of compromised family behaviors: verbally aggressive, controlling/demanding, denial/unrealistic expectations, abuse/exploitation, manipulation, and disengaged/resistant. Respondents reported five categories of responses to these family behaviors: relating (tuning in, active listening, trust-building), mediating, limit-setting, educating, and advocating. Narratives of family behaviors and social worker responses revealed creative ways social workers engaged family member role ambiguity and worked to improve transactions among struggling family members, residents, and facility staff and policy. The findings provide previously unavailable evidence on the social worker’s role in promoting family behavioral health and document an empirical basis for future study. Five recommendations are offered for enriching social work practice and education with families in the context of skilled nursing facility care.

Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus.

Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort. As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior. The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources. Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control. Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.

Victimization and Adversity in Child Welfare Involved Youth: The Cumulative Influence on Child and Caregiver Reported Behavioral Health Symptoms.

Exposure to childhood victimization and adversity (CVA) is pervasive for child welfare (CW) involved youth. However, most research with CW samples has focused on types of maltreatment and fails to recognize the additive influence of exposure to CVA beyond maltreatment. A subsample aged 8 to 17 (n = 1,887) was drawn from the National Survey of Child and Adolescent Well-Being (NSCAW) II. CVA included six domains. Behavioral health was assessed using the Child Depression Inventory, Trauma Symptom Checklist, and the internalizing and externalizing subscales of the Child Behavior Checklist. Logistic regression was used to explore the association between the number of CVA reported and the risk of clinical-range behavioral health symptoms. Analyses were adjusted for the cluster-based sampling design and sampling weights were applied to provide nationally representative estimates. More than 60% of the sample experienced three or more CVA domains. The number of CVAs reported was associated with all four behavioral health outcomes (p < .001). Children exposed to five or more domains were more likely to report high depressive symptoms (odds ratio [OR] = 5.0), high trauma symptoms (OR = 7.0), and to have internalizing or externalizing symptoms reported by caregivers (OR = 18.0), as compared with children reporting one or less CVAs. Youth involved with CW are exposed to staggeringly high rates of CVA beyond maltreatment. For children who are already at great risk for behavioral health challenges, research to understand screening and interventions for CVA is needed to inform policy and practice initiatives to prevent and mitigate harm.

Tailored Plans: The Next Step in a Long Evolution.

Medicaid transformation in North Carolina marks the next step in a lengthy history of caring for individuals with behavioral health challenges. "Tailored" health plans will cover people with severe mental illness, substance use disorders, intellectual/developmental disabilities, and traumatic brain injury, a vulnerable population that North Carolina's LME/MCOs are uniquely qualified to serve.

823-P: Characteristics of Type 1 Diabetes (T1D) Patients Attending a Young Adult Diabetes Clinic (YADC) as a Component of Transition from Pediatric to Adult Diabetes Care

Objectives: Transition age patients with T1D age 17 to 25 are at high risk of acute and chronic complications and poor glycemic control. Surveys of youth with T1D transitioning to adult care indicate they desire a formal transition process, orientation and introduction to an adult provider team. To address the needs of young adults with T1D, the YADC was created at the Harold Schnitzer Diabetes Health Center (HSDHC). Methods: The YADC is a comprehensive half day clinic which includes group orientation with peers, behavioral health screening, diabetes education assessment and a medical provider visit. Youth referred for an appointment are given the option to schedule into the YADC. The YADC is part of the larger program Movin’ Up Movin’ On for transition age youth with T1D at the HSDHC. Results: Thirty-four of 129 referred patients attended the YADC between November 2017 and December 2018. Half transferred care internally from pediatric to adult providers. Patients were predominantly from an urban area. Thirty eight percent had state medical insurance; 62% had commercial insurance. Mean a1c was 9.1. Five of 22 patients with available microalbumin levels screened positive for microalbuminuria. No patients reported retinopathy. Seventeen of 34 patients experienced inpatient admission or an ED visit between 2016 and 2018. Six patients had DKA in the year prior to their clinic visit. Greater than half the patients (20 of 34) had history of depression, anxiety or substance abuse listed in their medical record. Conclusions: Transition of pediatric to adult care is associated with high risk for acute and chronic complications. This data illustrates the high-risk nature of the YADC attendees and highlights in particular the predominance of behavioral health challenges in this group. Disclosure F. Joarder: None. H. Nagra: None. L. Rocha: None. L. Andreas: None. I. Guttmann-Bauman: None. A.J. Ahmann: Advisory Panel; Self; Eli Lilly and Company, MannKind Corporation, Novo Nordisk Inc., Sanofi-Aventis. Consultant; Self; Dexcom, Inc. Research Support; Self; Dexcom, Inc., Medtronic.

It shouldn’t be this hard: Systemic, situational, and intrapersonal barriers to exiting homelessness among homeless young adults

The purpose of this qualitative study was to explore homeless young adults’ perceptions of the systemic, situational, and intrapersonal barriers they encounter across multiple systems in trying to exit homelessness and the ways these barriers are interrelated. Thirty-one homeless young adults (ages 18–26) in Phoenix and Tempe, Arizona were recruited for in-depth interviews from two resource centers serving homeless youth. Template analysis was used to systematically analyze and code participants’ verbatim transcripts from the interviews into a template (codebook). Characteristic quotes from the interviews are used to illustrate the emergent themes. Findings indicate that structural barriers faced by homeless youth include inadequate homeless resources, employment challenges, discrimination by law enforcement, hot climate, lack of transportation, and legal concerns. Situational barriers include interpersonal relationships, the street environment, and lack of personal resources. Intrapersonal barriers include behavioral, mental, and physical health challenges, reluctance to reach out for help, money management, and lack of desire for stable housing. Participants also outlined multiple ways in which these barriers interact to hinder their exiting homelessness. Findings support current literature applying ecological theory to the issue of homelessness while highlighting young people’s own contextual descriptions of their lived experiences. Three approaches are recommended for improving homeless services with integrated housing, employment, and clinical interventions to help young adults successfully exit homeless.

Decreasing Disruptive Behavior While Decreaseing Psychoactive Medications in Our Nurisng Facility

Many older adults would like to remain at home as they age. Many of these older adults have dementia and behavioral health challenges. Psychoactive medications such as antipsychotics and anxiolytics are prescribed to manage these behaviors and facilitate the provision of care by the family members. These medications often place the individual at risk for sedation, falls, elevated blood sugar, elevated lipids, and even sudden death. Additionally, some carry a “black box” warning if prescribed for management of behavior in patients with dementia. Eventually, these patients present to nursing facilities for long-term care placement. The challenge then is that CMS lists only schizophrenia, Huntington's Disease, and Tourette's Syndrome as acceptable diagnoses in a nursing facility for which antipsychotics are appropriate treatment.

The Evolving Police Response to Individuals with Behavioral Health Challenges

Police are responsible for addressing a myriad of community problems, but none may be more challenging than responding to calls for service involving people with behavioral health challenges (e.g.,...

Police Response to People with Mental Illnesses in a Major U.S. City: The Boston Experience with the Co-Responder Model

ABSTRACTLike most major city police agencies, the Boston Police Department (BPD) serves a sizeable population of individuals with behavioral health challenges. In 2017, the BPD received a total of 681,546 calls for service; of those, 5,953 calls specifically involved people with mental illnesses. To better meet the needs of these individuals, the BPD has a strong history of working with the Boston Emergency Services Team (BEST) of the Boston Medical Center. This partnership resulted in the creation of the BPD’s co-response program, which was launched in January 2011 as a means to team Boston police officers with BEST clinicians. The goal of the program is to provide community-based psychiatric crisis services to stabilize nonviolent persons experiencing psychiatric emergencies, diverting these individuals from arrest and the criminal justice system when appropriate. In this article, we explore the development and implementation of the co-response model, both nationally and in Boston. Next, using quantitative co-responder data, we examine short-term outcomes of the BPD co-responder program. Finally, using qualitative data from officer interviews, we discuss the perspectives of police officers on the utility and effectiveness of the co-responder approach in Boston.

Exploring Physical Force and Subject Resistance in Police Encounters with People with Behavioral Health Issues

ABSTRACTThe interaction between police use of force and subject resistance or noncompliance is particularly complex in cases involving people with behavioral health issues (PBHI). Using three years of incident reports (2014–2016) and an officer survey from a midsize suburban police department, the authors explore this interaction and officers’ experiences and perceptions of encounters with PBHI. They find that police are less likely to use physical force in cases involving PBHI, even in the face of more, and more severe, resistance. However, officers believe they use force more frequently and are unsatisfied with the options available to them to address behavioral health challenges. The authors conclude with recommendations for police training and practice.