Behavioral Health Team Research Articles

The Who, What, and How of Interagency Criminal Justice–Behavioral Health Teams: Developing and Sustaining Collaborations

Interagency teams are considered an evidence-based change practice, but there is a paucity of research examining them in criminal justice (CJ) and behavioral health (BH) reform contexts. This study draws on qualitative interviews ( n = 52) and survey data ( n = 791) from BH and CJ leaders across the United States to examine who is on them, what they do, and effective strategies for building and sustaining them. Findings indicated that CJ–BH interagency teams often incorporate agencies from a range of CJ, BH, social service, and health agencies. Teamwork focused on connecting clients to resources or contributing to CJ–BH coalitions and resource centers. Although the team-building strategies learning about/from other agencies and system integration were significantly associated with developing more collaborations, consensus-building activities were not. These findings suggest that interagency teams need not necessarily reach consensus on goals and vision prior to working together, as this can be built through collaboration.

Occupational Therapy: A Potential Solution to the Behavioral Health Workforce Shortage.

Occupational therapy practitioners (OTPs) are clinically prepared to treat patients with behavioral health conditions. Yet, many state and national policies defining qualified behavioral health providers do not include occupational therapy. In this Open Forum, the authors argue that OTPs should be considered qualified to work as behavioral health professionals, especially given the severe behavioral health workforce shortage in the United States. The authors summarize policy barriers preventing OTPs from working on behavioral health teams and the evidence to support their presence. They also propose a policy and advocacy agenda to include and recognize OTPs as members of the behavioral health workforce.

Sickle Cell Disease and Comorbid Psychiatric Conditions: A Single-Center Retrospective Study

Introduction: It is established that patients with various chronic disease states are predisposed to psychiatric comorbidities. However, in the sickle cell disease (SCD) patient population, psychiatric comorbidities have been uniquely shown to exacerbate disease through a psychosomatic component. A co-existing diagnosis of depression is found in 1 of 3 patients with SCD, and they are more than 5 times as likely to suffer from a mood disorder than the general population. SCD patients with psychiatric illnesses have significantly worse physical and mental health outcomes. Additionally, healthcare costs are more than double for SCD patients with depression than for those without. Thus, SCD patients with psychiatric comorbidities have unique challenges and are an important population to study. Methods: This was a retrospective single-center study of patients with SCD, all genotyped and ≥16 years old, who were treated at UT Physicians Comprehensive Sickle Cell Center during the study period (March-July 2023). The demographics, clinical characteristics, psychiatry history, initial and recent PHQ-9 results, and laboratory findings were collected and analyzed. Descriptive statistics were obtained and analyzed between SCD patients with and without psychiatric disorders and are presented in percentages, medians, and interquartile ranges. Data analysis was completed using a p value < 0.05 to indicate statistical significance, using an independent group unpaired t-test for continuous variables and Chi-square and Fisher's exact tests for categorical data, respectively. Data was analyzed using GraphPad Prism version 9.0.2. Results: Patient sex was 45% male and 55% female; 73% of patients had the HbSS genotype. Of the studied cohort, 33% were affected by at least one psychiatric disorder. The most common psychiatric disorder was depression, which occurred in 26% of patients, followed by anxiety (21%). The most common pharmacotherapy for psychiatric conditions was tricyclic antidepressants (TCAs), followed by SSRIs and SNRIs. There was no significant difference in ED visits or hospitalization rates between patients with known psychiatric disorders versus those without. Common laboratory markers used to assess SCD (LDH, total bilirubin, reticulocyte count) were overall higher in the subset with psychiatric illnesses, but only LDH was statistically significantly higher. Surprisingly, SCD patients with psychiatric disorders used fewer opioids than those without with a lower Morphine Equivalent Daily Dose (although this was not statistically significant). Conclusion: Although it is known that psychiatric illnesses in SCD patients are prevalent, exacerbate disease, and pose a cost burden, in our study there was nosignificant increase in hospitalizations or ED visits. However, it is notable that our study patient population was an outpatient population that is compliant and generally has access to resources including a robust behavioral health team and regular psychotherapy sessions. Due to these factors, ourdata may not be generalizable to the entire SCD patient population. Additionally, althoughlaboratorymarkers were overall poorer in the psychiatric population, they were not statistically significant, perhaps owing to the small sample size. Our study calls for a broader look at SCD patients with psychiatric illness, perhaps also to review these variables in SCD patients in the inpatient setting. A future direction could also be to evaluate the efficacy of psychiatric pharmacotherapy versus cognitive behavioral therapy in this patient population. Word count: 518 words

Nurse perceptions of caring for pediatric patients with behavioral health needs on non-psychiatric units during the COVID-19 pandemic

PurposeThe study examined nurses' perceptions of barriers and needs when caring for pediatric patients with behavioral health needs in inpatient non-psychiatric units during the pandemic. Design and methodsA quantitative descriptive comparative design was used. Members of Society of Pediatric Nurses and National Pediatric Nurse Scientist Collaborative were recruited. The survey included questions about perceived barriers and needs in caring for children with behavioral health needs in their units. ResultsA total of 335 nurses across the United States participated. Descriptive statistics, chi-square, and Kruskal-Wallis evaluated responses. Nurses in Southeast/Southwest regions were less fearful when caring for pediatric patients with behavioral health needs (p = .03), more often knew what to do (p = .01), and were supported by a behavioral health team with regular rounding (p = .035). Nurses in adult/pediatric hospitals were less likely to have adequate education to feel competent (p = .012). Nurses in the emergency department were less fearful (p = .02), more confident (p = .025), and more competent (p = .006). Nurses with up to two years of experience were likelier to feel assignments reflected the patient workload (p = .001) and more familiar with trauma-informed care protocols (p = .013). ConclusionsThis study illustrated significant variations in competence, readiness, and attitudes among nurses across different regions, hospital types, departments, and experience levels when caring for pediatric patients with behavioral health needs. Practice implicationsResults from this study could lead to the development of clinical practice guidelines, protocols, or policies to guide practice.

Comprehensive Telehealth Model to Support Diabetes Self-Management

As the number of patients with diabetes continues to increase in the United States, novel approaches to clinical care access should be considered to meet the care needs for this population, including support for diabetes-related technology. To evaluate a virtual clinic to facilitate comprehensive diabetes care, support continuous glucose monitoring (CGM) integration into diabetes self-management, and provide behavioral health support for diabetes-related issues. This cohort study was a prospective, single-arm, remote study involving adult participants with type 1 or type 2 diabetes who were referred through community resources. The study was conducted virtually from August 24, 2020, to May 26, 2022; analysis was conducted at the clinical coordinating center. Training and education led by a Certified Diabetes Care and Education Specialist for CGM use through a virtual endocrinology clinic structure, which included endocrinologists and behavioral health team members. Main outcomes included CGM-measured mean glucose level, coefficient of variation, and time in range (TIR) of 70 to 180 mg/dL, time with values greater than 180 mg/dL or 250 mg/dL, and time with values less than 70 mg/dL or 54 mg/dL. Hemoglobin A1c was measured at baseline and at 12 and 24 weeks. Among the 234 participants, 160 had type 1 diabetes and 74 had type 2 diabetes. The mean (SD) age was 47 (14) years, 123 (53%) were female, and median diabetes duration was 20 years. Median (IQR) CGM use over 6 months was 96% (91%-98%) for participants with type 1 diabetes and 94% (85%-97%) for those with type 2 diabetes. Mean (SD) hemoglobin A1c (HbA1c) in those with type 1 diabetes decreased from 7.8% (1.6%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (1.0%) at 6 months (mean change from baseline to 6 months, -0.6%, 95% CI, -0.8% to -0.5%; P < .001), with an 11% mean TIR increase over 6 months (95% CI, 9% to 14%; P < .001). Mean HbA1c in participants with type 2 diabetes decreased from 8.1% (1.7%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (0.9%) at 6 months (mean change from baseline to 6 months, -1.0%; 95% CI, -1.4% to -0.7%; P < .001), with an 18% TIR increase over 6 months (95% CI, 13% to 24%; P < .001). In participants with type 1 diabetes, mean percentage of time with values less than 70 mg/dL and less than 54 mg/dL decreased over 6 months by 0.8% (95% CI, -1.2% to -0.4%; P = .001) and by 0.3% (95% CI, -0.5% to -0.2%, P < .001), respectively. In the type 2 diabetes group, hypoglycemia was rare (mean [SD] percentage of time <70 mg/dL, 0.5% [0.6%]; and <54 mg/dL, 0.07% [0.14%], over 6 months). Results from this cohort study demonstrated clinical benefits associated with implementation of a comprehensive care model that included diabetes education. This model of care has potential to reach a large portion of patients with diabetes, facilitate diabetes technology adoption, and improve glucose control.

Collaborative Mental Health Care in Collegiate Athletics: Behavioral Health Providers' Perceived Role of the Athletic Trainer.

Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT's role on interprofessional behavioral health teams is limited. To explore behavioral health providers' perceived role of ATs in collaborative behavioral health care. Qualitative study. Individual interviews. Nine behavioral health care providers (women = 6, men = 3; age range = 30-59 years, years in clinical practice = 6-25) from National Collegiate Athletic Association Power 5 schools were interviewed. Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes. Collaborative care models can enhance providers' abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.

Addressing Adolescent Suicidality in Pediatric Primary Care.

This study examines prevalence rates of reported suicidal ideation (SI) in 2107 adolescents, characterizes recommendations and interventions given by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to SI on the Patient Health Questionnaire 9-Item Modified for Adolescents (PHQ-9A) for 140 adolescents, and identifies factors associated with a decrease in the frequency of SI at follow-up visits for 85 adolescents. A retrospective mixed-method approach was taken. Clinical informatics was used to extract visit data, demographics, and PHQ-9A scores for all visits between January 3, 2017, and August 31, 2018. Conventional content analysis of electronic medical records was used to examine qualitative results, and qualitative codes were then analyzed using point-biserial correlations. The setting includes a fully integrated behavioral health team within the primary care clinic. Of the 2107 adolescents, 140 (7%) endorsed SI within the past 2 weeks. Content analysis yielded 40 actions (17 PCP codes and 23 BHC codes) used in response to SI. Significant correlations were found between decreased SI frequency and the PCP referring to integrated behavioral health ( r = 0.24) and family navigators ( r = 0.26) and BHCs conducting a risk assessment ( r = 0.24), completing a safety plan ( r = 0.21), involving caregivers ( r = 0.29), sending the adolescent to the emergency department ( r = 0.28), and referring to family navigators ( r = 0.21; all p values < 0.05). The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.

Perceived Educational Needs of Substance Use Peer Support Specialists: A Qualitative Study.

The opioid crisis is an ever-growing issue nationwide. The role of peer support specialists has received widespread acceptance in the substance use and behavioral health spheres. However, there is a lack of standardization on the training required for peer support specialists to function as competent members of integrated behavioral health teams. We conducted qualitative focus groups with 14 practicing certified peer support specialists to determine their perceived educational needs. Inductive thematic analysis was used to analyze the data and six themes emerged: mental health and suicide prevention training, diversity, equity, and inclusion training, counseling skills training, family systems approach to care training, professionalism training, and taking care of self - mind, soul, and body training. To improve peer support specialists' confidence in their ability to competently perform their jobs, important topics need to be incorporated into their educational training and preparation.

Pediatric Trauma and Posttraumatic Symptom Screening at Well-child Visits.

Our interdisciplinary behavioral and medical health team implemented 3 plan-do-study-act cycles to improve screening and response to pediatric traumatic experiences. Automated reports and chart reviews measured progress toward goals as we changed screening methods and provider training. During plan-do-study-act cycle 1, a chart review of patients with positive trauma screenings identified various trauma types. During cycle 2, a comparison of screening methods demonstrated that written screening identified trauma among more children than verbal screening (8.3% versus 1.7%). During cycle 3, practices completed trauma screenings at 25,287 (89.8%) well-child visits. Among screenings, 2,441 (9.7%) identified trauma. The abbreviated Post Traumatic Stress Disorder Reaction Index was conducted at 907 (37.2%) encounters and identified 520 children (57.3%) with PTSD symptoms. Among a sample of 250, 26.4% were referred to behavioral health, 43.2% were already connected, and 30.4% had no connection. It is feasible to screen and respond to trauma during well-child visits. Screening method and training implementation changes can improve screening and response to pediatric trauma and PTSD. Further work is needed to increase rates of PTSD symptomology screening and connection to behavioral health.

Collaborative approach to harm reduction by managed care pharmacy team for populations with substance use disorder

BackgroundOregon has one of the highest rates of substance use and substance use disorders (SUDs) in the nation. To improve access to SUD treatment in Oregon, CareOregon clinical pharmacists in collaboration with the behavioral health team have implemented these best practices to support members with SUD. ObjectiveThe primary objective of this article is to describe the various harm reduction programs and interventions implemented by managed care clinical pharmacists at CareOregon to prevent overdose and ensure improved health outcomes for populations with SUD. Practice descriptionThe CareOregon team of managed care clinical pharmacists acts as a liaison with provider networks by providing pharmacy benefit knowledge and implementing several interventions and best practices to improve health outcomes for populations with SUD. Practice innovationThe managed care clinical pharmacist team implemented a medication education (MEDS Ed) program to provide educational support to the CareOregon provider network on harm reduction, supported medication for opioid use disorder (MOUD) program initiatives to increase buprenorphine prescribing, and used programs to increase naloxone access for populations at high risk of overdose. Evaluation methodsA mixed-method approach was applied to evaluate the impact of the practice innovations implemented. A qualitative self-assessment questionnaire was used to evaluate the impact of the harm reduction MEDS Ed. Quantitative data accessed via CareOregon’s claims data were used to evaluate the effect of initiatives to expand naloxone access and increase buprenorphine prescribing. ResultsThe CareOregon provider network reported an increase in knowledge about harm reduction by attending the MEDS Ed training. From the first quarter of 2019 to the second quarter of 2022, the number of naloxone prescriptions filled increased by 346%. From the third quarter of 2017 to the first quarter of 2022, the number of Drug Addiction Treatment Act–waivered providers prescribing buprenorphine increased by 331%. As a result, the number of prescriptions for MOUD doubled during this period. ConclusionThe harm reduction interventions implemented by the managed care clinical pharmacist team at CareOregon were successful in improving knowledge on harm reduction and increasing naloxone access and buprenorphine prescribing for populations at risk of opioid use disorder.

Health professionals’ attitudes on integrated care and social work practice

ABSTRACT Research regarding the intersection of social work and integrated care has recently increased. Although research specific to the role and engagement of social workers in integrated care is promising, research regarding attitudes toward social workers on integrated behavioral health (IBH) teams remains scant. This study provides perspective regarding healthcare professionals’ attitudes toward the role of social workers on IBH teams. A survey was constructed and distributed to health professionals (n = 104) from medicine, nursing, pharmacy, and social work. Mixed methods were used to evaluate survey findings. Results suggest attitudes toward social workers on IBH teams are generally favorable.

ATA2022 Annual Conference &amp; Expo May 1–3, 2022Boston, Massachusetts

ATA2022 Annual Conference &amp; Expo May 1–3, 2022Boston, Massachusetts

756 Self-Inflicted Frostbite with Dry Ice: A Case Report

IntroductionFrostbite (FB) is a severe form of cold injury that may result in significant morbidity. Freezing causes formation of ice crystals and protein denaturation leading to cellular damage and tissue necrosis. Although commonly affecting populations who live and work or become stranded in cold environments, the true prevalence is unknown due to lack of standardized reporting. Dry ice is a solid form of carbon dioxide commonly found in the food industry, that can reach temperatures as cold as -110 degrees Fahrenheit and can be purchased at local department stores. Exposure to dry ice is an unusual cause of FB injury that could occur anywhere, especially in warmer climates. Healthcare professionals practicing in warmer climates may be unprepared to assess and treat patients with such injuries.MethodsWe describe a case of self-inflicted FB injury to the bilateral lower extremities (BLE) following intentional submersion in dry ice who presented to a Southern U.S. Burn Unit.ResultsA 20-year-old man with self-diagnosed Body Integrity Identity Disorder (BIID) sustained a 12% TBSA FB injury to his BLE following intentional submersion in dry ice for an estimated 4 hours (Figure 1). He presented to the Burn Center from an outside facility approximately 12 hours post injury with initial rewarming having already occurred. He immediately underwent catheter directed intra-arterial thrombolysis with tissue plasminogen activator (TPA) for leg length preservation. TPA infusion was initiated at 16 hours post-injury for a total infusion time of 24 hours. Wound care consisted of gentle twice daily cleansing with silver sulfadiazine and mafenide acetate creams. The patient ultimately required bilateral below the knee amputations which successfully healed with minimal autografting to the distal limbs. He was formally diagnosed with schizophrenia by our behavioral health team and initiated on risperidone. He underwent aggressive physical therapy and was discharged home with his parents after 21 days. He underwent weekly mental health follow up appointments and has been seen regularly in our burn and rehabilitation clinic.ConclusionsThis unusual case is one of few to describe Grade 4 FB after exposure to dry ice and highlights that severe FB may occur in any climate and can cause severe morbidity. Severe cold injury management is important for burn care professionals to maximize tissue and limb preservation.

Supporting school‐community collaboration for the implementation of a multi‐tiered school mental health program: The Behavioral Health Team model

AbstractInvesting in school mental health programs has the potential to improve youths' access to mental health services. Barriers to the implementation of school mental health programs include limited workforce capacity, competing priorities, and lack of coordinated care. The current paper describes the history, development, and key components of the Behavioral Health Team (BHT) model that was established to promote implementation of school mental health programming. The BHT is a multi‐disciplinary team designed to maximize resources and collaboration, provide early identification of students with behavioral health needs, and match and connect students to the indicated interventions using data‐informed decision making. BHTs are tasked with selecting appropriate interventions, assuring fidelity of implementation, monitoring student progress and making adjustments based on data to enhance the sustainability and dissemination of evidence‐based prevention and intervention in schools. The paper reviews two case examples to illustrate how this model has been applied both within a large urban school district and a medium‐sized suburban school district. Results demonstrate that district support facilitates sustainability and expansion of the BHT model over time. Schools implementing this model demonstrate improvement in implementation of the BHT key components.

Multidisciplinary Approach to Deprescribing Sedative-Hypnotic Medications in Geriatric Primary Care.

Introduction/Objectives:Due to the risks associated with sedative hypnotic medications in older adults, our study evaluated the impact of a multidisciplinary approach to deprescribing in geriatric primary care clinics.Methods:The study was a retrospective review of older adults at 2 academic, geriatric primary care clinics who were prescribed sedative-hypnotic medications. Patients were mailed an education packet of information that included working with the clinical pharmacy team, behavioral health team, or both in order to deprescribe their sedative-hypnotic medication. The study assessed the rate of discontinuation of sedative-hypnotic medications between the different intervention groups.Results:The study included 93 older adults with a mean age of 81.3 years and 39.8% discontinuation rate of their medication. The number of falls decreased in patients who discontinued use compared to when previously using a sedative hypnotic medication.Conclusion:Patients are more likely to discontinue their sedative hypnotic medication with a multidisciplinary approach, specifically with primary care provider support.

Prevention of psychological trauma among health care providers during the COVID-19 pandemic.

The COVID-19 pandemic presented unique biological, psychological, and social threats to health care providers. The failure of local macrosystems placed providers at elevated risk of psychological and physical harm. To reduce the immediate risk of trauma to our local physician workforce, our team initiated a program of proactive psychological first aid in which physicians were regularly contacted by behavioral health colleagues to assess safety conditions and physician's well-being. When threats to the physician's safety were identified, these concerns were escalated to leadership and addressed when possible. When threats to well-being were identified, behavioral health team members provided supportive listening, and, if indicated, provided referral information for appropriate treatment resources. This paper reviews the rationale for this program, addresses ethical concerns, and proposes future directions for responding to threats to safety during events such as the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Three case studies of community behavioral health support from the US Department of Veterans Affairs after disasters

BackgroundCommunity disaster resilience is comprised of a multitude of factors, including the capacity of citizens to psychologically recover. There is growing recognition of the need for public health departments to prioritize a communitywide mental health response strategy to facilitate access to behavioral health services and reduce potential psychological impacts. Due to the US Department of Veterans Affairs’ (VA) extensive experience providing trauma-informed behavioral healthcare to its Veterans, and the fact that VA Medical Centers (VAMCs) are located throughout the United States, the VA is well situated to be a key partner in local communities’ response plans. In this study we examined the role the VA can play in a community’s behavioral health response using case studies from three disasters.MethodsThis study investigated experiences of VA employees in critical emergency response positions (N = 17) in communities where disasters occurred between 2017 and 2019. All respondents were interviewed March–July 2019. Data were collected via semi-structured interviews exploring participants’ experiences and knowledge about VA activities provided to communities following the regional disasters. Data were analyzed using thematic and grounded theory coding methods.ResultsRespondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans. The majority also described the VA supporting community recovery. Specifically, three recent events provided key examples of VA’s involvement in disaster behavioral health response. Each event showed VA’s integration into local response structures was facilitated by pre-existing emergency management and clinical relationships as well as prioritization from VA leadership to engage in humanitarian missions. The behavioral health interventions were provided by behavioral health teams integrated into disaster assistance centers and non-VA hospitals, VA mobile units deployed into the community, and VA telehealth services.ConclusionsRecent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond to mental health needs, thereby fostering resilience. Building relationships with local VAMCs can help expedite how VA can be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated disaster mental health response would benefit from involving VA as a partner during planning.

Integrating Behavioral Health Care into an Urban Hospital-Based Pediatric Primary Care Setting.

Integration of behavioral health into pediatric primary care clinics is a recommended practice with potential to address the mental health needs of underserved children. We describe our process of integrating a behavioral health team into our hospital-based pediatric practice that serves a low-income, ethnically diverse, and underserved population of children and youth in the southeastern U.S. We provide a summary of our four-year program evaluation of feasibility and acceptability of embedding a behavioral health team in our practice. We also discuss the challenges faced, including staff turnover and difficulty with billing for sustainability. Finally, we provide recommendations for pediatric clinics that seek to integrate behavioral health care into their practices.

Depression, Anxiety and Pain Medication Utilization in Adult Patients with Sickle Cell Disease

Abstract Introduction:Sickle cell disease (SCD) is a debilitating chronic genetic disorder that affects approximately 100,000 people in the United States and millions of people worldwide. Chronically ill patients are at risk of developing psychological disorders such as depression or anxiety that can lead to deteriorating function and increased pain medication utilization. Prior studies have revealed that patients with SCD who have depression or anxiety also have poorer pain control and a decreased quality of life. The purpose of this study was to examine the prevalence of depression and anxiety in a cohort of patients at a sickle cell center located in a metropolitan city. Moreover, we investigated the association between depression, anxiety and utilization of pain medication or healthcare. Methods:We conducted an analytic cross-sectional study on SCD patients to determine the prevalence of depression. Descriptive analysis was performed with frequency distributions. Univariate logistic regression was conducted to investigate the relationship between depression and anxiety and pain medication utilization and psychiatric referral. Results:87 patients who completed questionnaires and have available information from electronic medical record were included in the analysis. Overall 35.6% of patients (N=31) from our cohort had a diagnosis of depression and 23% (N=20) were diagnosed with anxiety. 64.5% of depressed patients (N=20) reported taking at least 1 psychotropic agent. 100% of SCD patients with depression or anxiety used opioid pain medication. Number of pain crisis among SCD patients with depression was significantly different from that among SCD patients with no depression (Odds Ratio 3.043, 95% CI: 1.303-7.110). Healthcare utilization was also found to be positively associated with patients with a diagnosis of depression. Patients with depression were almost 16 times more likely to have psychiatric health care utilization than patients without depression (Odds Ratio 15.597, 95% CI: 5.028-48.387). However, the number of hospital admissions for pain crisis among patients with depression was not statistically different from those without depression (Odds Ratio 1.714, 95% CI: 0.752-3.909). Conclusion:Overall 40% of adult patients with SCD from our cohort had depression and/or anxiety. All of these patients (100%) were on chronic opioid medications. The presence of depression among SCD patients was significantly related to more pain crises and psychiatry health care utilization. We recommend that sickle cell clinics and sickle cell centers should provide necessary resources, so that behavioral health teams will be readily available on-site to serve this chronically ill population of patients. This would likely lead to better pain management and less utilization of health care resources. Disclosures Idowu: Cyclerion Therapeutics, Inc:Research Funding;Novartis:Membership on an entity's Board of Directors or advisory committees, Research Funding;Pfizer:Research Funding;Global Blood Therapeutics:Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

Development of a Care Plan for a Pregnant Woman With Severe Mental Illness

The purpose of the case study is to demonstrate the complexity of care for a pregnant woman with a severe mental illness under civil commitment and requiring hospitalization for her entire pregnancy. A 32-year-old, gravida 1 para 0 woman admitted to the adult behavioral unit at 8 weeks gestation for bipolar type schizoaffective disorder and intellectual disability presented with concerns of worsening psychosis and impulsivity as well as medical comorbidities. While under civil commitment for mental health, she received optimal care from a collaborative intraprofessional team who met routinely to review her progress and ensure patient and care provider safety. Her collaborative care included nursing, behavioral management, environment of care, pharmacology, obstetric and medical management, patient rights, legal issues, and safety of the newborn. Her obstetric and nursing care needs were provided on the adult behavioral unit to ensure optimal mental health support and safety. On transfer to the labor and delivery unit and for the duration of her postpartum stay, the behavioral health team supported her care with a constant presence of familiar team members. Nursing supported the birth process and postpartum care as well as breastfeeding support with the late-preterm infant. The patient’s legally appointed guardian was included in team huddles and offered advice for providing a supportive environment for this patient. Social workers from Behavioral Health and Birthplace were integral to the exploration of community resources for the patient’s potential parenting skills and discharge. Successful outcomes included vaginal birth, no behavioral emergencies, and a safe transition of care to the community for mother and baby. A detailed intraprofessional plan of care provides a shared mental model for all care team members. Plans for staffing, communication, and de-escalation strategies; prenatal and parenting education; documentation of behaviors; and care team safety provide a therapeutic environment of care with the central focus on the patient and her newborn. Nursing is a key discipline for care coordination.