Need For Health Services Research Articles

Health care needs and barriers to care among the transgender population: a study from western Rajasthan

BackgroundTransgender people comprise an estimated 0.3–0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. Methodology: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. Results: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual’s health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. Conclusion: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Cascade of care for substance use and mental health disorders for justice-involved populations

IntroductionJustice-involved populations have dramatically higher rates of substance use disorders (SUD) and mental health disorders (MHD) compared to the general population. Despite high rates of SUD and MHD, treatment for this population is often limited and not evidence-based. The cascade of care model estimates drop-offs in the continuum of care from screening to identification of need, referral, care initiation, care engagement, and care completion. Recently, healthcare providers have utilized the cascade of care to improve the continuity of care for people with SUD and MHD in justice settings. The purpose of the current study is to 1) identify typologies that explain the proportion of new intakes that pass through each level of the cascade of care for SUD and MHD, and 2) describe agency-level factors that predict typology assignments and agency ability to assess client flow through the levels of the care cascade. MethodUsing Latent Class Analysis, we classify 791 agencies serving justice-involved individuals into typologies according to utilization of each stage in the mental health and substance cascades of care. Then, we examined county and agency characteristics that affect three stages of the cascade process: identification of need for behavioral health services, referrals to appropriate services, and treatment initiation. We build on previous work by exploring these patterns for both SUD and MHD treatment. ResultsThe study identified four SUD/MHD treatment patterns: Low Access, SUD-Focused, High Need-High Access, and Lower Need-High Access classes. Factors influencing typology alignment include location, specialized staff availability, warm hand-off coordination, Medicaid reimbursement, and performance measure tracking. Thirty-nine percent (39 %) of agencies could not be classified because they were unable to report their rate of care along the cascade measures. ConclusionFocusing on factors influencing typology assignment can help counties in assessing service delivery, identifying barriers, and targeting areas for improvements in policies and practices, potentially facilitating long-term changes and overall improvement in the care of individuals with mental health and substance use disorders. Identification of these factors and typologies can improve mental health treatment and access in counties and agencies with large resource barriers or limited attention to mental health treatment.

Health Service Utilization Patterns Among Medicaid Enrollees With Intellectual and Developmental Disabilities Before and During the COVID-19 Pandemic: Implications for Pandemic Response and Recovery Efforts.

To assess the impact of COVID-19 on health service utilization of adults with intellectual and developmental disabilities (IDDs) through an analysis of Medicaid claims data. Retrospective cohort study of Medicaid claims. Medicaid members aged 25 to 64years from January 1, 2018, to March 31, 2021, from the states of Louisiana, Pennsylvania, and Wyoming. We analyzed data from two 12-month time periods (pre-COVID-19 and during COVID-19) and assessed the potential impact of the COVID-19 pandemic on health service utilization and service intensity for 3 cohorts: (1) IDD with preexisting mental health diagnoses, (2) IDD without mental health diagnoses, and (3) all other Medicaid members. Health service utilization determined by specific claims data classifications. The analysis showed reduced utilization for nonmental health service types with differing utilization patterns for IDD with preexisting mental health diagnoses, IDD without mental health diagnoses, and all other Medicaid members. Change in utilization varied, however, for mental health service types. Measures of service intensity showed decreased numbers of members utilizing services across most service types and increased Medicaid claims per person across most mental health service categories but decreased Medicaid claims per person for most nonmental health services. Results suggest a need for mental health services among all Medicaid members during the COVID-19 pandemic. By anticipating these needs, communities may be able to expand outreach to Medicaid members through enhanced case management, medication checks, and telemedicine options.

Effect of COVID-19 lockdowns on quality-of-life and health services access by socio-economic status in Australia.

This study examined changes in physical and mental health quality-of-life and health services access before and after the onset of the COVID-19 pandemic among individuals of lower and higher socio-economic status (SES) in Australia. Difference-in-differences and logistic regression models were undertaken using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey and government data on COVID-19 lockdowns between January 2020 and February 2021. Individuals from higher SES reported larger decreases in mental health quality-of-life scores than those from lower SES after the onset of the pandemic. Those from lower SES reported less disruption with any health services (24.2% vs 30.4%; OR = 0.68; p < 0.001), specifically dental services (8.2% vs 15.4%; OR = 0.51; p < 0.001) and allied health services (5.9% vs 8.5%; OR = 0.60; p < 0.001), compared with those from higher SES. Additional days under lockdown were associated with reduced access to all health services (OR = 1.19). Furthermore, long-term health conditions (higher SES: OR = 1.54) and scores indicative of poorer physical (lower SES: OR = 1.17; higher SES: OR = 1.07) and mental health (lower SES: OR = 1.16; higher SES: OR = 1.12) were associated with increased health services disruption. While individuals from higher SES were more likely than those from lower SES to experience greater relative declines in mental health and increased disruption with health services access, individuals with a greater apparent need for health services, regardless of SES, may have faced inequalities in accessing these services during the COVID-19 pandemic.

Treating Children and Adolescents with Aggressive Behaviors in the Inpatient Setting.

The mental health crisis in children and adolescents presents a unique challenge for pediatric providers in the inpatient setting. Patients are presenting to the emergency department in acute psychiatric crises, but the increased need for behavioral health services is met with an already limited supply of behavioral health services and facilities. As such, these patients are hospitalized on acute care floors, which can serve to exacerbate symptoms of aggression regardless of cause and complicates treatment and harm prevention strategies. We present a comprehensive management approach to the acutely agitated pediatric patient with aggressive behaviors, including prevention of symptoms in patients with risk factors; nonpharmacological approaches to de-escalation, including the use of restraint; and common oral and parenteral psychopharmacological agents. Such strategies are considered from a medical, ethical, and legal standpoint with the goal of maintaining safety and minimizing harm to patients, families, and staff. [Pediatr Ann. 2024;53(8):e293-e298.].

Ingredients of successful therapeutic relationships with foster youth according to key stakeholders in child welfare: A grounded theory analysis.

Foster youth reportedly have a significant need for mental health services and the quality of the therapeutic relationship can influence service engagement. We employed grounded theory methods to conduct interviews and focus groups with 48 key stakeholders in child welfare to deepen our theoretical understanding of therapeutic relationships with foster youth. The central theory that emerged was that a successful therapeutic relationship is an essential ingredient of the healing process for current and former foster youth. Participants identified hindrances to a successful therapeutic relationship, such as when therapist mishandles countertransference or inappropriately uses self-disclosure, as well as what therapists can do to build a successful therapeutic relationship, such as when a therapist fosters a secure attachment and promotes client agency. The findings offer insight into some of the important facets of building and maintaining a trusting and successful therapeutic relationship with current and former foster youth.

A Qualitative Study Exploring Aging Gay and Bisexual Men’s Needs From Healthcare Services in Israel

Abstract Introduction Older gay and bisexual men are exposed to heightened risks of physical and mental health disorders. Therefore, understanding their unique needs from healthcare services is essential and is set at the focus of the present study. Methods The current qualitative study explored aging gay and bisexual men’s unique experiences and needs from healthcare services in Israel. Participants (N = 80, age range 47–82, M = 59.59, SD = 7.40) were interviewed in the years 2018–2020 and queried regarding their needs from and experiences with healthcare services, which were later thematically analyzed using Braun and Clarke’s Thematic Analysis. Results Six themes were identified from participants’ responses: Romantic relationships and parenting, sexuality in old age, ageism, loneliness, the need for a unique support framework for the gay and bisexual communities, and perceived factors preventing accessibility to healthcare services. Conclusions The results revealed certain barriers for attaining healthcare services as well as the need for distinctive health and psychological services for gay and bisexual men. Policy Implications The participants’ unique experiences and needs may aid in offering useful solutions for policy makers, social agents, and clinicians in order to improve healthcare services utilized by aging gay and bisexual men.

Policy Recommendations for Coordinated and Sustainable Growth of the Behavioral Health Workforce.

Policy Points Demand for behavioral health services outpaces the capacity of the existing workforce, and the unmet need for behavioral health services is expected to grow. This paper summarizes research and policy evidence demonstrating that the long-standing challenges that impede behavioral health workforce development and retention (i.e., low wages, high workloads, training gaps) are being replicated by growing efforts to expand the workforce through task-sharing delivery to nonspecialist behavioral health providers (e.g., peer specialists, promotores de salud). In this paper, we describe policy opportunities to sustain behavioral health workforce growth to meet demand while supporting fair wages, labor protections, and rigorous training.

COMPARATIVE ANALYSIS OF UNMET NEED SERVICES IN HEALTH IN INDONESIA IN 2020 AND 2023

Data from the Central Statistics Agency (BPS) shows that the percentage of unmet need for health services in Indonesia decreased from 6.09% in 2020 to 5.22% in 2023, with a decrease of 0.87 percentage points. Unmet need refers to an unmet need for health services, caused by factors of accessibility, availability, cost, or awareness. This study aims to identify changes in the availability and accessibility of health services during this period. The results show that there is a significant gap between the western provinces (Java and Sumatra), which have improved access and quality of health services, and the eastern provinces (Papua and Maluku), which still lack medical facilities and personnel. 2023 shows an increase in the number of medical personnel in urban areas, but uneven distribution is still a problem, especially in rural and remote areas. This study uses a quantitative method with an independent t-test. In conclusion, despite the overall decline in unmet demand, the gap between urban and rural areas and between western and eastern parts of Indonesia remains significant.

Utilization and Perceived Need for Mental Health Services Among Homeless Seniors.

Homeless seniors confront distinct challenges regarding their mental health needs and service access. This study aims to illuminate the mental health landscape of homeless seniors by examining the prevalence of mental illness, utilization of mental health services, and perceived need for mental health care. The study comprises 177 homeless seniors in New York, NY. Findings indicate 10.2% experiencing depression, 10.2% schizophrenia, and 5.7% bipolar disorder. Despite high prevalence, there is a significant gap between diagnosed mental health conditions and service utilization, with only 50% of those with depression seeking care. Perceived need for mental health services emerges as a critical aspect of the study, with over half of those suffering from depression (61.1%; n = 11), PTSD (75%; n = 3), schizophrenia (77.8%; n = 14), and other mental illnesses (100%; n = 1) expressing a need for mental health care. Also, mental health conditions, loneliness, and levels of social support play significant roles in a need for mental health services.

Feasibility assessment of using ChatGPT for training case conceptualization skills in psychological counseling

This study investigates the feasibility and effectiveness of using ChatGPT for training case conceptualization skills in psychological counseling. The novelty of this research lies in the application of an AI-based model, ChatGPT, to enhance the professional development of prospective counselors, particularly in the realm of case conceptualization—a core competence in psychotherapy. Traditional training methods are often limited by time and resources, while ChatGPT offers a scalable and interactive alternative. Through a single-blind assessment, this study explores the accuracy, completeness, feasibility, and consistency of OpenAI's ChatGPT for case conceptualization in psychological counseling. Results show that using ChatGPT for generating case conceptualization is acceptable in terms of accuracy, completeness, feasibility, and consistency, as evaluated by experts. Therefore, counseling educators can encourage trainees to use ChatGPT as auxiliary methods for developing case conceptualization skills during supervision processes. The social implications of this research are significant, as the integration of AI in psychological counseling could address the growing need for mental health services and support. By improving the accuracy and efficiency of case conceptualization, ChatGPT can contribute to better counseling outcomes, potentially reducing the societal burden of mental health issues. Moreover, the use of AI in this context prompts important discussions on ethical considerations and the evolving role of technology in human services. Overall, this study highlights the potential of ChatGPT to serve as a valuable tool in counselor training, ultimately aiming to enhance the quality and accessibility of psychological support services.

Narrative Review on Universal Health Coverage in Thailand and China from the Lens of Social Determinants of Health Theory

This article through the literature review method briefly compares universal health coverage (UHC) in Thailand and China, highlighting their strategies and challenges in achieving UHC through the lens of social determinants of health: a) health financing design and sustainability, b) accessibility of healthcare resources, and c) participatory and responsive governance. While Thailand mainly utilizes a tax-based approach, China employs a health insurance model. Both countries have achieved high insurance coverage. However, some challenges exist. The unmet need for health services due to long waiting times has been a key concern in Thailand, whereas financial hardship from receiving care was a critical concern in the case of China. Thailand has created a mechanism to allow a wide range of stakeholders to participate in the UHC design to ensure responsive governance. In contrast, China has not yet formed comprehensive legal grounds for participatory and responsive governance on UHC. Their experiences and encountered obstacles can offer valuable lessons on how middle-income nations can advance towards UHC, highlighting the critical need for ongoing improvements in health systems to tackle the existing and new health challenges due to the change in population demographics and the continuing increase of population healthcare demand.

Aspek Hukum Pengaruh Transformasi Digital Terhadap Praktik Telemedicine Di Indonesia

Health is a basic human need that continues to increase along with the progress of the times. Technological advances and lifestyle changes have led to a variety of new diseases, increasing the need for health services. Indonesia, with the fourth largest population in the world (272,229,372 people) and 10.14% of the population poor in 2021, faces significant health challenges. The COVID-19 pandemic has exacerbated the situation by limiting access to health services. Barriers to access, unequal distribution of services, and a shortage of doctors hinder efforts to realize the welfare of citizens as mandated by the 1945 Constitution. However, advances in information and communication technology have brought significant benefits in the health sector. Information technology has had a major impact on health and medicine, enabling the rapid, efficient, and accurate dissemination of information. One important development is the practice of telemedicine, which offers innovative solutions in health care.

Interventions to promote mental health in the Occupied Palestinian Territories and Palestinian refugees: A scoping review.

The long history of the Palestinian-Israeli conflict has resulted in a public and mental health crisis. Despite the significant mental health burdens facing the Palestinian population in the Occupied Palestinian Territories (OPT) and refugee camps, this issue remains comprehensively unexplored. This scoping review identified mental health interventions and assessed their effectiveness among populations in the OPT and Palestinian refugee camps, while addressing delivery challenges. A scoping review was conducted using 14 databases to include relevant studies published through March 2024 using PRISMA guidelines for scoping reviews. Analyzing 31 intervention studies meeting the inclusion/exclusion criteria, revealed varied outcomes in interventions targeting post-traumatic stress disorder, depression, and overall mental well-being. While some interventions showed potential, others had limited effectiveness, underscoring the complexity of mental health needs in conflict zones. Gender- and risk-specific effectiveness was observed, emphasizing the need for tailored approaches. Challenges like low attendance rates and systemic barriers hindered intervention success. The profound impact of war on children stresses the urgency for targeted interventions. Empowerment and community connectedness are vital for resilience, along with the importance of family and community involvement and research that balances the need for strong evaluation designs with the need for ongoing mental health services. Advocacy for systemic changes is crucial to implement the complex sustainable interventions necessary to assure mental health in any population. This review highlights the importance of holistic, contextually relevant approaches for mental health intervention in OPT and refugee camps, emphasizing rigorous evaluations and community-driven approaches.

Adolescent sexual and reproductive health needs and utilisation of health services in the Bono East Region, Ghana

BackgroundAdolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region.MethodsUsing a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers.ResultsOur findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents’ utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services.ConclusionIn conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care.

The challenges and needs of male victims of intimate partner violence in Nigeria: what victims and professionals say

ABSTRACT Historically, interventions have focused on female victims due to intimate partner violence (IPV) disproportionate occurrence. Consequently, male victims face significant challenges and unmet needs due to lack of tailored interventions. In under-resourced countries like Nigeria, where male victimization is under-researched and under-documented, the situation is even worse. Using the grounded theory methodology, this study examined the needs and challenges of male victims from the perspective of victims, and professionals who served as key informants. Data were collected using semi-structured interviews from 35 male victims aged ≥18 across 12 states in the southern region of Nigeria, and four professionals were interviewed based on their availability. Data were analysed using content analysis based on category development of the grounded theory method. The challenges and needs identified include balance in the law, need for mental health services, creating a safe space, communal involvement, and victims need to speak up. They were all discussed around an overarching theme of masculinity and societal stereotypes. Re-examination of the existing laws as they apply to male victims, enlightenment campaigns, establishment of tailored institutions or rebranding of existing institution, and creation of support groups were recommended.

We are all Sentenced: The Lived Experience of Mothers With an Adult Incarcerated Daughter

The vast majority of research on the impact of familial incarceration focuses on its effect on children, even though one in eight adults in the United States has had a child in prison. While some studies have examined the lived experiences of mothers with an incarcerated adult son, no research has explored the effect of an adult daughter’s incarceration on their mother. Using in-depth interviews with four mothers who have adult daughters in prison, this study finds that these mothers were significantly affected by their daughter’s incarceration. They experience painful emotions, face significant barriers and challenges, and highlight the pressing need for mental health services. Along with other prior works, our findings can be used to inform policy and clinical recommendations for those working with and advocating for incarcerated populations and their impacted loved ones.

Exploring LGBT2Q+ Intracategorical Factors in Mental Health Service Utilization: Differences in Gender Modalities, Sexual Orientations, and Ethnoracial Groups in Canada.

LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.

Health Profile, Perpetuating Factors and Health Service Needs of Clients with Non-communicable Diseases

Health Profile, Perpetuating Factors and Health Service Needs of Clients with Non-communicable Diseases

The need and acceptability of a youth mental health mentoring model to supplement adolescent outpatient mental health services

Youth mental health challenges in the United States continue to escalate at an alarming rate. To address this crisis, there is an urgent need to develop innovative strategies for delivering effective mental health care to youth. The aim of this study was to assess the need and acceptability of a youth mental health mentoring model for adolescents engaged in outpatient mental health services. Participants included adolescents currently engaged in outpatient mental health services (n = 3, 14–17 years old; 66 % Black; 100 % cisgender boys), parents/guardians of adolescents currently engaged in mental health services (n = 4; 50 % Black; 100 % cisgender women), clinicians who provide adolescent mental health services in an outpatient setting (n = 5; 100 % White cisgender women), and potential paraprofessional mental health mentors recruited from a large land-grant University (n = 5; 40 % White; 60 % cisgender women). All participants were recruited from an urban setting in the midwestern United States. Data collection occurred remotely. Following protocols that were approved by an Institutional Review Board, participant groups were provided an overview of the proposed model and asked a series of open-ended questions in four separate focus groups to gauge the perceived need and acceptability of this type of program model. Thematic data analysis was used to analyze data. Across participant groups, results indicated a clear need for supplemental mental health services and high acceptability of the proposed youth mental health mentoring model. Participants offered specific recommendations for model development, especially related to mentor selection, training and supervision.