Behavioral Health Resources Research Articles

771 Improving Burn Care in the Amish Community: A Qualitative Study of Strengths and Needs

IntroductionAmish communities present with a higher risk for sustaining traumatic burn injuries; thus, these communities have a high need for culturally competent burn care. Although homeopathic remedies for mild to moderate burn injuries have been studied in Amish communities, little is known about hospital-community partnerships to facilitate culturally competent burn care, particularly with more severe injuries. The current study aimed to 1) understand the successful aspects of an existing hospital-community partnership for facilitating culturally sensitive burn care for Amish communities, and (2) identify the ongoing physical, structural, and behavioral health needs of this population as the partnership continues to develop.MethodsQualitative data from 12 Amish caregivers who participate on a burn/wound team or an oil therapy team, were collected on through a focus group interview. Caregivers identified as White, were majority male (83%), and resided in Amish communities. Retrospective thematic analysis was used to analyze the qualitative data. Five major themes (i.e., informational needs, strengths of Amish burn care, behavioral health concerns, behavioral health resources, and preferred teaching methods) evolved.ResultsResults indicated that Amish caregivers displayed a great curiosity and openness to learning about all aspects of recommended burn care from the medical providers. Caregivers also cited their traditional (homeopathic) burn care procedures (e.g., oil therapy) as strengths, while simultaneously maintaining that their relationship to the hospital is a valuable part of their burn care. Relating to behavioral health, caregivers highlighted difficulties in helping their children cope with burn injuries and pain during rehabilitation and treatment. Caregivers emphasized the role of strong social support that the Amish community provides to burn survivors. Additionally, caregivers stressed the significance of delivering burn care information in a form that is culturally appropriate for their community.ConclusionsResults of this study provide important considerations that other accredited burn centers may consider when establishing similar partnerships to enhance their delivery of culturally competent medicine for Amish burn survivors.

Assessing service quality and access in trauma centers through behavioral health screening, education, and treatment after pediatric injury

BackgroundOver 120,000 U.S. children are hospitalized annually for traumatic injury, with approximately 20% developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or depression. The ACS COT recommends that trauma centers address emotional recovery after injury; however, few pediatric trauma centers (PTCs) assess behavioral health symptoms. This study describes results from a survey with PTC providers assessing the landscape of behavioral health screening, education, and treatment. MethodsTrauma program leaders from 83 US Level I and II trauma centers across 36 states completed a survey assessing center characteristics and decision-making, availability, and perceptions of behavioral health resources. ResultsNearly half (46%) of centers provide behavioral health screens for pediatric patients, and 18% screen family members, with screens mostly conducted by nurses or social workers for ASD or PTSD. Two-thirds provide child behavioral health education and 47% provide education to caregivers/family. Two-thirds provide treatment connections, typically via referrals or outpatient clinics. Behavioral health screening, education, and treatment connections were rated as very important (M > 8.5/10), with higher ratings for the importance of screening children versus caregivers. Child maltreatment (59%), observed patient distress (53%), child substance use (52%), injury mechanism (42%) and severity (42%) were prioritized in screening decision-making. ConclusionService provision varies by method, resource, and provider, highlighting the lack of a roadmap for centers to provide behavioral health services. Adoption of universal education and screening procedures in PTCs is crucial to increase access to services for injured children and caregivers. PTCs are well-positioned to offer these services. Level of evidenceLevel II

Fertility Discussions: Perspectives of Adolescents and Young Adults With Differences of Sex Development.

Fertility-related health care and decision-making needs for youth with differences of sex development (DSD) are complex and vary by condition and the values and preferences of each individual and their partner and/or family. Discussing fertility implications can be a challenging aspect of clinician and family communication about a DSD diagnosis. This qualitative study assesses fertility-related communication experiences of adolescents and young adults (AYA) with DSD. Participants included 97 AYA with DSD ages 12-26 years (M = 18.5, SD = 3.9) who completed questionnaires on demographic and medical information and patient-clinician communication. A subsample of 33 AYA also completed semistructured interviews about experiences with fertility discussions. Two major themes, each with subthemes, were identified: (1) understanding of fertility related to (1a) one's own fertility status, (1b) reproductive and parenting options, and (1c) emotional reactions to one's own fertility status and (2) conversations about fertility related to (2a) reflections on conversations, (2b) barriers, and (2c) advice. AYA perspectives in this study provide important information about how youth with DSD learn about their fertility status, the impact their fertility status has on them, and the fertility-related conversations they have with their providers and families. Specific recommendations for providers and parents or caregivers include the following: inform youth of their fertility status as early as possible; be direct but patient in delivering information; begin by giving basic information and provide more detail as the conversation unfolds; revisit the conversation over time to allow for further discussion or information-seeking; offer additional information or resources, including behavioral health resources.

Latino sexual minority men’s intersectional minority stress, general stress, and coping during COVID-19: A rapid qualitative study

Introduction Sexual minority men face mental health, substance use, and HIV disparities, all of which can be understood by minority stress and intersectionality theories. With the emergence of COVID-19 and considering its disproportionate impact on Latinx and sexual minority communities, Latino sexual minority men (LSMM) may be facing unique consequences of this new pandemic that intersect with pre-COVID disparities. The purpose of the current study is to explore the impact of the COVID-19 pandemic on LSMM’s intersectional minority stress, general stress, and coping, filling a gap in the current literature. Methods The current rapid qualitative study explores the impact of COVID-19 on LSMM in South Florida who reported being HIV-negative (N = 10) or living with HIV (N = 10). Results The rapid analysis revealed themes of exacerbated intersectional minority stress and general stress in the context of COVID-19, some of which was related to the impact of pre-COVID-19 disparities in the LSMM community. Participants reported a variety of coping responses, some of which participants found helpful and others (e.g., substance use) which further exacerbated disparities. Conclusion The findings underscore the need to scale up and disseminate behavioral health resources to LSMM to address the impact of the COVID-19 pandemic on this community’s health and well-being.

306: Behavioral health resources and screening in military cystic fibrosis centers: A survey

306: Behavioral health resources and screening in military cystic fibrosis centers: A survey

System-level factors shaping the implementation of “hub and spoke” systems to expand MOUD in rural areas

Background: Hub and spoke systems (HSS) are increasingly promoted as a systems-level intervention to expand access to medication for opioid use disorders (MOUD), particularly in rural areas with limited treatment options. The HSS model consists of sub-systems in which “hubs” deliver specialized expertise to a regional network of office-based opioid treatment (OBOT) providers in “spokes,” who together create a continuum of acute and chronic care. Yet, little is known about system-level factors (e.g., system structure, financing) that influence HSS implementation and sustainability in rural areas. Methods: For this case study, we conducted semi-structured interviews with substance use disorder treatment providers (N = 26) and system-level stakeholders (N = 16) in five rural HSS sub-systems throughout one state. We undertook iterative textual analysis of interview transcripts, identifying and coding themes related to key implementation constructs associated with the Exploration, Preparation, Implementation and Sustainability (EPIS) framework. Results: California policy-makers adopted HSS to expand rural access to opioid treatment programs (OTPs, i.e., providers of methadone and other medications for opioid use disorder). However, stakeholders questioned the model’s fit for rural regions featuring few established OTPs that could function as hubs and critiqued its treatment-focused approach, felt to sideline harm reduction service providers. Contracts to serve rural regions were awarded entirely to for-profit methadone providers, contributing to stigma and distrust among many buprenorphine providers whose organizations were later recruited as spokes. While hubs offered financial resources enabling some spokes to expand MOUD, the needs of spokes varied considerably. Relationships between hubs and spokes to facilitate the care continuum under HSS were restricted by limited behavioral health resources and the large distances characterizing rural California. Conclusions: This case study reveals how rural contextual factors such as geography and behavioral healthcare resource availability can dramatically influence differential HSS implementation.

The fourth wave of the US opioid epidemic and its implications for the rural US: A federal perspective

The current opioid epidemic in the United States has been characterized as having three waves: prescription opioid use, followed by heroin use, and then use of synthetic opioids (e.g., fentanyl), with early waves affecting a population that was younger, less predominantly male, and more likely to be Caucasian and rural than in past opioid epidemics. A variety of recent data suggest that we have entered a fourth wave which can be characterized as a stimulant/opioid epidemic, with mental illness co-morbidities being more evident than in the past. Stimulant use has introduced new complexities in terms of behavioral consequences (e.g., neurological deficits, suicidal ideation, psychosis, hostility, violence), available treatments, and engagement into services. These compound existing issues in addressing the opioid epidemic in rural areas, including the low density of populations and the scarcity of behavioral health resources (e.g., fewer credentialed behavioral health professionals, particularly those able to prescribe Buprenorphine). Considerations for addressing this new wave are discussed, along with the drawbacks of a wave perspective and persistent concerns in confronting drug abuse such as stigma.

Screening for Children's Chronic Health Conditions and Their Strengths and Difficulties in Primary Care.

This study explores parents' perceptions of their child's health status and their strengths and difficulties using 2 validated instruments in primary care settings. This cross-sectional study was conducted between February 2018 and October 2019. Parents of children aged 2 to 18 years completed the Children with Special Health Care Needs (CSHCN) screener and the Strengths and Difficulties Questionnaire (SDQ) as well as demographics. The CSHCN uses 5 questions to identify children with chronic health conditions. Three subgroups were created: children with no chronic health condition (NCHC), chronic health condition with no functional limitations (NFLs), and chronic health condition with functional limitations (FLs). Higher SDQ scores indicate higher degrees of a factor. Associations between CSHCN subgroups and SDQ scores, controlling for demographics, were analyzed with multiple linear regressions. In total, 970 parents' surveys (87.9% completed surveys) were included in this analysis: 76.4% of respondents were married, 56.4% had an annual household income ≥$50,000%, and 61.7% were employed full time; 53.0% of the index children were males, 72.1% were White, and 61.4% had private insurance. Mean (SD) total SDQ scores across the 3 CSHCN subgroups were significantly different (NCHC, 7.7 [4.8]; NFL, 12.6 [6.6]; FL, 16.0 [6.7], p < 0.001). The mean SDQ prosocial scores were higher in the NCHC subgroup (p < 0.001), as hypothesized. The SDQ means for the 3 subgroups remained significantly different after controlling for demographics. Children with FLs had significantly higher total SDQ scores than children in the other 2 subgroups, which may aid clinicians in the early identification of children who would benefit from behavioral health resources.

Telemental Health and the Management of Psychosis.

Purpose of ReviewThe purpose of this paper is to review the application of telehealth in the assessment and treatment of psychotic illnesses. We present the contextual factors which make this approach to clinical care compelling, and review existing evidence about feasibility, acceptability, and effectiveness.Recent FindingsThe use of telehealth with individuals that suffer from serious mental illness and psychosis has been demonstrated to be feasible and acceptable, with effectiveness that is comparable to in-person clinical care. Telehealth holds the additional promises of expanding access, connecting patients, families, and the general public to behavioral health resources, and reducing overall health care costs.SummaryWe provide two case examples which demonstrate the successful use of technology for the delivery and coordination of effective patient care for individuals with psychotic illnesses.

Evaluation of healthcare for transgender veterans

PurposeTo identify the cohort of veterans diagnosed with gender dysphoria obtaining care through VA Northern California Healthcare System (VANCHCS), and evaluate their care. MethodsUsing ICD-10 criteria, we identified veterans with a diagnosis of gender dysphoria. We stratified these individuals by self-identified gender, and evaluated their medical records for gender affirming-hormone therapy and access to behavioral health, endocrine, speech pathology, and dermatology resources. ResultsOf the 148 Veterans found, 95 identified as transwomen, 43 as transmen, and 10 as non-binary. Non-binary Veterans were excluded from further analysis. Transmen were significantly younger than transwomen (42±13.7 vs 51.5±15.9 yrs., p< 0.001 by t-test). Transwomen were more likely to be Air Force Veterans than transmen (21.1% vs 17.1%), and less likely to be Army Veterans (38.9% vs 43.9%), but were more likely to see a Endocrinologist (83.2% vs 72.1%) and Speech Therapist (44.2% vs. 25.6%). Gender affirming hormone therapy for transwomen included combinations of gonadotropin-releasing hormone analogs, spironolactone, finasteride, estradiol, and progesterone, whereas for transmen, testosterone was the sole therapy. The majority of our Veterans (65 transwomen (68.4%) and 38 transmen (88.4%) had not undergone gender-affirming surgery. Only 59 transwomen (62%) had measurements of prostate-specific antigen (PSA). Both groups were followed comparably in Behavioral Health Clinics (87.4% for transwomen, 90.7% for transmen). Only 35 transwomen (36.8%) were seen in Dermatology clinics for gender specific needs. ConclusionOur patients and their management were diverse. We conclude that care for transgender Veterans could be enhanced by a more consistent, team-based approach to therapy.

Supporting Adolescents and Young Adults Exposed to or Experiencing Violence During the COVID-19 Pandemic

Supporting Adolescents and Young Adults Exposed to or Experiencing Violence During the COVID-19 Pandemic

ATA2020 Session Summaries (Abstracts)

ATA2020 Session Summaries (Abstracts)

Organophosphate Poisoning and Suicide in Nepal: A Reflection on the limitations of Behavioral Health Resources

Organophosphate Poisoning and Suicide in Nepal: A Reflection on the limitations of Behavioral Health Resources

Training Primary Care Practitioners about Integrated Behavioral Health: How Integrated is the Training?

Integrating behavioral health into primary care has shown promise in extending access to evidence-based care to the underserved while demonstrating increasing benefits in outcomes and in the practice environment as the level of integration increases. Primary care trainees must be ready for the increase in mental health and substance abuse treatment needs during and after the COVID-19 pandemic. To maximize primary care trainee skill building and leverage adult learning theories, training programs should involve something like apprenticeship rather than being didactic. In fully integrated behavioral health primary care settings, there should be behavioral health resources either on site or available virtually to meet patients' multiple biopsychosocial needs and to support primary care trainees. The level of integration of these programs can be evaluated via the Integrated Practice Assessment tool (IPAT) to assess gaps in structural components and to identify needed resources for fully integrated care settings that provide the optimal training environment. Future assessment of integrated care training is discussed.

Improving Care of Pediatric Behavioral Health Patients and Employee Safety through Quality Collaborative Participation

Background: With limited behavioral health placements, our hospital houses behavioral health patients for extended periods of time. Without a dedicated behavioral health unit and full-time behavioral health staff members, there was no consistent process for the management and care of pediatric behavioral health patients in our facility, a children’s hospital within an adult hospital, within a larger system. This led to patient and employee harm. A review of employee injury reports and days away restricted/transferred (DART) events related to behavioral patients found 5 total reports, 2 DART events, 64 lost days, and 146 restricted days (210 DART days total) between June 2017 and June 2018 (Fig. 1). Methods: Our interdisciplinary behavioral health team created a standardized room safety/preparation checklist, established a template and process for daily individualized safety plans based on the patient’s assigned safety classification, and developed a formalized process for the management of these patients. The facility also supported de-escalation training for all pediatric staff members, providing additional behavioral health education and resources for pediatric nurses and providers. Simultaneously, our facility joined the SPS Employee/Staff Safety: Patient Behavioral Events group. This provided a venue to share our progress and learn from other organizations. Results: After the process rollout in June 2018, 91% of behavioral health patients had individualized safety plans created, ensuring continuity between caregivers and as patients transfer units, and no serious patient harm has been reported. Postintervention employee injury report and DART results between June 2018 and June 2019 were 11 reports received, 1 DART event, 3 lost days, and 28 restricted days (31 DART days total) (Fig. 1). The interdisciplinary team has implemented a process to review pediatric behavioral health cases twice monthly to monitor progress and address opportunities. Our campus adult and system partners have adopted some of these best practices and we continue to share information to spread best practices across both the pediatric and adult population.Fig. 1.: Children's Memorial Hermann Hospital Employee Safety Reported Events and Days Away Restricted/Transferred (DART) Days, June 2017-September 2019/. Graph shows number of events reported per month and number of staff days from work or restricted per month related to violence caused by a behavioral health patient. Preintervention (June 2017 and June 2018), staff reported 5 events, 3 of which were OSHA recordable (TRIR) and 2 of which sustained injuries, resulting in 64 total lost days (days away) and 146 restricted days (210 DART days total). Postintervention between June 2018 and June 2019, 11 event reports were received (a 120% increase). One event was OSHA recordable (a 66% decrease) with the employee reporting sustaining injuries, which resulted in 3 lost days (a 95% decrease), and 28 restricted days (an 80% decrease), for a total of 31 DART days reported (an 80% decrease). CMHH, Children's Memorial Hermann Hospital; DART, days away restricted/transferred; OSHA, Occupational Safety and Health Administration; TRIR, Total Recordable Incident Rate.Conclusions/Implications: Through our safety classification and daily safety plans, we have improved the standardization of care for our behavioral health patients. These interventions have reduced variability in care among caregivers and nursing units and provided a process for providers and nursing staff members to communicate and coordinate care for these patients. Decreased variability and improved coordination of care has led to improved competency in caring for this patient population as evidenced by decreased patient and staff member harm. We learned that data collection and regular retrospective chart audits help ensure compliance and timely course correction, stakeholder buy-in is crucial for a project of this magnitude, and the project must be scoped appropriately to continue moving toward goals.

Mind the Gaps: Facilitators and Barriers to Behavioral Change Related to Infant Mortality Rate

Background and Hypothesis: Marion County suffers from stark racial disparities in infant mortality rate (IMR) with black babies experiencing an IMR of 11.6 and white babies 4.5, to culminate at a state average of 7.3. Since 2016, WeCare Indiana has worked to reduce the IMR in Central Indiana by connecting pregnant, post-partum, and childbearing age women with Community Health Workers (CHW) and community organizations that help with areas including but not limited to baby supplies, housing, and food insecurity. The goal of this research was to identify factors that promote changes in behaviors in WeCare clients as well as barriers to behavior modification in relation to the five pillars of the WeCare program: food insecurity, mental health, smoking, breastfeeding, and safe sleep.&#x0D; Experimental Design or Project Methods: Qualitative analysis of unstructured CHW follow-up notes from 2016 to 2018 of 1775 WeCare clients from mostly 13 highest risk zip codes for IM in Central Indiana was completed using keyword searches and clustering narrative entries into themes associated with the apriori areas of behavioral change.&#x0D; Results: Several key influencers of behavioral change were identified: (1) CHW dissemination of eligibility information about WIC, (2) CHW referral of clients to behavioral health resources, and (3) Pack n Play resources bundled with Safe Sleep class. Persistent barriers to positive behavioral change included: (1) lack of transportation to food resources, (2) unmanaged stress propagating substance use and smoking, (3) employment interfering with breastfeeding, and (4) lack of Safe Sleep education for all caretakers.&#x0D; Conclusion and Potential Impact: Next steps include sharing qualitative findings with CHW to reinforce positive behavioral change as well as investigating solutions for the barriers that prevent change within the five pillars of WeCare Indiana. Data from this study will be used to help interpret the calculated behavioral change scores relative to baseline measures that were found from quantitative analysis.

Parents’ interest in resources to address their child’s behavioral health through primary care.

The purpose of this study was to investigate parents' interest in additional primary care-based resources for their children's behavioral health, including parenting support. We surveyed 264 English- or Spanish-speaking parents (80% mothers) of children between the ages of 3 and 11 years as they arrived for an appointment at an urban, pediatric primary care clinic. Measures included demographics, the Pediatric Symptom Checklist (PSC-17) as a parent report of the child's behavioral health, and interest in behavioral resources (e.g., a parenting class, online videos). We used multiple regression to evaluate the predictors of resource interest. Most parents reported interest in behavioral health resources, including many parents not reporting behavioral symptoms high enough to meet criteria for a positive PSC-17. Overall, 82% of parents reported interest in at least 1 resource item; 28% reported interest in all 7 resource items. The resource item with the most interest was online videos and resources (64%). More behavioral health issues (indicated by higher PSC-17 total scores) were positively related to interest in resources; 20% screened positive for behavioral health concerns. Parental report of child behavioral health issues was related to greater interest in resources for children's behavioral health; of note, much of the interest came from parents reporting levels of behavioral health concerns that would be scored as negative on the screening tool in practice. These results provide support for efforts to increase parenting and behavioral health resources through primary care, and raise questions about how to best direct resources. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

National initiative brings health systems together to transform BH care

Addressing the challenges associated with vulnerable populations and improving behavioral health access and outcomes, while managing the financial impact, are the goals associated with the coming together of more than two dozen health systems last month in a new effort to transform this country's behavioral health resources, particularly in underserved communities.

Suicide Screening and Behavioral Health Assessment in the Emergency Department

ABSTRACT Suicide is a leading cause of death among our young patients. Healthcare providers in acute care settings like the emergency department have an opportunity to identify and intervene with those at risk in order to prevent death from suicide, future psychiatric emergencies, and the considerable morbidity that patients with unmet behavioral health needs experience. This article describes the current state of depression and suicide among young people and the strategies for implementing and improving screening in the emergency department. Finally, the article will articulate how to prepare for the challenges that emergency care providers face, as we work to reduce barriers for all patients to access behavioral health resources and receive needed care.

ACOG Committee Opinion No. 757 Summary: Screening for Perinatal Depression.

Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects. Several screening instruments have been validated for use during pregnancy and the postpartum period. The American College of Obstetricians and Gynecologists recommends that obstetrician-gynecologists and other obstetric care providers screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. It is recommended that all obstetrician-gynecologists and other obstetric care providers complete a full assessment of mood and emotional well-being (including screening for postpartum depression and anxiety with a validated instrument) during the comprehensive postpartum visit for each patient. If a patient is screened for depression and anxiety during pregnancy, additional screening should then occur during the comprehensive postpartum visit. There is evidence that screening alone can have clinical benefits, although initiation of treatment or referral to mental health care providers offers maximum benefit. Therefore, clinical staff in obstetrics and gynecology practices should be prepared to initiate medical therapy, refer patients to appropriate behavioral health resources when indicated, or both.