Mental Health Care Engagement Research Articles

237 Empowering Youth in Mental Health Treatment: A Co-Designed Approach to Measurement-Based Care

OBJECTIVES/GOALS: This integrated knowledgetranslationproject aims to increase youth engagement in mental health services through enhancing shared decision-making processes. To do this, a knowledge product to support greater involvement in measurement-based care practices will be evaluated and co-developed with youth study participants. METHODS/STUDY POPULATION: This study population includes youth (aged 12-25) with lived/living experience of accessing mental health services through an integrated service delivery model in Ontario. Study methods focus on co-designing a knowledge product with youth partners guided by the Knowledge-to-Action (KTA) Framework. The prototype knowledge product addressing identified barriers to MBC understanding, will be quantitatively evaluated by study participants. Through semi-structured focus groups, qualitative perspectives of the intervention’s impact on shared decision-making and overall engagement in treatment will be collected. The study’s design ensures active collaboration with the study population and aims to enhance MBC understanding and engagement in mental health care among youth. RESULTS/ANTICIPATED RESULTS: We anticipate increased youth involvement within MBC practices, and overall increased engagement in shared-decision making in treatment. We anticipate the developed knowledge product will enhance youth’s understanding of MBC, foster dialogue between youth and clinicians, and promote active involvement and informed decision-making in their mental health treatment. By involving youth in the co-design process, our project is poised to foster a sense of ownership and relevance, ultimately improving youth engagement, decision-making, and mental health outcomes within integrated mental health services. DISCUSSION/SIGNIFICANCE: Youth deserve to have an active role in shaping treatment decisions. This tool may bridge a gap by equipping youth with the knowledge needed to engage in decisions that are often practitioner-led. This study will discuss the impact and strategies for increasing involvement in MBC practices on youth engagement within treatment.

Impact of Primary Care-Mental Health Care Integration on Mental Health Care Engagement Across Racial and Ethnic Groups.

Receiving mental health services as part of primary care in the Veterans Health Administration (VHA) might increase engagement in specialty mental health care. The authors reexamined the association between primary care-mental health integration (PCMHI) and continued engagement in specialty mental health care for VHA patients and assessed differences by race and ethnicity. The study included 437,051 primary care patients with a first in-person specialty mental health encounter in 2015-2016 (no specialty mental health encounters in prior 12 months), including 46,417 patients with new PCMHI encounters in the year before the first specialty mental health encounter. Multivariable logistic regression assessed odds of follow-up specialty mental health care within 3 months of the first specialty mental health encounter. The dependent variable was care engagement (attending a second specialty mental health appointment); independent variables were whether patients were seen by PCMHI on the same day as the primary care appointment ("same-day access"), the time between PCMHI and first specialty mental health appointments, and race and ethnicity. PCMHI was associated with increased engagement in specialty mental health care for all patients, with a greater likelihood of engagement among non-Hispanic White patients. Same-day access to PCMHI was positively associated with care engagement, with no significant differences by race or ethnicity. PCMHI care within 3 months before a first specialty mental health encounter was associated with greater care engagement. PCMHI, especially same-day access to PCMHI care, may boost engagement in mental health care, although the study design precluded conclusions regarding causal relationships.

The Relationship Between State Level Policy, Insurance and Health Care Engagement for LGBTQ+ Foster Alumni

ABSTRACT Minority stress theory posits that external environmental factors such as state level policies around equity and inclusion of LGBTQ+ people can have a significant impact on the health and wellness of those identifying as part of the larger LGBTQ+ community, as well as on their decisions to seek needed physical or mental health care. This secondary data analysis explored the relationship between state level policies related to LGBTQ+ equity and inclusion and physical and mental health care engagement for foster care alumni. Using data from the Jim Casey Opportunity Passport Survey (n = 2,420), the research team conducted a longitudinal analysis of youth’s engagement with healthcare professional as needed physical and mental health care, using sociodemographic characteristics of the respondents and state level policies, such as Medicaid expansion and state level protections for LGBTQ+ citizens as predictors. Results indicate obtaining health insurance increased the likelihood that the youth would seek physical health care. LGBTQ+ young adults assigned female at birth had higher odds of not receiving physical health care relative to non-LGBTQ+ peers. Compared with non-LGBTQ+ youth, LGBTQ+ youth showed higher odds of not seeing mental health professionals when they needed to. Implications for practice, policy and advocacy are presented.

Engagement With Mental Health Services Among Survivors of Firearm Injury

Despite the prevalence of posttraumatic stress symptoms after firearm injury, little is known about how firearm injury survivors connect with mental health services. To determine facilitators and barriers to mental health care engagement among firearm injury survivors. A qualitative study of 1-on-1, semistructured interviews conducted within a community setting in Indianapolis, Indiana, between June 2021 and January 2022. Participants were recruited via community partners and snowball sampling. Participants who survived an intentional firearm injury, were shot within Indianapolis, were aged 13 years or older, and were English speaking were eligible. Participants were asked to discuss their lives after firearm injury, the emotional consequences of their injury, and their utilization patterns of mental health services. Data were analyzed from August 2022 to June 2023. Survivors' lived experience after firearm injury, sources of emotional support, mental health utilization, and their desired engagement with mental health care after firearm injury. A total of 18 participants (17 were Black [94%], 16 were male [89%], and 14 were aged between 13 and 24 years [77%]) who survived a firearm injury were interviewed. Survivors described family members, friends, and informal networks as their main source of emotional support. Barriers to mental health care utilization were perceived as a lack of benefit to services, distrust in practitioners, and fear of stigma. Credible messengers served as facilitators to mental health care. Survivors also described the emotional impact their shooting had on their families, particularly mothers, partners, and children. In this study of survivors of firearm injury, findings illustrated the consequences of stigma and fear when seeking mental health care, inadequate trusted resources, and the need for awareness of and access to mental health resources for family members and communities most impacted by firearm injury. Future studies should evaluate whether community capacity building, digital health delivery, and trauma-informed public health campaigns could overcome these barriers to mitigate the emotional trauma of firearm injuries to reduce health disparities and prevent future firearm violence.

Pilot outcomes of a filmmaking intervention designed to enhance treatment entry and social reintegration of veterans.

Military personnel transitioning to civilian life have reported significant challenges in reintegrating into civilian culture. Filmmaking has been used as a therapeutic intervention to enhance the community reintegration of veterans, but there are no published quantitative data documenting its impact. The present study provides outcome data on 40 veterans who participated in the I Was There (IWT) filmmaking workshop. This 3-day (20-hr) group intervention involved veterans working in small teams with a film coach, making short films designed to communicate some aspect of their experience during or after military service, and then creating a screening event to show their films to community members. The sample consisted of community-dwelling veterans who reported at least some mental health symptoms and who were not engaged in mental health treatment for those symptoms. Targeted outcomes included engagement in mental health care, symptoms of posttraumatic stress disorder (PTSD) and depression, and reported perception of community interest in their experience as veterans. Fifty-six percent of participants entered treatment within 4 months of participation. Significant decreases were noted in symptoms of PTSD at 1-month follow-up but not at the 4-month follow-up, while changes in depression were not statistically significant. Participation was related to increased perception of community interest in veterans' experience, and increased interest among community members who viewed the films. These data provide initial support for the conclusion that the IWT film workshop is a potentially effective tool for treatment engagement and for community reintegration among veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mental Health, Self-Care, and Engagement in Care among Black Women Living with HIV

Objectives Due to sociostructural factors, Black women living with human immunodeficiency virus (HIV) in the United States represent the highest percentage of women with HIV and experience mental health struggles that impact health behaviors. This study examines associations between mental health, self-care, medication adherence, engagement with healthcare, HIV-related healthcare visits, and hospitalization. Methods One hundred and nineteen Black women living with HIV in the Southeastern United States completed measures on scheduled visits (general and HIV-related healthcare), visits attended/missed/rescheduled, mental healthcare engagement (therapy and support groups), hospital visits (emergency room and overnight stays), medication adherence, and a clinician-administered interview assessing mental health. Results Higher self-care was associated with fewer emergency room visits (β=−0.31, P<.001) and hospitalizations (β=−0.22, P<.05). Higher post-traumatic stress disorder symptoms were associated with hospitalization (β=0.23, P<.05) and missed HIV-related visits (β=0.20, P<.05) but higher outpatient mental healthcare visits for group psychotherapy (β=0.20, P< .05). Higher suicidality was associated with lower HIV-related healthcare visits scheduled (β=−0.26, P<.01). Higher HIV load was associated with higher HIV-related healthcare visits scheduled (β=0.45, P<.001) and hospitalization (β=0.41, P<.001). Higher Wisepill medication adherence (β=−0.28, P<.01) and self-reported adherence (β=−0.33, P<.001) were associated with fewer HIV missed visits. Higher self-reported adherence was associated with fewer emergency room visits (β=−0.38, P<.001) and hospitalizations (β=−0.27, P<.001). Conclusions Our findings highlight the need for treating mental health symptoms and enhancing self-care among Black women living with HIV to improve engagement in care and health behaviors and decrease emergency room visits and hospitalization.

Development of a brief support and education intervention for loved ones of veterans with posttraumatic stress disorder.

Clinical practice guidelines for managing posttraumatic stress disorder (PTSD) encourage incorporating loved ones into treatment, and supportive relationships can increase engagement in mental health care for veterans with PTSD. This study describes the iterative refinement, feasibility/acceptability testing, and national dissemination of a brief support and psychoeducation intervention for loved ones of veterans with PTSD. Loved ones (n = 181; range:1-11 per group) attended and qualitatively rated "PTSD 101 for Family and Friends: A Support and Education Workshop." Open-ended questions were used to gather data on suggestions for improvement and descriptions of helpful content, and the workshop was refined following participant and operational partner feedback using a quality improvement framework. Rating quantitative items on a 1-5 scale, participants found the overall quality (M = 4.76) and relevance (M = 4.82) to be excellent, noting they learned substantial new information (M = 4.45). Sense of support (M = 4.95), intentions to use the material (M = 4.87), PTSD self-efficacy (M = 4.41), and understanding of PTSD (M = 4.76) were rated favorably. Common themes among helpful elements were a sense of shared experience and optimism and increased knowledge of treatments/resources. Suggestions for improvement referenced logistics. Following continual stakeholder feedback and refinement, the workshop represents a novel method for providing loved ones with empirically supported psychoeducation, coping skills, and community. It is being disseminated by the Family Services Section of the Veterans Health Administration Office of Mental Health and Suicide Prevention.

Disparities in eating disorder symptoms and mental healthcare engagement prior to and following the onset of the COVID-19 pandemic: Findings from a national study of US college students.

Early COVID-19 eating disorders (EDs) research used regionally restricted samples with little sociodemographic diversity. The present study aimed to address these research gaps by examining whether pandemic-related changes in ED symptoms and mental healthcare prevalence differed for historically marginalized groups within a national sample of US college students. Participants included 242,906 US college students (Mage =23.45, SD=7.04; MBMI =25.28, SD=5.91) who completed the repeated cross-sectional multi-institute Healthy Minds Study between January 2019 and May 2021. Moderated logistic regressions examined whether pandemic-related changes in individuals' likelihoods of exhibiting current probable ED, reporting lifetime ED diagnoses, and-among individuals with current probable ED-mental healthcare engagement differed for diverse gender, sexual, and racial/ethnic identity groups, and by body mass index (BMI) and financial stress. There were increases of 5% and 12% in individuals' likelihoods of exhibiting current probable ED and symptomatic individuals' mental healthcare engagement, respectively, pre- to post-COVID-19 onset, but no pandemic-related changes in lifetime ED diagnosis prevalence. There were also important variations in these time-trends for different marginalized groups. For example, individuals identifying as genderqueer/gender nonconforming and lesbian exhibited increasing ED symptoms pre- to post-COVID-19 onset, and individuals with current probable ED and higher BMIs were increasingly likely to receive mental healthcare. Associations between financial stress, and the ED and mental healthcare outcomes did not change over time. These findings provide insight into groups of US college students that experienced disproportionate ED burden during the pandemic at the population level, and directions for research and interventions that warrant consideration.

Mental health impact and mental health care among first responders following the Paris terror attacks in November 2015

Abstract Introduction During the evening of 13 November 2015, a terror attack occurred in France in the Paris area. Overall, 130 people were killed, 643 were injured and several thousands were psychologically impacted. Thousands of first responders (FRs), including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on FRs, and its associated factors 12 months after the 13 November 2015 terrorist attacks, as well as their engagement in mental health care and its associated factors. Methods FRs who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of Post Traumatic Stress Disorder (PTSD). PTSD and partial PTSD were measured using the PTSD checklist for DSM-5 (PCL-5) and depression with the hospital anxiety and depression (HAD) scale. Results Overall, 663 FRs were included in the analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers. Low educational level, social isolation, intervention on unsecured crime scenes and lack of training were associated with PTSD. Among FRs with PTSD, partial PTSD or depression, 38% sought mental health care. Mental health care engagement was associated with a history of mental health care, post-immediate support and the presence of PTSD, partial PTSD or depression. Conclusions Our results highlight that improving access to mental health care for FRs after terror attacks is needed. Efforts should be made before and after potentially traumatic events to ensure mental health education for FRs. Special attention should be given to FRs living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes.

5.O. Workshop: Psychosocial impact and healthcare utilization after terrorist attacks

Abstract Terrorist attacks can be regarded as a major public health issue, confronting not only political leaders with adequate answers to these threats, but also the public healthcare, and especially the public mental healthcare. The impact of terrorist attacks is mostly severe, widespread, affecting those directly exposed and their close ones, but also first responders, healthcare workers, local communities and even the society at large. While the directly involved are often confronted with severe physical and acute, often transient, traumatic stress symptoms, longitudinal studies increasingly show that a much larger group is affected by persistent mental health problems, such as posttraumatic stress disorders, depression, or a general undermining of their mental and physical wellbeing, sometimes seriously impairing their personal and social functioning. These problems may differ by severity of exposure and individual risk factors, but are also related to access to timely, appropriate and effective healthcare and psychosocial support. The mostly unpredictability of these threatening events, the urgency of response, and the often-chaotic circumstances are challenging factors to identify the most vulnerable people that need psychosocial care, and to organize optimal care. It also impedes the assessment of the efficiency of implemented psychosocial care. However, systematic planning and evaluating psychosocial care based on scientific evidence on the best practices is important to efficiently respond to and recover from mass casualty incidents such as terrorist attacks. Until now, scientific knowledge about the current state of utilization of healthcare by the affected population, and about the best practices taking into account specificity of certain vulnerable subgroups is still very scarce. In this workshop four speakers from different countries will present their research findings about the psychosocial impact of terrorist attacks, the way how this is addressed by society and the actual healthcare utilization of the affected people. Recommendations regarding a more adequate response are proposed. Roel Van Overmeire will talk about the long-term psychosocial care response by the Belgium government, from both the level of the policy, as well as from the perspective of victims. Lise Stene will present a register-based study of survivors'utilization of primary care and mental health services before and after the Utoya attack in Norway. Yvon Motreff will inform us about the psychological impact on first responders and their engagement in mental health care after the 2015 terrorist attacks in France. Finally, Ulrich Wesemann will further focus on mental healthcare provided to emergency responders after the Berlin terrorist attack in 2016 in Germany, and will specifically examine the outcome of crisis intervention in relation to gender and occupational characteristics. Key messages • Public mental health impact of terrorist attacks is substantial and needs an adequate and differentiated psychosocial care response. • Research on healthcare utilization after terrorist attacks is needed to strengthen public health preparedness.

2.111 Suicidal Ideation, Attempts, and Self-Harm Among Children and Adolescents Admitted to a New York City Psychiatric Unit Before and During the COVID-19 Era

Child and adolescent mental health has been drastically impacted by the COVID-19 pandemic, leading to higher rates of engagement in mental health care. We hypothesized that suicidal ideation (SI) and suicide attempts (SAs) would increase in the COVID-19 era due to social isolation and difficulties with online schooling.

Understanding Mental Health Needs and Gathering Feedback on Transcutaneous Auricular Vagus Nerve Stimulation as a Potential PTSD Treatment among 9/11 Responders Living with PTSD Symptoms 20 Years Later: A Qualitative Approach.

Posttraumatic stress disorder (PTSD) remains one of the most prevalent diagnoses of World Trade Center (WTC) 9/11 responders. Transcutaneous auricular vagus nerve stimulation (taVNS) is a potential treatment for PTSD, as it can downregulate activity in the brain, which is known to be related to stress responses and hyperarousal. To understand barriers and facilitators to engagement in mental health care and the feasibility and acceptability of using the taVNS device as a treatment for PTSD symptoms, a focus group was conducted among patients from the Queens WTC Health Program who had elevated symptoms of PTSD. The focus group discussion was recorded, transcribed, and analyzed. Three themes and subthemes emerged: (1) the continued prevalence of mental health difficulties and systematic challenges to accessing care; (2) positive reception toward the taVNS device as a potential treatment option, including a discussion of how to increase usability; and (3) feedback on increasing the feasibility and acceptance of the research methodology associated with testing the device in a pilot clinical trial. The findings highlight the need for additional treatment options to reduce PTSD symptoms in this population and provide key formative phase input for the pilot clinical trial of taVNS.

Pediatric Mental Health Emergency Department Visits and Access to Inpatient Care: A Crisis Worsened by the COVID-19 Pandemic.

Pediatric Mental Health Emergency Department Visits and Access to Inpatient Care: A Crisis Worsened by the COVID-19 Pandemic.

Perspectives of Black Immigrant Women on Mental Health: The Role of Stigma.

Background:Black immigrants are a major growing segment of the United States population. The intersection of race, gender, and migration places black immigrant women at the confluence of multiple social determinants of health, and thus, black immigrant women experience ongoing mental health disparities. Understanding their perspectives, mental health needs, and associated stigma is critical to promoting positive mental health outcomes.Methods:We conducted five focus groups (N = 22) among women from two black immigrant community organizations from February 2019 to June 2019. We used an inductive driven thematic analysis to identify codes and themes related to mental health and the role of stigma.Results:Overall five core themes associated with mental health and associated stigma concepts were found: The critical role of trusted sources and confidentiality, Conceptualization of mental illness and anticipated discrimination, Acculturative influence and migration as a source of emotional distress, Spirituality as a source of support and source of stigma, and Management of mental illness and addressing stigma.Conclusion:The conceptualization of mental illness and the associated stigma may be rooted in cultural and religious belief systems among black immigrants. Cultural beliefs and biopsychosocial models can coexist positively without interrupting the pathway toward optimized engagement in mental health care. Our mental health systems need to take these factors into consideration to implement programs that effectively serve black immigrant women's mental health needs.

Lessons learned from designing an asynchronous remote community approach for behavioral activation intervention for teens

Adolescent depression is common; however, over 60% of depressed adolescents do not receive mental health care. Digitally-delivered evidence-based psychosocial interventions (EBPIs) may provide an opportunity to improve access and engagement in mental health care. We present a case study that reviews lessons learned from using the Discover - Design - Build - Test (DDBT) model to create, develop, and evaluate a high-fidelity prototype of an app to deliver an EBPI for depression, behavioral activation (BA), on an Asynchronous Remote Communities (ARC) platform (referred to as ActivaTeen). We review work at each stage of the DDBT framework, including initial formative work, iterative design and development work, and an initial feasibility study. We engaged teens with depression, mental health clinicians, and expert evaluators through the process. We found that the DDBT model supported the research team in understanding the requirements for our prototype system, ActivaTeen, and conceiving of and developing specific ideas for implementation. Our work contributes a case study of how the DDBT framework can be applied to adapting an EBPI to a new, scalable and digital format. We provide lessons learned from engaging teens and clinicians with an asynchronous approach to EBPIs and human centered design considerations for teen mental health.

Near-Fatal Self-Harm Among Canadian Adolescents.

ObjectiveTo evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm.Methods2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases.ResultsNinety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ2 = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ2 = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ2 = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ2 = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ2 = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm.ConclusionsAmong Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.

Mental health care utilization by first responders after Paris attacks.

BackgroundFirst responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC).AimsThis study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris.MethodsA web-based study was conducted 8–12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC.ResultsOverall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression.ConclusionsAmong FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.

Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece

BackgroundA subset of adolescents with mental disorders are likely to have decision-making capacity that facilitates their therapy engagement. However, there are high rates of drop-out in mental health settings.AimThis study aims to identify perceived barriers to or facilitators of mental health care engagement among adolescents with decision-making competence in Greece.MethodsA qualitative study was conducted using semi-structured interviews of adolescents with a wide range of mental health problems. In addition, two psychometric assessment measures were used to define who to include or exclude from the study sample.ResultsPositive attitudes and experiences with therapy were reported as strong (“major”) facilitators of therapy engagement for adolescents with mental disorders, whereas negative experiences with therapy were reported as strong barriers to it. Furthermore, and most importantly, a “good” adolescent-therapist relationship was reported as a strong facilitator, whereas negative experiences of participants with their therapist were reported as strong barriers. Moreover, goals such as getting rid of symptoms, improving personal well-being, and improving social skills and relationships (especially with peers) emerged as strong facilitators of therapy engagement. Importantly, the early remission of symptoms emerged from the study as a strong barrier to therapy engagement for participants. Among the weaker (“minor”) perceived facilitators were goals such as confessing to a trustworthy person, becoming able to achieve personal expectations and life goals, enhancing independence and self-esteem, and developing a positive self-image. The (active or supportive) role of family emerged as a facilitator. The stigma related to mental health emerged as both a (“minor”) facilitator of and barrier to therapy engagement for participants. Friends were reported as having a role ranging from neutral to mildly supportive.ConclusionA number of more or less strong barriers and facilitators were identified that, for the most part, were consistent with prior literature. However, the authors identified some nuances that are of clinical importance. For instance, adolescents are most likely to terminate the treatment prematurely if they experience early symptom remission. Highlighting the role of therapy in achieving their goals or improving their families’ well-being might be used by therapists to reduce the attrition rate.

Assessing the Amenability of Rural MSM to Using Telemedicine for Medical and Mental Healthcare

Rural men who have sex with men (MSM) experience numerous barriers to healthcare, including stigma, which impedes medical and mental healthcare engagement. Given this, rural MSM are less likely to be engaged in routine healthcare compared to their urban counterparts. Telemedicine has been advocated for to address these disparities in care access; however, no known studies have explored the amenability of telemedicine for both medical and mental healthcare among rural MSM. In-depth interviews were conducted with a sample of MSM (n = 23) residing in rural Oklahoma and Arkansas. Respondents described a willingness to use telemedicine to engage with medical and mental health providers as it presented a mechanism to overcome identified barriers to care. Removing barriers, notably lack of access to knowledgeable and affirming providers, is one potential method for increasing engagement in routine care which provides opportunities for rural MSM to engage in primary and secondary prevention services.

Improving Suicide Risk Detection and Clinical Follow-up after Discharge from Nursing Homes

ABSTRACT Objectives: Suicide Awareness for Veterans Exiting Community Living Centers (SAVE-CLC) is a brief intervention to standardize suicide-risk screening and clinical follow-up after VA nursing home discharge. This paper examines the outcomes of SAVE-CLC compared to care as usual. Methods: A quasi-experimental evaluation was conducted (N = 124) with SAVE-CLC patients (n = 62) matched 1:1 to a pre-implementation comparison group. Data were obtained through VA Corporate Data Warehouse resources and chart reviews. Outcomes examined (within 30/90 days of discharge) included mortality rates, frequency of outpatient mental health visits, emergency department visits, rehospitalizations, depression screens (PHQ-2), and the latency period for outpatient mental health care. Results: A greater portion of SAVE-CLC patients received a depression screen after discharge, n = 42, 67.7% versus n = 8, 12.9%, OR = 14.2 (5.7, 35.3), p < .001. The number of days between discharge and first mental health visit was also substantially shorter for SAVE-CLC patients, M = 8.9, SD = 8.2 versus M = 17.6, SD = 9.1; t = 2.47 (122), p = .02. Significant differences were not observed in emergency department visits, hospitalizations, or mortality. Conclusions: SAVE-CLC is a time-limited intervention for detecting risk and speeding engagement in mental health care in the immediate high-risk post-discharge period. Clinical Implications: Care transitions present an important opportunity for addressing older adults’ suicide risk; brief telephone-based interventions like SAVE-CLC may provide needed support to individuals returning home.