Mental Health Referrals Research Articles

Single-item depression screening with the Neurobehavioral Symptom Inventory (NSI): Do scores assist clinicians with predicting need for mental health interventions?

The purpose of this study was to examine the relationship between a single item for depression from the Neurobehavioral Symptom Inventory (NSI) and a common depression screening measure to predict need for further mental health consultation for veterans with traumatic brain injury (TBI). Three hundred eighty veterans referred to a Veterans Affairs Health Care System TBI clinic for evaluation were administered the NSI and a common depression screening measure (Beck Depression Inventory-Second Edition; BDI-II). Receiver Operating Characteristic (ROC) curve analyses were conducted to determine best cutoff scores on the BDI-II corresponding with a single item of the NSI item pertaining to depression (i.e., "depressed or sad"). Using multiclass ROC curve analyses, results suggested that a minimum score of 3 (severe) on the specific NSI item indicated need for further mental health referral without warranting additional screening for depression. Analyses further demonstrated that removal of invalid NSI protocols did not significantly change ROC curve findings. Therefore, the NSI item for depression can still be used for making clinical decisions despite the protocol being considered otherwise invalid. Implications for treatment and recommendations for screening are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Beliefs, attitudes and experiences of virtual overdose monitoring services from the perspectives of people who use substances in Canada: a qualitative study

BackgroundSolitary use of substances is a risk factor for substance use-related mortality. Novel e-health harm reduction interventions such as virtual overdose monitoring services (VOMS) have emerged in North America to improve access to emergency overdose support for people who use substances (PWUS). To date, little research has been published, and the perspectives of PWUS are needed to inform evaluation and policy efforts.ObjectiveTo explore the beliefs, values and perceptions of PWUS around using and accessing VOMS in Canada.MethodsA qualitative study following grounded theory methodology was conducted. Using existing peer networks, purposive and snowball sampling was conducted to recruit PWUS (≥ 18 years) with previous experience with VOMS. Thematic analysis was used to analyze twenty-three interviews. Several methods were employed to enhance rigor, such as independent data coding and triangulation.ResultsTwenty-three one-on-one telephone interviews of PWUS with previous experience with VOMS were completed and analyzed. The following themes emerged: (1) feelings of optimism around VOMS to save lives; (2) privacy/confidentiality was highly valued due to stigma and fear of arrest; (3) concerns with reliable cell phones negatively impacting VOMS uptake; (4) concerns around emergency response times, specifically in rural/remote communities; (5) desire for trusting relationships with VOMS operators; (6) importance of mental health supports and referrals to psychosocial services; and (7) possible limited uptake due to low public awareness of VOMS.ConclusionThis qualitative study provided novel insights about the VOMS from the perspectives of PWUS. PWUS generally felt optimistic about the potential of VOMS as a suitable harm reduction intervention, but several potential barriers around accessing VOMS were identified that may limit uptake. Future research is warranted.

Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study.

A warm handoff from a physician to a mental health provider is often patients' first contact with psychological services and provides a unique opportunity for improving treatment engagement in integrated primary care (IPC) settings. In light of the COVID-19 pandemic, this study sought to examine the impact of different types of telehealth mental health referrals on both the anticipated likelihood of accepting treatment services and anticipated likelihood of continued treatment engagement. A convenience sample of young adults (N=560) was randomized to view 1 of 3 video vignettes: warm handoff in IPC, referral as usual (RAU) in IPC, or RAU in standard primary care. Logistic associations between referral type and the likelihood of referral acceptance (χ21=10.9, P=.004) and the likelihood of continued engagement (χ21=32.6, P<.001) were significant. Participants who received a warm handoff were significantly more likely to anticipate both accepting the referral (b=0.35; P=.002; odds ratio 1.42, 95% CI 1.15-1.77) and engaging in continued treatment (b=0.62; P<.001; odds ratio 1.87, 95% CI 1.49-2.34) compared with those who received RAU in the standard primary care condition. Furthermore, 77.9% (436/560) of the sample indicated that they would be at least somewhat likely to access IPC mental health services for their own mental health concerns if they were readily available in their own primary care physician's office. A telehealth warm handoff resulted in the increased anticipated likelihood of both initial and continued engagement in mental health treatment. A telehealth warm handoff may have utility in fostering the uptake of mental health treatment. Nonetheless, a longitudinal assessment in a primary care clinic of the utility of a warm handoff for fostering referral acceptance and continued treatment engagement is needed to hone the adoptability of a warm handoff process and demonstrate practical evidence of effectiveness. The optimization of a warm handoff would also benefit from additional studies examining patient and provider perspectives about the factors affecting treatment engagement in IPC settings.

What influences referral for mental health support in audiology clinics? A qualitative exploratory approach of barriers and facilitators

ABSTRACT Objective This study aimed to gain an in depth understanding of factors influencing mental health referrals for adults with hearing loss in the audiology setting. Method A semi-structured focus group with hearing care practitioners (HCPs) and reception staff (N = 12, M age = 45 ± 12 years, 10 female) from a large hearing services provider in Western Australia in 2020. Results Three themes were identified: (1) beliefs about and the recognition of the need for referral, (2) knowledge, skills, and training for mental health referral, and (3) outcomes and consequences of referring clients for mental health support. Discussion This study identified a wide range of factors influencing referral of adults with hearing loss for mental health support. The findings of this research may be used to inform intervention development targeting mental health referral behaviours within the audiology setting.

Using the Project ECHO Model to Increase Pediatric Primary Care Provider Confidence to Independently Treat Adolescent Depression.

The model for the Extension for Community Healthcare Outcomes (Project ECHO®) was used to extend specialist support to the pediatric medical home for the treatment of adolescent depression by taking a comprehensive, disease-specific approach. Child and adolescent psychiatrists constructed a course to train community pediatric primary care providers (PCPs) to screen patients for depression, initiate evidence-based interventions, and provide ongoing management. Participants were assessed for changes in clinical knowledge and self-efficacy. Secondary measures included self-reported practice change and emergency department (ED) mental health referrals 12months pre- and post-course completion. Sixteen out of 18 participants in cohort 1 and 21 out of 23 participants in cohort 2 completed the pre- and post-assessments. Clinical knowledge and self-efficacy showed statistically significant improvement pre- and post-course completion. ED mental health referrals from participant PCPs decreased by 34% (cohort 1) and 17% (cohort 2) after course completion. These findings indicate that utilizing the Project ECHO format to provide subspecialist support and education on the treatment of depression can improve pediatric PCPs' clinical knowledge and confidence in their ability to independently treat depression. Secondary measures suggest that this can translate into practice change and improved treatment access with decreased ED referrals for mental health assessments by participant PCPs. Future directions include more robust outcomes measurement and developing more courses with an in-depth approach to a single or similar cluster of mental health diagnoses such as anxiety disorders.

A comprehensive assessment of social determinants of health for metastatic breast cancer.

e18562 Background: We evaluated the utility of an electronic medical record (EMR)-based risk stratification tool of social determinants of health (SDOH), financial toxicity and social barriers to identify metastatic breast cancer (MBC) patients (pts) at risk of inequity in cancer care. Methods: We enrolled 40 female pts within 60 months (mo) of a MBC diagnosis (dx). Pts had an encounter with social work (SW) at baseline that includes: 1) Eleven SDOH domains 2) Financial toxicity 3) CMS validated psychosocial assessment (Ax). A 2nd Ax within 3 mo was optional. SW documented interventions offered to pt. Retrospective chart review included pt demographics, treatment (Tx) and clinical outcomes. Descriptive statistics were calculated for pt demographics, clinical outcomes, SDOH acuity scores, and interventions offered by SW. Clinical outcomes were summarized with frequency counts and percentages. All analyses were performed with SAS 9.4 (SAS Institute Inc., Cary, NC). Interactions between race and SDOH risks were explored by logistic regression analysis but limited by sample size constraints. Results: Of 40 enrolled pts, 39 completed baseline and 24 completed 2nd Ax. Mean age 61 y (range 31-85); 20 White (W) and 19 Minority (MIN) [18 Black, 1 Asian]. Median time from MBC dx to baseline Ax was 7.3 mo (2.7-19.5) for MIN pts and 16.2 mo (3.8-28.8) for W pts. Mean time for SW to complete baseline Ax was 32.7 min and 2nd Ax was 26.7 min. Of 11 SDOH domains, MIN pts were more likely at risk in 6 domains compared to W pts: Financial Resource Strain (MIN 63% v W 45%), Housing Stability (MIN 16 % v W 0%), Depression (MIN 11% v W 5%), Physical Inactivity (MIN 84% v W 65%), Transportation Needs (MIN 26% v W 10%), and Food Insecurity (MIN 42% v W 10%). W pts were at greater risk compared to MIN pts for Tobacco Use (MIN 47% v W 60%) and Lack of Social Connections (MIN 53% v W 65%). Both groups reported similar risk for Stress (MIN 74% v W 70%). Every pt was at risk in at least one SDOH domain. Eleven (58%) MIN v 5 (25%) W pts were at risk in the 5 or more SDOH domains. At the baseline Ax, the most common interventions provided by SW: financial (MIN 36.8% v W 25.0%), food (MIN 42.1% v W 0%), transportation (MIN 21.1% v W 0%), and mental health referral (MIN 5.3% v W 15.0%). MIN pts were more likely to have delay in starting 1st line Tx &gt; 21 d with a median time of 29 mo (range 20-52) v 19 mo (range 9-54.5) for W pts. Within 3 months of a referral, 13 MIN (68.4%) v 6 W (30%) pts had a palliative care encounter, and 6 MIN (31.6%) v 5 W (40%) pts met with a genetic counselor. On regression analysis, no associations were detected between SDOH risk or SDOH risk-by-race interactions with time-to 1st line Tx or time to palliative care encounter. Conclusions: In our catchment, MIN pts with a MBC dx were more likely to face multiple SDOH risks compared to W pts. The impact of interventions to address SDOH and social barriers on cancer care outcomes should be evaluated in a larger cohort of MBC patients determined to be at risk.

Team-focused implementation strategies to improve implementation of mental health screening and referral in rural Children’s Advocacy Centers: study protocol for a pilot cluster randomized hybrid type 2 trial

BackgroundChildren’s Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs’ capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings.MethodsWe will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers’ understanding of their child’s mental health needs and caregivers’ intentions to initiate mental health services (effectiveness aim).ConclusionsTargeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings.Trial registrationClinicaltrials.gov, NCT05679154. Registered on January 10, 2023.

An Examination of School District Reopening Plans for Mental Health Supports amid COVID-19 School Reopening

Abstract The purpose of this exploratory qualitative study was to understand the types of mental health supports described in school district reopening plans in one southeastern state, and to understand school social workers’ involvement in developing these plans during the first full academic year of the COVID-19 pandemic. Publicly accessible school district reopening plans were collected from the 80 school districts in South Carolina, and 15 school social workers participated in virtual interviews. Out of the 80 school districts, 67 had reopening plans, and of those, only 43 percent mentioned mental health services and supports. Most school district reopening plans described Tier 1 universal prevention services and supports and a process for mental health assessment, identification, and referral. Fewer included Tier 2 early intervention and Tier 3 targeted and intensive services. Of the school social workers interviewed, only four were involved in helping to develop their school district reopening plans, and when involved, advocated for mental health services and supports for their students. The article concludes with a discussion of the study's implications for school social work practice.

Factors associated with surgeon recognition of mental health care opportunities and inclination to attend to mental health

PurposeA notable percentage of people that die by suicide have had a medical visit within a few months of their death. In a survey-based experiment, we evaluated: 1) whether there are any surgeon, setting, or patient factors associated with surgeon rating of mental health care opportunities, and 2) if there are any surgeon, setting, or patient factors associated with likelihood of mental health referrals. MethodsOne hundred and twenty-four upper extremity surgeons of the Science of Variation Group viewed five scenarios of a person with one orthopedic condition. The following aspects of the scenarios were independently randomized: Social worker or psychologist available, office workload, socioeconomic status, gender, age, mental health factors, mental health clues, and diagnosis. ResultsAccounting for potential confounders, surgeon likelihood of discussing mental health was associated with cancer, disadvantaged socioeconomic status, mental health factors other than being shy, prior suicide attempt, history of physical or emotional abuse, isolation, and when the office is not busy. Factors independently associated with higher likelihood of referring a patient for mental health care included cancer, disadvantaged socioeconomic status, mental health cues, mental health risk factors, and a social worker or psychologist available in the office. ConclusionUsing random elements in fictitious scenarios we documented that specialist surgeons are aware of and attuned to mental health care opportunities, are motivated to discuss notable cues, and will make mental health referrals, in part influenced by convenience.

Food insecurity, mental health and in-hospital mortality following the COVID-19 pandemic in a socially deprived UK coastal town

BackgroundPublic health interventions are essential to prevent a long tail of costly, avoidable and worsening ill health in coastal communities following the COVID-19 pandemic, yet no research exists to guide...

Development and Piloting of a Mental Health Prevention and Referral Program for Veterans and Their Families in Ukraine.

While growing evidence exists for the effectiveness of mental health interventions in global mental health, the evidence base for psychosocial supports is lacking despite the need for a broader range of supports that span the prevention-treatment continuum and can be integrated into other service systems. Following rigorous evaluation of the Common Elements Treatment Approach (CETA) in Ukraine, this article describes the development and feasibility testing of CETA Psychosocial Support (CPSS), a brief psychosocial prevention and referral program for Ukrainian veterans and their families. CPSS development used evidence-based CETA intervention components and was informed by a stakeholder needs analysis incorporating feedback from veterans and their families, literature review, and expert consultations. The program includes psychoeducation, cognitive coping skill development, and a self-assessment tool that identifies participants for potential referral. After initial development of the program, the intervention underwent: (1) initial implementation by skilled providers focused on iterative refinement; (2) additional field-testing of the refined intervention by newly trained providers in real-world conditions; and (3) a formal pilot evaluation with collection of pre-post mental health assessments and implementation ratings using locally validated instruments. Fifteen CPSS providers delivered 14 group sessions to 109 participants (55 veterans, 39 family members, and 15 providers from veterans' service organizations). After incorporating changes related to content, process, and group dynamics, data from the pilot evaluation suggest the refined CPSS program is an acceptable and potentially effective brief psychosocial prevention and promotion program that can be implemented by trained veteran providers. Forty percent of participants required safety or referral follow-ups. The iterative, inclusive development process resulted in an appropriate program with content and implementation strategies tailored to Ukrainian veterans and their families. Brief psychosocial programs can fit within a larger multitiered mental health and psychosocial continuum of care that supports further referral.

The Diabetic Foot-Pain-Depression Cycle.

More than 86,000 Americans with type 2 diabetes mellitus (T2DM) undergo nontraumatic lower-extremity amputations annually. The opioid-prescribing practice of podiatric surgeons remains understudied. We hypothesized that patients with T2DM who undergo any forefoot amputation while using antidepressant medication will have reduced odds of using opioids beyond 7 days. We completed a retrospective cohort study examining patients with T2DM who underwent forefoot amputation (toe, ray, transmetatarsal). Data were restricted to patients with a hemoglobin A1c level less than 8.0% and an ankle-brachial index greater than 0.8. The outcome was use of postoperative opioids beyond 7 days. Patients received an initial opioid prescription of 7 days or less. We developed simple logistic regression models to identify the odds of a patient using opioids beyond 7 days by patient variables: age, race, sex, amputation level, body mass index, antidepressant medication use, and marital status. Variables with P < .1 in the univariate analysis were included in the multiple logistic regression model. Fifty patients met the inclusion criteria. Antidepressant use and marital status were the only statistically significant variables. Adjusting for marital status, patients with antidepressant use had decreased odds (odds ratio, 0.018; 95% confidence interval, 0.001-0.229; P = .002) of using opioids beyond 7 days after a diabetic forefoot amputation. Patients with T2DM who used antidepressants had significantly reduced odds of using opioids beyond 1 week after forefoot amputations compared with those without antidepressant use. We proposed an underlying diabetic foot-pain-depression cycle. To break the cycle, podiatric surgeons should screen this population for depression preoperatively and postoperatively and not hesitate to make a mental health referral if warranted. Nontraumatic amputations can be a traumatic experience for patients; psychiatrists and other mental health providers should be members of limb preservation teams.

Identifying Barriers to Effective Outpatient Mental Health Referral for Medical Inpatients.

Identifying Barriers to Effective Outpatient Mental Health Referral for Medical Inpatients.

Effect of Digital Application Intervention On Mental Health Referral Practices Among Religious Leaders in Ogun State, Nigeria

Effect of Digital Application Intervention On Mental Health Referral Practices Among Religious Leaders in Ogun State, Nigeria

A Systemwide Postpartum Inpatient Maternal Mental Health Education and Screening Program

ObjectiveTo expand a hospital system’s maternal mental health program to standardize screening for perinatal mood and anxiety disorders. DesignQuality improvement initiative using a continuous Plan–Do–Study–Act (PDSA) cycle. Setting/Local ProblemIn a hospital system consisting of 66 maternity care centers across the United States, there was significant variation in maternal mental health screening, referral, and education practices. The COVID-19 pandemic and increasing rates of severe maternal morbidity further elevated system-level concern about the quality of maternal mental health care being provided. ParticipantsPerinatal nurses. MethodsAn “all-or-none” bundle methodology was used to measure adherence to a system standard for maternal mental health screening, referral, and education. InterventionsA toolkit was designed internally to support streamlined implementation and ensure standardization for screening, referral, and education. This comprehensive toolkit includes screening forms, a referral algorithm, staff education, patient education literature, and a community resource list template. Training on how to use the toolkit was provided to nurses, chaplains, and social workers. ResultsThe initial system bundle adherence rate was 76% (2017) in the first year of the program. The following year, the bundle adherence rate increased to 97% (2018). Despite the disruption caused by the COVID-19 pandemic, this mental health initiative has maintained an overall adherence rate of 92% (2020–2022). ConclusionThis nurse-led quality improvement initiative has been successfully implemented across a geographically and demographically diverse hospital system. The initial and sustained high rates of adherence with the system standard for screening, referral, and education illustrate perinatal nurses’ commitment to the delivery of high-quality maternal mental health care in the acute care setting.

Evaluation of the Mental Health Referral Process for African American Adolescent Patients Within a Primary Care Setting: A Quality Improvement Project

Mental health disorders affect 18% of the U.S. Problems with access to mental health care for the African American community are multifactorial. Provider and staff perceptions and opinions regarding factors attributing to problems with mental health access are explored. Providers and staff (N=10) completed a 26-item electronic questionnaire RESULTS: The primary barriers to screening, consultation, and follow-through were time constraints, location of services, and lack of parental support, respectively. Integrating behavioral health into primary care is a promising way to address many reported barriers, such as time restraints, social stigma, and lack of resources.

Trichotillomania in Children − How can a Dermatologist Deal with it?

Hair loss in children is an important cosmetic concern, especially in adolescents where body image matters. Trichotillomania manifests through patchy hair loss which reflects underlying psychiatric conditions. It is a challenge for the dermatologist, who are first contact physicians, to deal with such cases who are secretly struggling with their inner turmoil. Hence, they must be well versed to deal with such patients. The current review aims to facilitate the dermatologist to handle them effectively. We performed PubMed and Google Scholar searches of English literature using the terms “Trichotillomania”, “Trichotillosis,” “Trichotillomania in Children,” “Trichotillomania in pediatrics,” “Trichotillomania in adolescents,” “Hair pulling disorder,” “Obsessive-Compulsive disorders AND Dermatology,” “Psychodermatology,” and “Psychocutaneous disorders.” The selected publications were reviewed for additional resources. Thorough psychological evaluation of the patient along with the cutaneous examination will help the dermatologists in establishing the diagnosis. Dermatologists should be empowered regarding the need of mental health referral and should be able to convey the same to the patient/family members empathetically. They can offer habit reversal therapy, mainstay treatment, as well as pharmacotherapy as and when needed after adequate training.

U.S. Middle and High School Teacher Attributions of Externalizing Student Behavior

Teachers’ attributions of student behavior are associated with the decisions they make about how to respond to behavior problems and support their students. This exploratory study investigates teachers’ attributions of student externalizing behavior, how attributions vary as a function of teacher and school characteristics, and the association of those attributions with teachers’ perceived likelihood of referring students to mental health services or implementing punitive discipline. We provided a sample of U.S. secondary school teachers ( N = 426) a vignette depicting a student with oppositional defiant disorder and asked them to describe what was happening with the student. Attributions were categorized as internal to the student (e.g., mental health), external (e.g., problems at home), both (internal and external), and neutral (e.g., “normal teen behavior”). Results indicated the majority of teachers attributed vignette behavior to external factors. Results suggest that teachers indicating both internal and external attributions had increased likelihood of providing a mental health referral. Teacher and school characteristics were also associated with attributions. Results provide support for the importance of considering teachers’ attributions of student behavior and the association of these attributions to pathways into mental health services.

Secondary data analysis of social care records to examine theprovision of mental health support for young people in care.

Young people in care are much more likely to experience mental health difficulties than the general population, yet little is known about the provision of mental health support for this group in the United Kingdom. Using routinely collected social care data, we explored the provision of mental health support for 112 young people in care in the UK. We identified young people experiencing elevated internalising or externalising difficulties in their first year in care (based on strengths and difficulties questionnaire scores) and extracted data on mental health referrals and provision. We generated descriptive statistics relating to provision of mental health support and used regressions to examine predictors of mental health provision, and associations between support and mental health outcomes one and 2years later. Eighty-one percent of the children (n=79) were referred to mental health services in their first year of being in care. Referrals were usually for emotional or conduct problems. Those with higher externalising symptoms were more likely to be referred than those with higher internalising symptoms (OR=1.2, (95% confidence interval (CI): 1.01, 1.38)). Females were more likely to access support than males (OR=3.82 (95% CI: 1.2, 13.3)). Sixty-eight percent of children (n=66) accessed mental health services in their first year of being in care. Of those who accessed services, support ended prematurely for 29 (44%) of them, often due to placement instability or disengagement. Accessing support in the first year of care was not associated with changes in mental health 1year (OR: 2.14 (95% CI: 0.62,7.29)), or 2years after entering care (OR: 0.72-8.57, (95% CI: 0.72, 8.57)), although methodological limitations are noted. Mental health difficulties for children in care are recognised quickly, but mental health support may be difficult to access, with issues evident in retention and engagement.

Strabismus and Pediatric Psychiatric Illness: A Literature Review.

This literature review aims to investigate the potential association between strabismus and mental illness among children. The search was conducted in the PubMed and Google Scholar databases using a wide range of search terms related to strabismus, mental disorders, psychiatric illness, childhood, and adolescence. Eleven published studies were included in this review. The findings from this review suggest an association between strabismus and mental illness. Negative attitudes and social bias against children with strabismus were also noted. These findings should alert healthcare providers to counsel children and their caregivers regarding the risk for mood disorders in children with strabismus and to consider mental health screening and referral as needed.