Outpatient Treatment Program Research Articles

Structured diagnosis and timely treatment of dual diagnosis: effect on the retention rate in outpatient treatment for substance use disorders

ABSTRACT Background In patients with substance use disorders (SUD), adherence to outpatient treatment programs is critical. There is little research in Mexico on the evaluation of different treatment models. The objective of this study was to evaluate and adjust an ambulatory treatment model in subjects with SUD in a care centre in Mexico. Methods This project was planned in two stages: the first consisted of evaluating the efficacy of the established model and determining the variables associated with compliance at 12 weeks. The second stage has reevaluated the model once the variables associated with the abandonment of the treatment were modified. Results A total of 220 (S1) and 161 (S2) patients were included. The first model showed a 12-week retention rate of 24% and lower comorbidity than that reported in the literature (32% versus 60–80%). Then the model was adjusted to include the structured diagnosis and the systematized treatment of the dual pathology. In the reassessment phase, psychiatric comorbidity increased to 86.3% and the retention rate was increased to 40.37%. Conclusions The structured diagnosis and timely treatment of dual pathology is a fundamental component to improving retention rates in outpatient programs for treating patients with SUD.

57 EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder

Emergency departments (ED) are a critical access point for individuals with opioid use disorder (OUD). Medications for OUD decrease: (1) mortality after nonfatal overdose, (2) withdrawal symptoms, (3) craving, and (4) illicit opioid use. Buprenorphine (BUP) can be safely initiated in the ED and increases retention in outpatient treatment programs. Adoption of ED-initiated BUP has been slow due to lack of physician knowledge, experience, and time. The study objective was to determine the effect of a user-friendly clinical decision support system (CDS) on rates of ED-initiated BUP in the routine emergency care of individuals with OUD. A parallel group randomized pragmatic trial was conducted in 18 EDs across 5 health care systems in the United States. The EMBED intervention is a user-centered, physician-facing CDS system integrated into the electronic health record (EHR) to facilitate ED-initiation of BUP by: (1) determining a diagnosis of OUD, (2) assessing withdrawal severity, (3) motivating patients to accept treatment, and (4) automating EHR workflow including clinical and after visit documentation, order entry, prescribing, and referral. EDs were randomly allocated to the intervention versus usual care using stratified covariate constrained randomization of clusters to arms with a ratio of 1:1. Constraining covariates included EHR vendor, patient volume, practice setting, ongoing resources for OUD patients, and proportion of attending physicians waivered to prescribe BUP. Participants included adult ED OUD patients meeting a predetermined EHR phenotype for OUD and the attending emergency physicians caring for them. Control site visits associated with attending physicians who practiced at both intervention and control sites were excluded. The primary outcome was the rate of ED-initiated BUP (administration or prescription of BUP). Implementation outcomes as compared to usual care were measured using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. 354, 800 ED visits (166, 184 intervention and 188, 616 control) from November 2019-March 2021 were assessed for eligibility. Overall, 4, 561 OUD patients (2, 457 intervention, 2, 104 controls) under the care of 607 attending physicians (335 intervention, 272 controls) were included in the analysis. Among these patients, 33% and 36% were female and the mean age (SD) was 39.4 y (13.3) and 38.5 y (13.0) in the intervention and control groups, respectively. Though the analysis is not complete at this time, full results are forthcoming and will be available in advance of the ACEP21 Research Forum. This pragmatic trial involving patients with OUD will report the effect of a user-centered CDS system that automates EHR workflow to initiate BUP in the ED.

55.3 PEDIATRIC CHRONIC PAIN: INFRASTRUCTURES AND LEVELS OF CARE

Objectives: Successful management of chronic pain requires addressing physical symptoms and comorbid mental health conditions. Pharmacological and nonpharmacological interventions can be successfully provided by a multidisciplinary approach that is both effective and safe. This model can be delivered in different settings, including outpatient, intensive outpatient, and inpatient. In this module, we focus on assessing the patient’s presentation, establishing the appropriate level of care, detecting the need to transition or modify settings, and understanding the prevalent challenges due to the COVID-19 pandemic. Methods: Souraya Torbey, MD, will: 1) highlight the distinction between outpatient clinic program and intensive day treatment, with an emphasis on the advantages and challenges of each model;2) clarify the intensive day treatment programs, their types, and structures;3) discuss medical decisions in the appropriate level of care;4) review the referral processes;and 5) discuss treatment modalities in the setting of COVID-19, including telehealth. Results: Outpatient pain treatment programs allow the child to stay at home in a familiar environment. However, such arrangements may lack the intensity, consistency, and integration necessary to make progress. Intensive day treatment or partial hospitalization programs are a midway between inpatient and outpatient. They provide a smooth transition from inpatient to outpatient through the support of a structured treatment program. The COVID-19 pandemic has resulted in an increase in pediatric chronic pain and mental health issues, concomitant with a decrease in availability of in-person psychiatric and rehabilitation services. The development of telehealth/hybrid models arose to respond to these needs and to increase access for those who might not be close to big centers. We discuss the implementation of these virtual platforms in the outpatient treatment models of chronic pain. Conclusions: This presentation aims to explore the distinction between outpatient clinic and intensive day treatment, highlighting the advantages and challenges of each model respectively, including the effect of the COVID-19 pandemic. Attendees will also be equipped with the necessary tools to implement alternate multimodal approaches in communities where such multidisciplinary programs are scarce. MDM, PAH, TVM

Plasma Levels of Peptide YY in Obese Adolescents Throughout A Year of Treatment for Weight Loss

Objective: To evaluate serum PYY levels in obese adolescents treated in an outpatient obesity treatment program at a public hospital in southern Brazil. Methods: Fifty-one adolescents with obesity were included and followed up for 12 months. They attended 12 consultations with weight loss recommendations based on quantitative and qualitative food goals and reduction of sedentary behavior. Fasting serum levels of PYY, total cholesterol, HDL-cholesterol, triglycerides (TG), LDLcholesterol (LDL-C), insulin and glycemia were collected in T0 (before the first consultation), T1 (after 24 weeks) and T2 (after 48 weeks). Besides blood samples, abdominal circumference (AC) was measured, and the homeostasis model assessment (HOMA-IR) was calculated. By electrical bioimpedance analysis, fat mass and basal metabolic rate were measured. Results: Between T0 and T2, there was weight loss with a significant reduction of body mass index (BMI) Z-scores (p<0.001). There were also a significat reduction of PYY (p=0.026), TRIG (p=0.016), LDL-C (p=0.016), HOMAIR (p=0.004), AC (p<0.001) and BMI (p=0.002). In T2, there was a reduction in the baseline weight and in the proportion of severe obesity, and there was an increase in PYY levels (r=-0.421; p=0.002). Conclusion: Obese adolescents who changed their sedentary behavior and adopted a balanced diet showed weight loss and increse in PYY levels.

Predicting Outcome in an Intensive Outpatient PTSD Treatment Program Using Daily Measures.

It is useful to investigate factors that could predict treatment outcomes for PTSD. The current study aims to investigate the relationship between daily measured PTSD symptoms during an intensive six-day treatment program and overall post-treatment outcomes. The treatment program combines eye movement desensitization with reprocessing and prolonged exposure, as well as physical activity and psychoeducation. It was expected that for the entire duration of treatment, as well as the first half of the treatment, a greater decline in daily PTSD symptoms would be a predictor for a greater decline in PTSD symptoms at a four-week follow-up. Data from 109 PTSD-patients (87.2% female, mean age = 36.9, SD = 11.5) were used. PTSD symptoms were measured with the CAPS-5 and the self-reported PTSD checklist for DSM-5 (PCL-5). Daily PTSD symptoms were measured with an abbreviated version of the PCL-5 (8-item PCL). Latent growth curve models were used to describe changes in daily PTSD symptoms and predict treatment outcome. Results show that a greater decline in daily PTSD symptoms measured by the 8-item PCL predicts better treatment outcome (CAPS-5 and PCL-5), but that a patient’s PTSD symptoms on the first day of treatment has no predictive effect. A decline in PTSD symptoms only during the first half of treatment was also found to predict treatment outcomes. Future research should be focused on replicating the results of the current study.

Obesity treatment effect in danish children and adolescents carrying melanocortin-4 receptor mutations

This study investigated the influence of MC4R variants on treatment effectiveness in a large cohort undergoing an outpatient treatment program. Carriers of MC4R loss-of-function (LoF) variants showed a lack of improvement in BMI, in contrast to non LoF carriers.

An accelerated, weekend-based, prolonged exposure therapy program for veterans and service members with posttraumatic stress disorder

Accelerated models of care may be one solution to the problem of underutilization of mental health treatment in veterans. We report on a novel implementation of prolonged exposure (PE) therapy in a four-day, weekend-based intensive outpatient treatment program. Seventeen military veterans and service members ( M age = 45.23, SD age = 10.18; 76.47% male) completed the program. Symptoms of posttraumatic stress disorder (PTSD) and depression were targeted in five separate cohorts. Given that this was an uncontrolled pilot study, we assessed patient satisfaction and treatment completion. In a completers analysis, PTSD and depression symptoms decreased significantly from pre- to posttreatment ( p' s < .05), with effect sizes of 1.22 and 0.85, respectively. Using recommended treatment response categories for the PCL-5, 76.47% were reliably changed at posttreatment. The dropout rate was 5.55%. Preliminary findings indicated that PTSD symptoms reductions were maintained from baseline to 1-month ( Cohen's d = 1.19) and 3-month ( Cohen's d = 1.46) follow-up. Delivering PE in a 4-day, intensive format was associated with clinically significant reductions in self-reported PTSD and depression symptoms. Additionally, completion rates and patient satisfaction were high, suggesting feasibility for patients.

Pilot program integrating outpatient opioid treatment within a rural primary care setting

Canada is experiencing an opioid crisis. In rural areas, limited access to specialty addictions services, public transportation, and many of the social determinants of health create a unique set of challenges for people who use substances. The Rural Outpatient Opioid Treatment (ROOT) program was created to bring some of the structure of an inpatient treatment program into a rural primary care setting in Ontario, Canada. The program uses a harm reduction approach to provide group recovery work, primary care, peer support, smoking cessation, opioid agonist therapy, screening and treatment for hepatitis C and HIV, and longitudinal follow-up. Sixteen participants have enrolled in three rounds of the ROOT program to date. A program evaluation shows that opioid use decreased while use of other substances remained high, in particular methamphetamine use, which is increasing more broadly in the local area. Participants described feeling cared for and appreciated the 'seamless' nature of the multidisciplinary program, the peer support provided, and their new and expanded social networks. The rural context created both benefits and challenges for their substance use, recovery, and for community programming. In conclusion, the evaluation of this pilot program demonstrates that it is possible to successfully integrate an outpatient substance-use treatment program into rural primary care.

Patients' perceptions of telehealth services for outpatient treatment of substance use disorders during the COVID-19 pandemic.

Background and ObjectivesThe rapid scale‐up of telehealth services for substance use disorders (SUDs) during the COVID‐19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management.MethodsTwo hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23‐item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics.ResultsParticipants were predominately male, White, and well‐educated. The majority (86.2%) were “very satisfied” or “satisfied” with the quality of telehealth care. “Very satisfied” ratings were highest for individual therapy (90%), followed by medication management (75%) and group therapy (58%). Top reasons for liking telehealth included the ability to do it from home (90%) and not needing to spend time commuting (83%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28%) and the ability for telehealth to be interrupted at home or work (26%).Discussion and ConclusionsTelehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy.Scientific SignificanceThis is the first study examining patients' perceptions of telehealth for outpatient SUD treatment during the COVID‐19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in‐person treatment, there was variability with respect to the preferred mode of treatment delivery.

Tobacco Dependence Treatment: Examining Cessation Effectiveness in Oncology Settings

The Wilmot Cancer Institute launched the Tobacco Dependence Treatment Program in 2015. Formal program evaluation consisted of 324 patients who presented for at least one visit to assess quit rates. The secondary aim was to ascertain the effectiveness of guideline recommendations that four or more visits would be beneficial in an outpatient oncology tobacco treatment program to promote success in smoking cessation. The first 32 months of program data revealed that there were significantly improved quit rates for those who were seen for four or more visits compared to those seen for three or fewer visits.

Psychometric assessment of two suicide screeners when used under routine conditions in military outpatient treatment programs.

Suicide remains a pressing problem among active-duty military personnel. Recent Department of Veterans Affairs and Department of Defense suicide prevention practice guidelines highlight the need for further screening research. The present study assessed the psychometric properties of 2 common self-report suicide screening tools: the Suicidal Behaviors Questionnaire-Revised (SBQ-R) and the Columbia Suicide Severity Rating Scale (C-SSRS) ideation subscale. Data (n = 200 active-duty personnel) were drawn from medical records and self-report questionnaires from 2 outpatient treatment settings in a military hospital. Primary findings include: (a) confirmatory factor analytic support for the SBQ-R but not the self-report version of the C-SSRS ideation severity subscale; and (b) acceptable reliability for both the SBQ-R and C-SSRS ideation severity subscale. Recommendations are offered for military suicide screening practice and research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Voices from the rooms and programs: recovery capital speaks

ABSTRACT People recovering from substance use disorders have a variety of options from which to choose to help them achieve their goal of sobriety. Often, they seek the assistance of peer- run 12-step programs such as Alcoholics Anonymous (AA). Others may seek professional help through residential or outpatient treatment programs, while some use both types of interventions. Both intervention options offer people in recovery viable assistance. With this in mind, the goal of this study was to further understand the factors influencing recovery (see, for further details1 1 Author’s Note: The previous 2018 paper and the current paper were based on my dissertation. ). Those factors, conceptualized as ‘recovery capital,’ have a consistent and positive impact on recovery. This study conceptualized recovery capital to include Alcoholic Anonymous, spirituality, social support, and physical capital. The author reviewed these factors through a historical and empirical discussion of Alcoholics Anonymous and treatment effectiveness.

Plasma concentrations of granulocyte colony-stimulating factor (G-CSF) in patients with substance use disorders and comorbid major depressive disorder

Granulocyte colony–stimulating factor (G-CSF) has raised much interest because of its role in cocaine addiction in preclinical models. We explored the plasma concentrations of G-CSF in patients diagnosed with substance use disorder (SUD) and highly comorbid psychiatric disorders. In particular, we investigated the association between G-CSF concentrations and comorbid major depressive disorder (MDD) in patients with cocaine and alcohol use disorders (CUD and AUD, respectively). Additionally, patients with MDD but not SUD were included in the study. Three hundred and eleven participants were enrolled in this exploratory study: 136 control subjects, 125 patients with SUD (SUD group) from outpatient treatment programs for cocaine (N = 60, cocaine subgroup) and alcohol (N = 65, alcohol subgroup), and 50 patients with MDD but not SUD (MDD group) from primary-care settings. Participants were assessed based on DSM-IV-TR criteria, and a blood sample was collected to examine the plasma concentrations of G-CSF. G-CSF concentrations were negatively correlated with age in the entire sample (r = − 0.233, p < 0.001) but not in the patients with MDD. G-CSF concentrations were lower in patients with SUD than in controls (p < 0.05), specifically in the cocaine subgroup (p < 0.05). Patients with SUD and comorbid MDD had lower G-CSF concentrations than patients with SUD but not comorbid MDD or controls (p < 0.05). In contrast, patients with MDD but not SUD showed no differences compared with their controls. The negative association between G-CSF concentrations and age in the sample was not observed in patients with MDD. G-CSF concentrations were decreased in patients with SUD and comorbid MDD but not in patients with MDD. Therefore, G-CSF may be useful to improve the stratification of patients with dual diagnosis seeking treatment. Further investigation is needed to explore the impact of sex and type of drug on the expression of G-CSF.

Trends in cannabis-related attitudes and behaviors among cannabis-using adolescent and young adult outpatients following medical cannabis legalization in Massachusetts

Background: Among youth already using cannabis, legalization of medical cannabis may influence cannabis-related attitudes and behaviors, including increasing access through use of someone else’s medical cannabis (diversion). Objective: To examine cannabis-related attitudes and behaviors (including diverted cannabis use) in cannabis-using youth in the four years following medical cannabis legalization. Additionally, we investigated characteristics of youth who used vs. did not use diverted medical cannabis. Methods: Data were collected in Boston from 2013 (when medical cannabis legislation took effect in Massachusetts) through 2016 (when recreational cannabis use became legal in Massachusetts). Cannabis-using youth (age 13–24) presenting to an outpatient adolescent substance use treatment program (ASUTP) or recruited for an adolescent medicine clinic study (AMCS) completed a confidential survey on demographic characteristics and cannabis use behaviors and attitudes. We used multiple logistic regression to analyze changes in attitudes and behaviors over three years versus the reference year (2013), controlling for demographics. We used chi-square to compare characteristics of youth reporting use of diverted medical cannabis versus those not. Results: The sample included 273 cannabis-using youth (ASUTP n = 203, AMCS n = 70; 2013 n = 67, 2014 n = 67, 2015 n = 77, 2016 n = 62). Mean ± SD age was 18.2 ± 2.5 years, 32% were female, 58% were White non-Hispanic, and 70% had college-graduate parents. In 2013, most youth reported that cannabis was easy to obtain (97.9%), and that occasional cannabis use had “no” or “slight” risk of harm (89.4%), with little change across years. In 2016, 44% of youth reported using someone else’s medical cannabis, versus 15% in 2013 (aOR 4.66, 95% CI 1.81, 11.95). Youth using diverted medical cannabis had higher likelihood of reporting riding with a driver, or driving themselves, after cannabis use (both p < .01). Conclusion: Among at-risk youth in Massachusetts, use of diverted medical cannabis increased after medical cannabis legalization, and those using diverted medical cannabis reported higher risk for cannabis-related traffic injury.

Buprenorphine Naloxone and Extended Release Injectable Naltrexone for the Treatment of Opioid Use Disorder Among a Veteran Patient Sample: A Retrospective Chart Review

Objective Previous research has demonstrated the effectiveness of both extended-release injectable naltrexone (XR-NTX) and buprenorphine/naloxone (BUP-NX) in the treatment of opioid use disorder (OUD). However, studies using real-world samples with multiple medical and psychiatric comorbidities are lacking. The study’s primary aims were to: (1) compare clinical presentations in an inclusive sample of OUD-diagnosed US military veterans receiving XR-NTX and BUP-NX, and (2) investigate differences in 90-day treatment outcomes between these two groups. Methods: The medical records of 79 patients receiving medications to treat OUD in a VA hospital’s addiction outpatient treatment program were reviewed retrospectively. The analysis included all veterans who initiated medication treatment during the study period. Differences between medication groups on co-occurring diagnoses, treatment retention, and related outcomes were examined. Results: The two groups were similar in medical and psychiatric comorbidity, although the BUP-NX group were more likely to have a pain diagnosis. No statistically significant differences in retention or toxicology results were found between the two groups over the 90-day study period. The rate of positive urine screens for the BUP-NX group was 19.2% for opiates and 13.5% for other illicit substances, and 3.7% and 11.1% respectively for the XR- NTX group. Conclusion: There was no evidence that 90-days outcomes differed for veterans based on medication received, and there were more similarities than differences in clinical characteristics. Additional research is needed, including larger sample size and prospective randomized control trial to evaluate VA patients’ treatment outcomes receiving BUP-NX or XR-NTX for OUD.

Course and Correlates of Stigma in Patients on Opioid Agonist Treatment: A Prospective Study from an Outpatient Treatment Program in India.

Background:Individuals with opioid dependence experience stigma and discrimination. Stigma can potentially reduce treatment-seeking and negatively affect treatment outcomes. We aimed to study the course of stigma and its correlates among patients receiving opioid agonist treatment (OAT).Methods:We recruited 51 subjects (aged between 18 and 45 years) registered in the OAT clinic from February to September 2019. We excluded subjects dependent on alcohol and other drugs (except for cannabis and tobacco), with severe mental illness, intellectual disability, and organic brain disease. We assessed the internalized and enacted stigma and quality of life at the treatment entry and after 3 months. Relationship of stigma with quality of life, socio-demographic, and other clinical variables were examined at the treatment entry.Results:Mean age of the subjects was 26.7 (± 5) years. At the end of three months, 33 (64.7%) patients were retained in the treatment. Internalized stigma correlated negatively with the social and environmental domains of quality of life. The strength of the correlations was modest. No significant correlation was found between demographic and clinical variables and internalized stigma and enacted stigma scores. Both internalized and enacted stigma scores reduced significantly at 3 months follow-up. The significance levels were retained even after controlling for the baseline quality of life scores. Stigma at the treatment entry did not predict early dropout.Conclusion:Despite higher severity at the treatment entry, the level of internalized and enacted stigma reduced significantly within three months of an outpatient-based OAT program.

Virtual Care in an Outpatient Subspecialty Substance Use Disorder Treatment Program.

This article reports on the experience of an outpatient adolescent substance use disorder treatment program transitioning to virtual care during the COVID-19 pandemic. We describe the processes used to make the transition, including development of a safety protocol for patients seen virtually, present clinical volume data before and after the transition, and we describe a range of patient experiences through 3 clinical vignettes. Using data from the electronic health record, we generated counts of the total number of scheduled and completed appointments between December 2019 and June 2020. We used simple proportions to calculate the completed visit rate. Both the absolute number of scheduled appointment and the percent of appointments completed increased with the initiation of virtual care, supporting the acceptability of this modality. Several patients experienced clinical improvements in conjunction with greater engagement, though challenges were also noted. Virtual visits are a practical mode of treatment for adolescent substance use disorders, and more evidence is needed to understand the risks and benefits of this treatment modality.

Dismantling weight stigma: A group intervention in a partial hospitalization and intensive outpatient eating disorder treatment program.

The authors piloted a weight stigma psychotherapy group at an eating disorder partial hospitalization (PHP) and intensive outpatient program (IOP). This was an optional, transdiagnostic eating disorder group for patients with past/present weight stigma experiences related to being in large bodies. A total of 36 individuals participated in the weekly group from June 2018 to June 2019 during their PHP/IOP episode of care. We present the group's overarching framework of destigmatizing language and intersectional discussions of weight stigma. We also discuss clinical processes that unfolded during this group including simulated dialog from the group. Finally, we present relevant client quotes that provide preliminary support for future exploration in this area, as client subjective experiences of the group were positive. Our preliminary pilot experience suggests that delivering a group of this nature in a PHP/IOP eating disorder treatment setting is feasible and that further work is needed to build upon this antiweight stigma framework as a critical piece of eating disorder treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Exploratory Study of Sex and Gender Differences in Demographic, Psychosocial, Clinical, and Substance Use Treatment Characteristics of Patients in Outpatient Opioid Use Disorder Treatment with Buprenorphine.

As treatment expansion in the opioid epidemic continues, it is important to examine how the makeup of individuals with opioid use disorder (OUD) is evolving. Treatment programs are increasingly utilizing buprenorphine, an effective OUD medication. This exploratory study examines sex and gender differences in psychosocial, clinical and substance use treatment characteristics of a clinical population in outpatient medication treatment for OUD with buprenorphine. This is a secondary data analysis from a cross-sectional survey study with retrospective medical record review conducted with patients recruited from an office-based opioid treatment clinic between July-September 2019. Participants on buprenorphine for at least 28 days at time of survey completion were included (n=133). Differences between men and women were explored with Pearson χ2 and Fisher's Exact Tests for categorical variables and T-Tests for continuous variables. The sample was 55.6% women and nearly three-fourths Black (70.7%). Mean days in current treatment episode was 431.6 (SD=244.82). Women were younger and more likely to be unemployed, identify as a sexual minority, and live alone with children than men. More women than men had a psychiatric comorbidity. Women reported more prescription opioid misuse while men had more heroin only opioid use. More men reported comorbid alcohol use and a history of drug overdose. One-third of participants reported recent discrimination in a healthcare setting due to substance use. As buprenorphine-based outpatient treatment programs continue to expand, present study findings support evaluation of the unique needs of men and women in order to better tailor OUD-related services and improve treatment outcomes.

COVID-19 in a New York City Behavioral Health Housing and Treatment System.

This study sought to characterize the incidence of COVID-19 illness, hospitalization, and death among congregate and noncongregate cohorts served by a New York City behavioral health agency. From March 9 to May 3, 2020, data were collected on COVID-19 symptoms, testing, hospitalization, and mortality for 8,256 individuals living in 29 congregate programs (residences and homeless shelters) or served by 41 noncongregate programs (scattered-site housing or outpatient treatment programs). Of the 218 (2.6%) individuals who developed COVID-19-like illness, 84 (39%) were able to obtain testing. Of the 77 individuals who tested positive, 49 (64%) were hospitalized and 19 (25%) died. Congregate housing, age over 45, and intellectual/developmental disabilities were significantly associated with hospitalization and death. Further research on risk and preventive factors is needed to address the high risk for people with serious mental illnesses and intellectual/developmental disabilities during a pandemic, particularly for those living in congregate housing.