Behavioral Health Conditions Research Articles

Comparison of Musculoskeletal Injury and Behavioral Health Diagnoses Among U.S. Army Active Duty Servicewomen in Ground Combat and Non-Ground Combat Military Occupational Specialties.

The U.S. Army's Soldier 2020 program, which started in January 2016, was designed to achieve full integration of women in all military occupational specialties. This study was undertaken to determine differences in risk of musculoskeletal injury and behavioral health (BH) disorders among U.S. Army Active Duty Servicewomen (ADSW) in ground combat military occupational specialties (MOS) versus those in non-ground combat MOS since the start of the program until January 2019. Using healthcare claims data from the Military Health System's Data Repository we conducted a cross-sectional study on ADSW from January 1, 2016 to January 1, 2019 and categorized them as either ground combat specialists (GCSs) or non-ground combat specialists (NGCSs). We identified all female soldiers in our cohort with a musculoskeletal injury (MSKI) and/or BH diagnosis during the study period. A multivariable logistic regression, adjusted by pregnancy or delivery status, was used to assess risk factors associated with GCS and included soldier age, race, body mass index (BMI), tobacco use, alcohol/substance use, and MSKI and BH status as predictor variables. A total of 92,443 U.S. Army ADSW were identified, of whom 3,234 (3.5%) were GCS (infantry, field artillery, cavalry/armor, and air defense) and 89,209 (96.5%) were in non-ground combat billets. A large difference was observed when comparing the age of the population by occupation; GCS women were predominantly between the ages of 18-23 years (71.9%), compared to NGCS women aged 18-23 (41.0%). Top MSKI and BH diagnoses for both occupations were joint pain (44.9% GCS, 50.2% NGCS) and adjustment disorders (26.2% GCS, 28.0% NGCS). GCS women had lower odds for musculoskeletal injury (0.86 AOR, 0.79-0.93 CI, P = 0.0002), obesity per BMI classification (0.82 AOR, 0.70-0.97 CI, P = 0.0214), and BH disorders (0.87 AOR, 0.80-0.95 CI, P = 0.0019); and higher odds for tobacco use (1.44 AOR, 1.27-1.63 CI, P < 0.0001), substance use (1.36 AOR, 1.04-1.79 CI, P = 0.0257), and alcohol use (1.18 AOR, 1.02-1.38 CI, P = 0.0308) when compared to NGCS women. With the increasing focus on soldier medical readiness in today's U.S. Army, the health of all soldiers is of paramount concern to command groups, unit leaders, and individual soldiers. The integration of women into ground combat military occupational specialties is a relatively new program; further longitudinal research of these groups should follow, focusing on their progression and improvement in soldier readiness, overall health, and the well-being of all servicewomen.

GAO points to populations at high risk of BH effects of COVID

Americans have reported feeling more isolated and stressed, and many have experienced economic hardship as a result of COVID‐19, causing an increase in demand for behavioral health services, including those from mental health and substance use, according to a new Government Accountability Office (GAO) report. People most at risk of the effects of the pandemic include health care workers, children and adolescents, and people with preexisting behavioral health conditions, the GAO report stated.

Loss aversion and risk for cigarette smoking and other substance use

BackgroundCigarette smoking is among the leading preventable causes of global morbidity and mortality. We aimed to determine whether individual differences in loss aversion, a bias in decision-making wherein losses are valued greater than gains, predicts smoking and other addiction risk. MethodsWe recruited current daily cigarette smokers (n = 181; > 10 cigarettes per day) and never-smokers (n = 237; < 100 cigarettes lifetime) from the United States using Amazon Mechanical Turk. Groups were matched on gender, educational attainment, and age. All completed items related to current cigarette smoking, alcohol use, other drug use, sleep problems, and depressed mood, and task-based measures of loss aversion and delay discounting, a decision-making bias associated with cigarette smoking. ResultsSmokers were less loss averse than never-smokers (F(1, 411) = 24.19, η2 = 0.02, p < .0001) even after accounting for delay discounting (F(1, 410) = 20.53, η2 = 0.02, p < .0001). Loss aversion was also a significant independent risk factor for alcohol (F(1, 410) = 21.47, η2 = 0.02, p < .0001) and other drug use (F(1, 410) = 54.12, η2 = 0.04, p < .0001), although not other behavioral-health conditions (i.e., sleep disturbance, depressed mood). Further analyses revealed that co-occurring low loss aversion and high delay discounting were independently associated with greater risk for all patterns of substance use. ConclusionsLoss aversion was associated with current cigarette smoking and other substance use patterns independent of delay discounting. Loss aversion may warrant attention as a protective factor and potential target for preventive intervention for substance use and addiction.

Alcohol Consumption and COVID-19-Related Stress Among Health Care Workers: The Need for Continued Stress-Management Interventions.

Although a known association exists between stress and alcohol consumption among health care workers (HCWs), it is not known how the COVID-19 pandemic has affected this association. We assessed pandemic work-related stress and alcohol consumption of HCWs. We emailed a cross-sectional, anonymous survey in June 2020 to approximately 550 HCWs at an academic hospital in New Orleans, Louisiana. HCWs from all departments were eligible to complete the survey. Questions measured work-related stress and emotional reactions to the pandemic (using the Middle East Respiratory Syndrome [MERS-CoV] Staff Questionnaire), depressive symptoms (using the Patient Health Questionnaire-9 [PHQ-9]), coping habits (using the Brief COPE scale), and pre-COVID-19 (March 2020) and current (June 2020) alcohol consumption. We measured alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), with scores >3 considered positive. We asked 4 open-ended questions for in-depth analysis. One-hundred two HCWs participated in the survey. The average AUDIT-C scores for current and pre-COVID-19 alcohol consumption were 3.1 and 2.8, respectively. The level of current alcohol consumption was associated with avoidant coping (r = 0.46, P < .001). Relative increases in alcohol consumption from March to June 2020 were positively associated with PHQ-9 score and greater emotional reactions to the pandemic. Availability of mental health services was ranked second to last among desired supports. Qualitative data demonstrated high levels of work-related stress from potential exposure to COVID-19 and job instability, as well as social isolation and negative effects of the pandemic on their work environment. Ongoing prevention-based interventions that emphasize stress management rather than mental or behavioral health conditions are needed.

Together in care: Lessons learned at the intersection of integrated care, quality improvement, and implementation practice in opioid treatment programs.

Integrated care programs that systematically and comprehensively address both behavioral and physical health may improve patient outcomes. However, there are few examples of such programs in addiction treatment settings. This article is a practical implementation report describing the implementation of an integrated care program into two opioid treatment programs (OTPs). Strategies used to implement integrated care into two OTPs included external facilitation, quality improvement (QI) processes, staff training, and an integrated organizational structure. Service, implementation, and client outcomes were examined using qualitative interviews with program staff (n = 16), program enrollment data, and client outcome data (n = 593) on mental health (MH), physical health, and functional indicators. Staff found the program to generally be acceptable and appropriate, but also noted that the new services added to already busy workflows and more staffing were needed to fully reach the program's potential. The program had a high level of penetration (∼60%-70%), enrolling over 1,200 clients. Staff noted difficulties in connecting clients with some services. Client general functioning and MH symptoms improved, and heavy smoking decreased. The organizational structure and QI activities provided a strong foundation for interactive problem-solving and adaptations that were needed during implementation. This article highlights an example of the intersection of QI and implementation practice. Simplified QI processes, consistent post-implementation meetings, and change teams and champions facilitated implementation; however, ongoing training and support, especially related to data are needed. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff is necessary.Plain Language Summary: Providing medical and behavioral health treatment services in the same clinic using coordinated treatment teams, also known as integrated care, improves outcomes among those with chronic physical and behavioral health conditions. However, there are few practical examples of implementation of such programs in addiction treatment settings, which are promising, yet underutilized settings for integrated care programs. A multi-sectoral team used quality improvement (QI) and implementation strategies to implement integrated care into two opioid treatment programs (OTPs). The program enrolled over 1,200 clients and client general functioning and mental health (MH) symptoms improved, and heavy smoking decreased. Qualitative interviews provided important information about the barriers, facilitators, and context around implementation of this program. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff, as well as ongoing training and supports for staff, are necessary. This project may help to advance the implementation of integrated care in OTPs by identifying barriers and facilitators to implementation, lessons learned, as well as providing a practical example of potentially useful QI and implementation strategies.

Perda de função mastigatória e risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo

Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.

Perinatal Psychiatry: Improving Access to Perinatal Mental Health Care.

Back to table of contents Previous article Next article Editor's ChoiceFull AccessPerinatal Psychiatry: Improving Access to Perinatal Mental Health CareKunmi Sobowale, M.D., Misty Richards, M.D., M.S., Lisa B. Dixon, M.D., M.P.H.Kunmi SobowaleSearch for more papers by this author, M.D., Misty RichardsSearch for more papers by this author, M.D., M.S., Lisa B. DixonSearch for more papers by this author, M.D., M.P.H.Published Online:1 Jan 2022https://doi.org/10.1176/appi.ps.2021.73102AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This Editor’s Choice collection was published online in November 2021 and refreshes the original April 2019 collection on perinatal psychiatry. To review all collections, please visit the Editor’s Choice section of ps.psychiatryonline.org.Over the past 20 years, maternal mortality in the United States has more than doubled, topping the mortality list for high-income countries. This increased rate is alarming: according to the Centers for Disease Control and Prevention, more than 700 women die each year due to complications related to pregnancy and childbirth, and more than 50,000 women suffer from a life-threatening complication. Behavioral health conditions make up a significant proportion of perinatal morbidity and increase the risk of perinatal mortality through self-harm, unintentional overdose, inadequate management of physical health, and suicide. At least half of maternal deaths in the United States are preventable; to help prevent ongoing death and suffering, stakeholders must address racial and ethnic disparities in perinatal care and reduce barriers to early health care access. Increasing access to perinatal mental health treatment will promote maternal health through improved health-related behaviors, mitigation of high-risk behaviors, and better prenatal and postnatal engagement in care.This Editor’s Choice collection builds on the April 2019 perinatal psychiatry collection and highlights innovative service models across the care continuum, from screening to longitudinal treatment. The first set of articles details the large treatment gap for perinatal mental illness despite its association with pregnancy complications. The second set of articles discusses digital health tools (e.g., mobile apps and telepsychiatry) to support perinatal mental health screening and integrated care. The last group of articles discusses the benefits of perinatal collaborative care models in controlled trials and real-world settings in socioeconomically, racially, ethnically, and geographically diverse populations. It is incumbent upon mental health clinicians to build upon the innovations in this collection to expand access to perinatal mental health care with the goal of reversing the concerning rise in maternal morbidity and mortality.THE TREATMENT GAPRelationship Between Pregnancy Complications and Psychiatric Disorders: A Population-Based Study With a Matched Control GroupKang-Yi CD, Kornfield SL, Epperson CN, et al.Psychiatr Serv 2018; 69:300–307DOI: 10.1176/appi.ps.201700097Mental Health Treatment and Unmet Mental Health Care Need Among Pregnant Women With Major Depressive Episode in the United StatesSanmartin MX, Ali MM, Chen J, et al.Psychiatr Serv 2019; 70:503–506DOI: 10.1176/appi.ps.201800433State Mandates Regarding Postpartum DepressionaRowan PJ, Duckett SA, Wang JEPsychiatr Serv 2015; 66:324–328DOI: 10.1176/appi.ps.201300505USE OF TECHNOLOGY IN PERINATAL MENTAL HEALTH CAREEvaluation of Telepsychiatry-Enabled Perinatal Integrated CareShore JH, Waugh M, Calderone J, et al.Psychiatr Serv 2020; 71:427–432DOI: 10.1176/appi.ps.201900143Perinatal Mental Health in Community Psychiatry: A Reproductive Psychiatry eConsult Pilot ProjectDossett EC, Benitez C, Garcia NPsychiatr Serv 2019; 70:1075–1076DOI: 10.1176/appi.ps.201900316Use of Text Messaging for Postpartum Depression Screening and Information ProvisionaLawson A, Dalfen A, Murphy KE, et al.Psychiatr Serv 2019; 70:389–395DOI: 10.1176/appi.ps.201800269A Mobile Application for Monitoring and Management of Depressed Mood in a Vulnerable Pregnant PopulationaHantsoo L, Criniti S, Khan A, et al.Psychiatr Serv 2018; 690:104–107DOI: 10.1176/appi.ps.201600582INNOVATION IN COLLABORATIVE CARE AND PERINATAL MENTAL HEALTHCollaborative Care for Perinatal Depression Among Socioeconomically Disadvantaged Women: Adverse Neonatal Birth Events and Treatment ResponseBhat A, Grote NK, Russo J, et al.Psychiatr Serv 2017; 68:17–24DOI: 10.1176/appi.ps.201600002Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged WomenGrote NK, Simon GE, Russo J, et al.Psychiatr Serv 2017; 68:1164–1171DOI: 10.1176/appi.ps.201600411Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care ProgramMiller ES, Grobman WA, Ciolino JD, et al.Psychiatr Serv 2021; 72:1268–1275DOI: 10.1176/appi.ps.202000563PRogram In Support of Moms (PRISM): Development and Beta TestingaByatt N, Pbert L, Hosein S, et al.Psychiatr Serv 2016; 67:824–826DOI: 10.1176/appi.ps.201600049Longitudinal Remote Coaching for Implementation of Perinatal Collaborative Care: A Mixed-Methods AnalysisBhat A, Bennett IM, Bauer AM, et al.Psychiatr Serv 2020; 71:518–521DOI: 10.1176/appi.ps.201900341Pregnant and Postpartum Women With Bipolar Disorder: Taking the Care to Where They AreBhat A, Cerimele JM, Byatt NPsychiatr Serv 2018; 69:1207–1209DOI: 10.1176/appi.ps.201800133a Article from the April 2019 Editor’s Choice on Perinatal Psychiatry FiguresReferencesCited byDetailsCited byNone Volume 73Issue 1 January 01, 2022Pages 116-117 Metrics PDF download History Published online 1 January 2022 Published in print 1 January 2022

Remote Collaborative Care With Off-Site Behavioral Health Care Managers: A Systematic Review of Clinical Trials.

In the United States, most patients who require behavioral health care do not receive it owing to an overall shortage of behavioral health specialists. The Collaborative Care Model (CoCM) is a team-based, highly-coordinated approach to treating common mental health conditions in primary care that has a robust evidence base. Several recent randomized controlled trials have demonstrated the effectiveness of remote CoCM teams. As telehealth technology advances and uptake expands, understanding the evidence for remote CoCM becomes increasingly crucial to inform CoCM practice and implementation. The objective of this study was to systematically review randomized controlled trials regarding the effectiveness of remote CoCM teams in treating common psychiatric conditions in primary care and medical settings. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to structure our review. Our search strategy and development of search terms was informed by knowledge and review of the CoCM literature. Articles were reviewed by 3 authors, and once selected, they were sent to 2 authors for further data extraction to describe various study characteristics and process measures relating to remote CoCM. The literature search identified 13,211 articles, 9 of which met inclusion criteria. The 9 studies collectively demonstrate effectiveness of remote CoCM in treating a range of behavioral health conditions (depression [n= 7], anxiety [n= 2], and PTSD [n= 1]), across various populations and settings. Sample sizes ranged from 191 patients to 704 patients, publication dates from 2004 to 2018, and studies were conducted from 2000 to 2014. Various process measures were also reported. As the 9 studies included in our systematic review demonstrate, remote CoCM can be effective in treating a range of behavioral health conditions in various primary care and specialty medical settings. These findings suggest organizations may have more flexibility in building their CoCM team and drawing upon wider workforces than previously recognized. As recent shifts in telehealth policy and practice continue to motivate telehealth approaches, further research that can inform best practices for remote CoCM will be useful and valuable to those making organizational decisions when implementing integrated care models.

Health and Health Care Use Strongly Associated with Cumulative Burden of Social Determinants of Health.

Understanding health outcomes and patterns of health care utilization associated with patients' cumulative social determinant of health (SDOH) risk is essential to supporting better health care. This study compared mental and physical health outcomes and health care utilization by increasing number of social needs among a clinical adult population. Surveys were sent to 6000 patients with recent visits to 7 primary care clinics in Portland, Oregon in 2018. The final study sample included respondents who matched to medical claims data, N = 1748. The authors used a modified logistic regression model to estimate risk ratios for the relationship between cumulative SDOH factors and self-reported chronic conditions, and a 2-part model to estimate the effects of cumulative SDOH risk on health care utilization. Increased SDOH need was associated with increasing likelihood of worse self-reported health outcomes, especially mental health. Compared with those with no SDOH need, having 1-2 SDOH need(s) (adjusted risk ratio [aRR] 1.25; 95% confidence interval [CI]: 1.06-1.46) and 3 or more SDOH needs (aRR 1.45; 95% CI: 1.22-1.73) had a greater risk of reporting any behavioral health condition. However, the number of SDOH had a graded but inverse impact on use of mental health care services where fewer visits were observed among those using care. Having SDOH was associated with increased likelihood of having an emergency department visit and increased number of primary care visits. This study demonstrates the compounding impact of SDOH on health and health care use. This highlights the importance of collecting SDOH, including the total number of SDOH needs, when considering a patient's health and health care.

Change in Gender on Record and Transgender Adults’ Mental or Behavioral Health

Within gender-diverse populations, gender-affirming changes in gender on record may improve mental or behavioral health. This study uses claims data to investigate whether sex assigned at birth modifies the association between change in gender on record and mental or behavioral health. Adult Oregon Medicaid beneficiaries with gender identity-related diagnoses and enrolled during 2010-2019 were included. Sex assigned at birth was inferred from medical and pharmacy claims and was categorized as assigned female, assigned male, or unknown sex assigned at birth. Self-reported gender ascertained at initial enrollment differing from sex assigned at birth indicated a change in gender on record. Multivariable logistic regression estimated the association between change in gender on record and mental (anxiety, depression, suicidal ideation, post-traumatic stress disorder) or behavioral (alcohol, substance, or tobacco use disorders) health. Analyses were conducted in February 2021. This study included 2,940 transgender and nonbinary adults. Of the 1,451 self-reporting female gender and 1,489 self-reporting male gender, 449 (30.9%) were assigned male at birth, and 303 (20.3%) were assigned female at birth, classified as changing their gender on record. Predicted probability of mental or behavioral conditions was significantly lower in those who changed their gender on record. Sex assigned at birth modified the association with mental health: assigned female at birth reporting female gender had the highest burdens, followed by assigned male at birth reporting male. Secondary analyses using a modified change in gender definition or alternative sex assigned at birth inference method found similar trends. Oregon Medicaid gender-diverse beneficiaries who changed their gender on record had a meaningfully lower probability of mental and behavioral health conditions. Those assigned female at birth reporting female gender had the highest burdens.

Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019.

This is the fourth Journal of Marital and Family Therapy (JMFT) special issue on the efficacy and effectiveness of couple and family therapy. Articles in this issue review studies published from 2010 to 2019 on couple and family interventions for prevalent mental and behavioral disorders and health conditions. The final article on mental health disparities tracks progress in the field and emphasizes the need for additional attention. In the current article, we provide a description of our methodological approach for the special issue and an overview of the state of the evidence for couple and family interventions across the conditions reviewed. We also offer recommendations to inspire researchers to further expand the empirical support for couple and family interventions to address pressing public health needs.

Occupational Risk of Low-Level Blast Exposure and TBI-Related Medical Diagnoses: A Population-Based Epidemiological Investigation (2005-2015).

Because traumatic brain injury (TBI)—most often caused by exposure to high-level blast (HLB)—is a leading cause of medical evacuations of deployed U.S. service members in recent conflicts, researchers seek to identify risk factors for TBI. Previous research using self-reported data has identified low-level blast (LLB) as one such risk factor and suggests an association with susceptibility to and symptoms associated with TBI. This article presents a population-based study of all branches of military service that examines the association between occupational risk for LLB and both clinically diagnosed TBIs—from concussions to severe and penetrating TBIs—and conditions commonly comorbid with concussion. Using archival medical and career records from >2 million service members between 2005–2015, this work demonstrates that occupational risk of LLB is associated with any TBI, mild TBI, moderate TBI, cognitive problems, communication problems, hearing problems, headaches, any behavioral health condition, anxiety, drug abuse/dependence, alcohol abuse/dependence, delirium/dementia, posttraumatic stress disorder, post-concussive syndrome, tinnitus, fatigue, and migraines. Understanding the full scope of the effects of LLB on service members will help ensure the health and readiness of service members and may influence both military policy and clinical practice guidelines for blast-induced injuries.

Payors Train PCPs to Treat Mental Health in House

Payors Train PCPs to Treat Mental Health in House

The Quality and Utility of Referral Letters for Gender-Affirming Surgery.

The World Professional Association for Transgender Health (WPATH) recommends referral by a mental health professional for gender-affirming chest and genital surgeries. However, several transgender health guidelines propose an informed consent model of care to respect patient autonomy. This research aimed to understand, characterize, and asses the quality of information gathered through referral letters for patients consulting for gender-affirming surgeries. A retrospective review of electronic medical records (EMRs), including referral letters from behavioral health (BH) and primary care providers (PCPs), was conducted for patients seeking chest or genital surgery by a single surgeon between 2017 and 2019. Data were abstracted manually and included medical and gender history and documentation of WPATH-recommended surgical criteria. A total of 233 patient records, including 171 PCP letters and 231 BH letters, were reviewed. With respect to documentation of surgical criteria, 92% of BH letters documented a diagnosis of gender dysphoria, 63% ability to provide informed consent, and 51% management of BH comorbidities. More than half of individuals with chronic physical health conditions did not have those conditions documented in their referral letters. Similarly, BH letters often failed to document BH diagnoses endorsed by patients. For example, while 80% of patients endorsed a diagnosis of anxiety, more than half did not have it documented in their letters. Overall, greater than half of diagnoses across BH conditions were only documented as present in the EMR. Referral letters only variably documented WPATH-recommended surgical criteria and did not reliably document physical and mental health comorbidities. Our research suggests that multidisciplinary pre-surgical assessment may be more useful than referral letters in some settings.

Trends in US Patients Receiving Care for Eating Disorders and Other Common Behavioral Health Conditions Before and During the COVID-19 Pandemic

Trends in US Patients Receiving Care for Eating Disorders and Other Common Behavioral Health Conditions Before and During the COVID-19 Pandemic

Veterans with PTSD still suffer despite years‐long treatment

Nearly six in 10 veterans who have been diagnosed with post‐traumatic stress disorder (PTSD) still suffer from the often‐debilitating symptoms of the condition despite months to years of treatment with first‐line therapies, according to a new survey, released by Freespira, developer of digital therapeutic solutions to treat behavioral health conditions.

Serious Mental Illness in Post-Acute and Long-Term Care:Building Knowledge, Sharing Care

Serious Mental Illness in Post-Acute and Long-Term Care:Building Knowledge, Sharing Care

Assessing the extent of shared decision making in Pediatrics: Preliminary psychometric evaluation of the German CollaboRATEpediatric scales for patients aged 7–18 years, parents and parent-proxy reports

ObjectiveTo conduct a preliminary evaluation of psychometric properties of CollaboRATEpediatric, a set of three scales to assess shared decision making (SDM) with pediatric patients, parents and parents on behalf of their children (parent-proxy reports). As secondary objectives we examined the scales’ distributional characteristics, acceptability, and agreement between scales. MethodsPatients aged ≥ 7 years and parents were recruited in two outpatient facilities providing healthcare services for children with neurological and behavioral health conditions. We collected 46, 169 and 227 pediatric patient, parent-proxy and parent reports, respectively. Convergent, divergent and discriminative validity were investigated. Acceptability of the scales and agreement between patient and parent-proxy reports were explored by assessing item nonresponse and Bland-Altman plots. ResultsWhile convergent and divergent validity were established for the parent scale, discriminative validity was not demonstrated for any of the scales. The scales showed good to excellent acceptability. Parent-proxy reports agreed to a moderate extent with patients’ self-reports of SDM. ConclusionCollaboRATEpediatric offers a starting point for parsimoniously assessing SDM in Pediatrics, however further psychometric testing is warranted. Practice ImplicationsGiven limited psychometric support for the pediatric patient scale, we recommend using both the pediatric patient and parent-proxy report scales to assess SDM in pediatric patients until further psychometric testing is concluded.

Factors Associated With Initial Treatment Choice, Engagement, and Discontinuation for Patients With Opioid Use Disorder.

Pharmacotherapy for opioid use disorder is effective but underused from a clinical perspective, and average treatment duration is shorter than current recommendations. In this analysis, the authors examined factors associated with initiation of, engagement in, and duration of treatment among patients with opioid use disorder. Using the OptumLabs Data Warehouse (a large, national, deidentified database of commercial or Medicare Advantage plan enrollees), the authors identified a sample of 204,225 patients with opioid use disorder between July 1, 2010, and April 1, 2019. Factors associated with initial treatment type were identified with multinomial logistic regression. The odds of treatment engagement, defined as two claims for treatment and a treatment episode of ≥30 days, were estimated with logistic regression. The hazard ratios for treatment discontinuation were estimated with a Cox proportional hazards model. Treatment initiation with pharmacotherapy (alone or in combination with psychosocial therapy) was associated with higher odds of treatment engagement and a lower hazard of treatment discontinuation. Patients with certain behavioral health conditions (e.g., anxiety or mood disorders) had higher odds of initiating treatment with pharmacotherapy and engaging in treatment and a lower hazard of discontinuing treatment. Patients with certain painful general health conditions (e.g., fibromyalgia or musculoskeletal disorders) had lower odds of initiating and engaging in treatment. Treatment initiation with pharmacotherapy was associated with treatment engagement and duration. Previous contact with behavioral health treatment may support initiating, engaging in, and remaining in treatment. Patients with painful conditions may benefit from provider support in initiating treatment for opioid use disorder.

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.