This case report describes the presentation and clinical care of an 8-year-old girl treated in an eating disorder partial hospitalization program (PHP) for Avoidant/Restrictive Food Intake Disorder (ARFID), fear of aversive consequences subtype, who had never transitioned from liquids and purees to solid food. The patient's choking fears manifested as complete avoidance of solid foods, maladaptive mealtime behaviors, marked food selectivity, and significant emotional, cognitive, and interoceptive distress. This report describes the successful use of multimodal therapy, including Family-Based Treatment (FBT) and Cognitive Behavioral Therapy for ARFID (CBT-AR), adapted for a higher level of care and delivered using an inhibitory learning-informed exposure framework, in combination with psychopharmacologic treatment. This case highlights the applicability of the inhibitory learning approach to exposure therapy within CBT-AR for pediatric choking phobia and underscores the value of PHP-level of care for younger children with severe ARFID. It also suggests that targeting anxiety, appetite, and cognitive rigidity with psychopharmacological treatments may increase food approach and interest in patients with specific food- and eating-related phobias. Finally, the report illustrates the successful treatment of an atypically severe, longstanding illness and offers clinical guidance for similar cases.

Eating disorders (EDs) are prevalent in the adolescent and young adult populations, and there is a significant burden of disease with high morbidity and mortality. Many patients do not initially seek ED subspecialty care, and primary care clinicians must identify and treat these patients with the help of a multidisciplinary team of ED-specialized dietitians, therapists, and psychiatrists. The primary care clinician must also be able to monitor for and identify medical instability or failure of outpatient treatment and recommend a higher level of care if necessary. Higher levels of care include medical inpatient treatment, psychiatric inpatient treatment, residential programs, partial hospital programs, and intensive outpatient programs. For optimal treatment outcomes, it is critical to select the appropriate level of care for each patient and step down as indicated.

Adequate geographic access to eating disorder treatment is essential for timely care. Yet the distribution of in-person and telehealth programs, and their accessibility across urban and rural settings and across communities with different socioeconomic conditions, remains unclear. We combined an official registry of eating disorder programs from the National Alliance for Eating Disorders with an AI-augmented web corpus built from U.S. domains using ISTARI.AI and large language models. After cleaning and linkage, we analyzed 328 registry centers for in-person care and an augmented set of 2,045 physical sites for proximity checks; telehealth programs were mainly limited to intensive outpatient and partial hospitalization. In-person accessibility was estimated at the census tract level with the two-step floating catchment area method (2SFCA) using program-based capacity. Telehealth accessibility used an unbounded two-step virtual catchment area (u2SVCA) that discounts demand by internet subscription. We also derived tract-level proximity indicators within 30 miles, namely nearest distance and the best available facility size. Population and covariates came from the American Community Survey and the 2020 Census. Multivariable ordinary least squares models related accessibility to median household income, rurality, education, insurance, and race or ethnicity. Correlation-based sensitivity analyses compared metrics across data sources and service regimes that either permit cross-state care or restrict care to within-state. Large language models classified employee size from web summaries with an accuracy of 0.641 and Cohen's kappa of 0.176. In-person access concentrates in metropolitan corridors, with longer distances and lower accessibility in rural tracts; allowing cross-state care improves proximity near many borders, while within-state constraints reduce reachable capacity across interior states. Telehealth per capita availability varies by state, and effective telehealth access declines after discounting by subscription, with lower values across parts of the South and interior West and the longest mean distances in Alaska. Regression models show strong rural and income gradients. Higher income and urban residence are associated with shorter distance and higher accessibility, while rurality is associated with poorer access for both in-person and telehealth measures. Conditional associations for Black and Latine population shares are small once socioeconomic factors are included. Proximity metrics from the AI-augmented set are moderately correlated with registry-based 2SFCA scores, and telehealth and in-person accessibility show lower but nonzero correlation, suggesting that telehealth and in-person measures capture partially distinct dimensions of potential access, while cross-source differences may also reflect coverage and measurement differences. Eating disorder treatment access remains uneven across the United States. In-person capacity is sparse outside metropolitan regions, and telehealth expands potential reach but remains constrained by broadband subscription and state-based administrative boundaries. Combining registry data with AI-augmented provider information and paired in-person and telehealth accessibility models can help identify communities with limited access. These findings support policy efforts to expand cross-state practice pathways, improve broadband affordability and availability, and increase transparency in program capacity reporting.

The objective of this study was to examine how DBT in a PH and IOP setting effect change scores in clinical symptoms and mindfulness. This research examined outcomes with a heterogeneous sample of patients including 171 adults that attended either a PH program or an IOP in 2023 (N = 87) and 2024 (N = 84). This current study assessed intake/discharge data to examine change scores in symptoms of depression, anxiety, stress, hopelessness, and post-traumatic stress disorder (PTSD). Mindfulness changes were also assessed. Findings showed symptom reduction on all clinical scales and mindfulness increased on some sub-scales for patients in both programs. Mindfulness was analyzed and reported separately from other clinical symptom variables, depression, anxiety, stress, hopelessness, and PTSD. This is because mindfulness represented a core DBT skill and a hypothesized mechanism of change rather than a symptom outcome. As such, mindfulness outcomes were examined independently alongside changes in clinical symptoms. DBT-PH programs or IOPs may have benefits for patients seeking a more intense alternative to standard outpatient treatment or as an alternative to residential treatment.

Borderline personality disorder (BPD) diagnoses reliably predict worse mental health treatment outcomes. It is unknown whether multidimensional models of psychopathology, increasingly viewed as viable alternatives to traditional diagnostic systems, can match BPD's predictive power in clinical settings. In a sample of 2,625 partial hospital patients, we compared BPD with internalizing and harmful substance use dimensions as predictors of treatment success, defined by improvement in symptom severity, functional impairment, and quality of life. On a bivariate level, BPD features were moderately related to posttreatment functional impairment (r = .28) and quality of life (r = -.24), but not self-rated symptom improvement (r = .04). When adjusting for internalizing and harmful substance use, however, BPD features had very little unique predictive power. Instead, the internalizing spectrum was the strongest, most consistent predictor of symptom and functional improvement. This pattern of effects suggests that broad dimensions of psychopathology, particularly internalizing, capture much of BPD's prognostic utility in a partial hospital setting. We advise more attention to how the traditional BPD diagnosis compares to broad psychopathology dimensions in terms of clinical utility. This study's data, analysis code, and materials are posted at https://osf.io/wpy7e. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Treatment of opioid use disorder in pregnancy among individuals with and without co-occurring stimulant use disorder: A retrospective cohort study.

Though perinatal psychiatric disorders affect the entire family, most perinatal mental health interventions only include mothers. Here, we detail the implementation of a single-session, virtual, family support group for partners and family members of mothers with perinatal psychiatric disorders. The family support group was created within a mother-baby partial hospital program for people experiencing perinatal psychiatric disorders. Patients in the program provided consent to contact their partner or family member. This person was offered participation in a complementary, one-hour virtual support group. Led by a clinical psychologist, the support group was designed to serve as a standalone psychoeducational intervention on perinatal mood disorders. Sessions were offered bi-weekly to facilitate access. Participants were asked to complete an anonymous survey soliciting mixed-method feedback about the group. Of 105 people who consented to contacting their family members regarding the support group, 70 (65%) family members reported interest, and of these, 45 (64%) attended a support group session. Among the 13 participants who provided feedback (29%), there was a high level of satisfaction (Client Satisfaction Questionnaire-8 M=27.25; score >24=high satisfaction) and the perception that participation increased their knowledge of and empathy toward their family member's experiences. The most common feedback was a desire for more sessions. In this pilot study, a virtual family support group was feasible and yielded high participant satisfaction. Future research should examine how this or other digital programs could make perinatal mental health care more accessible for partners and family members.

PurposeRates of adolescents with Autism Spectrum Disorder (ASD) and suicidality have increased. Dialectical Behavioral Therapy (DBT) historically has been found to be effective in targeting suicide risk across the lifespan. Adolescents presenting with parent-reported autism traits were compared to those with low traits on DBT outcomes and suicidality in this study. Moreover, therapeutic alliance was also examined.MethodsEighty-seven adolescents attended a 4-week DBT partial hospital program (PHP); parent-report was administered to assess ASD traits. Adolescents completed self-report questionnaires at admission and discharge on four DBT outcomes. Suicidality characteristics were examined through a structured interview.ResultsWe found that adolescents presenting with autism traits did not significantly differ from adolescents presenting with low or no autism traits on suicide ideation, suicide gestures, and self-harm. They did, however, significantly report fewer suicide plans and attempts. Across the sample, DBT was most effective in improving most of adolescents' outcome skills, and this did not significantly differ based on autism traits. We also found that therapeutic alliance ratings were significantly and positively associated with the improvement outcomes observed across this sample.ConclusionOverall, this research supports DBT use for adolescents presenting with autism traits and emotion dysregulation.

BackgroundDialectical Behavior Therapy's (DBT) original biosocial theory and subsequent iterations as a transactional model suggest that invalidating social and family environments can contribute to emotion dysregulation and patterns of self-invalidation that may lead to suicidal and non-suicidal self-injurious behaviors over time. To our knowledge, no studies have examined the relationship between parental and self-invalidation on suicidality in a treatment setting or longitudinally over the course of treatment from pre-to post-treatment. This study examined the relationship between youth-reported parental invalidation, self-invalidation, and suicidality over the course of treatment in a comprehensive DBT partial hospitalization program (PHP).MethodsTwo hundred sixty-four adolescents and young adults admitted to a four-week comprehensive DBT PHP that incorporated family, individual, and skills group therapy components. All patients completed surveys evaluating perceived parental-invalidation, self-invalidation, and suicidality pre- and post-treatment.ResultsPatients reported significant decreases on all outcome measures: perceived mother and father invalidation, self-invalidation, and suicidality after 4weeks. Changes (reductions) in both self-invalidation and mother invalidation were significant predictors of reduced suicidality.ConclusionComprehensive DBT is a viable treatment option for decreasing invalidation and suicidality in four weeks. These findings emphasize the importance of parent involvement in improving treatment outcomes for adolescents and young adults.

Associations Between Sleep and Adolescent Mental Health Before and During the COVID-19 Pandemic in a Partial Hospitalization Program

This column describes 3 mechanisms of therapeutic action in the treatment of mental and substance use disorders. These mechanisms include biomedical interventions, dyadic interventions, and interventions involving transdyadic social learning. Combining mechanisms of action offers the potential to augment treatment response. Intermediate levels of care (Intensive Outpatient Programs, Partial Hospital Programs, and Residential Treatment Centers) are generally designed to provide treatment combining all 3 mechanisms of therapeutic action in the service of helping patients better use outpatient treatment to pursue recovery.

Effectiveness of a CBT and DBT-based partial hospital program across ethnoracial identities.

Many forms of psychiatric treatment include social experiences as part of treatment. Patients often have both formal and informal opportunities to interact with their peers while receiving treatment in settings such as residential, inpatient, and partial hospital levels of care. However, patients' perceptions of these formal and informal social encounters are not routinely assessed in clinical care or clinical research, and the extent to which these social experiences are related to positive or negative outcomes during treatment is unclear. The authors developed a 19-item self-report measure of social experiences during treatment, with input from stakeholders comprised of former patients at the study site. 470 adults receiving psychiatric treatment at a partial hospitalization program then completed this novel measure, the "Fellow Travelers in Treatment" Scale, alongside symptom and personality measures. These measures were used to test the factor structure of the new Scale, and the hypothesis that more positive and more frequent social interactions would be associated with less post-treatment depression and anxiety symptoms. We also assessed whether more frequent and more positive social interactions with peers were related to established measures of extraversion and social anxiety. Finally, we conducted exploratory analyses of symptoms and frequency of specific social behaviors. Exploratory factor analysis (EFA) yielded a 3-factor solution for the measure, with domains of learning from others, frequency of social contact, and respect from peers; in addition, a separate set of items not included in the factor analysis assessed frequency of specific social behaviors. Broadly, these subscales showed the expected relationships with extraversion, social anxiety, and social support. Mostly consistent with hypotheses, higher levels of respect from peers and learning from peers were associated with lower depression and anxiety scores; however, frequency of social contact was unrelated to symptom measures. Results of this preliminary study illustrate the potential value of assessing patients' social experiences with peers during acute treatment, and demonstrate that peer social interactions are a significant correlate of treatment outcome. Future research is needed to further establish the validity of this novel measure.

Background/Objectives: In recent decades, new technologies have been progressively integrated into various areas of mental health care. Mobile applications are potentially effective tools that allow psychiatric patients themselves to access self-management resources and tools within the community setting. Mental health nursing plays a key role in enabling patients to take an active role in their care and in promoting activities that foster their involvement and empowerment. The primary aim of this pilot study was to develop the PsyAPP mobile application to support both nurses and individuals with mental illness in managing care and improving health outcomes, and to assess its feasibility within a real-world clinical setting. Methods: A mobile application (PSYAPP) and a complementary web-based nursing management platform were designed and implemented. A total of 20 psychiatric patients enrolled in a partial hospitalization program in Soria (Spain) participated. Participants were assigned to experimental (app users) and control groups. Psychological empowerment, global functioning, and suicide risk were assessed before and after the intervention. Results: Patients who used the application showed significantly greater psychological empowerment (W = 2.04, p ≤ 0.04) compared with the control group. Statistically significant improvements were observed in psychological, social, and occupational functioning. Regarding suicide risk, no statistically significant changes were detected between pre- and post-intervention measurements in either group. Overall, PSYAPP demonstrated feasibility and potential utility as an innovative tool to support mental health care follow-up. Conclusions: This study developed and implemented a mobile application designed to enhance mental health care by supporting both patients and psychiatric nurses. Results showed significant improvements in global functioning in both the app and control groups, suggesting that rehabilitative treatment contributed to overall progress. Suicide risk did not significantly change within groups, although improvements were seen in the full sample, likely due to clinical care rather than app use. Only the experimental group demonstrated increased psychological empowerment, indicating that the app may effectively enhance patient engagement and involvement in their own care.

Eating disorders are often underdiagnosed and untreated. Among Medicaid beneficiaries, standard outpatient care is often the only service received for eating disorders. More severe cases, however, may require more intensive services (e.g., intensive outpatient, partial hospitalization, residential, or inpatient care). Medicaid is the largest public health insurance payer, but whether Medicaid beneficiaries have access to these services and what barriers to access they face remain unclear. This study aimed to investigate the availability of intensive eating disorder services across the United States and to identify factors affecting access to these services. A state-level database was developed by combining Medicaid claims data, National Alliance for Eating Disorders data on treatment centers, and publicly available state census information. Across 45 states and the District of Columbia, 384 eating disorder treatment centers providing intensive services were found. Five states had no treatment centers. Of the treatment centers found, only about one-quarter accepted Medicaid, and >90% accepted commercial health insurance. States with a lower proportion of Medicaid-accepting treatment centers tended to have larger populations, a higher percentage of the population living in urban areas, and more eating disorder treatment centers operated by large chains. Medicaid reimbursement rates did not appear to be significantly associated with care access, but these rates were not available in many states. Although access varied by state, most eating disorder treatment centers did not accept Medicaid. Additional studies are needed to investigate the unmet needs of Medicaid beneficiaries and ways to ensure access to adequate care.

Primary care is a common healthcare contact before suicide. When suicide risk is identified in primary care, patients are often referred to specialty outpatient mental health care. However, many do not initiate care. Strategies to improve the initiation of specialty outpatient mental health care among adults in primary care settings with suicidal thoughts and/or behaviours remain unclear. This scoping review operationalized implementation strategies used in primary care to facilitate the initiation of specialty mental health care. We used established methodology and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE, CINAHL, Embase, PsycInfo, and Google Scholar were searched for peer-reviewed articles in English that contained implementation strategies to improve the initiation of specialty outpatient mental health care among adults in primary care settings with suicidal thoughts and/or behaviours. We excluded abstracts, editorials, grey literature, and studies focused on intensive outpatient or partial hospitalisation programmes. At least two independent reviewers screened, completed a full-text review, and extracted study data. Implementation strategies were labelled and defined using the Expert Recommendations for Implementing Change (ERIC) strategies and operationalized using recommended reporting guidelines. Of the 606 citations screened, five studies were retained. An average of 8.6 unique strategies per study were identified. No study used an established taxonomy of strategies to label and define strategies nor stated all recommended reporting details. Common strategies aligned with ERIC strategies to 'promote adaptability', 'develop and implement tools for quality monitoring', 'remind clinicians', 'facilitate relay of clinical data to providers' and 'centralise technical assistance'. Studies generally reported strategies' actions, targets, timing, and outcomes, but inconsistently reported strategy actors, dose, and justification. Greater specification of implementation strategies to improve the initiation of specialty outpatient mental health care among adults in primary care settings with suicidal thoughts and/or behaviour is needed.

Background/Objectives: People suffering from mental illnesses are more likely to experience adverse social and health outcomes. Various interventions have been shown to help people with mental illness achieve better results in terms of symptom reduction, functional status, and quality of life. Psychiatric rehabilitation interventions integrate evidence-based practices, promising approaches, and emerging methods that can be effectively implemented to enhance health outcomes in this population. This study aims to examine whether the rehabilitative treatment provided to a group of patients with mental illness leads to improvements in health outcomes and psychiatric symptomatology. Methods: This study employed a retrospective quasi-experimental design. Data were collected between 2023 and 2025 within the Partial Hospitalization Program of the Psychiatry and Mental Health Service of Soria (Spain). The sample consisted of 58 participants who received rehabilitative treatment in this setting. Data were collected at the time of patients’ admission and at discharge. Gender, age, psychiatric diagnosis according to ICD-10, and the average length of stay in the rehabilitation program were assessed. The questionnaires administered were psychometrically validated scales related to heteroaggressiveness, perceived quality of life, global functioning, attitudes toward medication, and the risk of suicide. Results: A significant improvement was observed in the Global Assessment of Functioning (GAF) Scale (t = −7.1, p < 0.001), with mean scores increasing from 42.17 at admission to 69.13 at discharge. Additionally, reductions in suicidal risk and hetero-aggressive behavior were noted, alongside improvements in quality of life and treatment adherence. Conclusions: The findings highlight the effectiveness of implementing activities and programs focused on psychiatric rehabilitation processes to promote positive health outcomes. Future research directions and practical implications are discussed to support the continued development and optimization of psychiatric rehabilitation programs.

Introduction: in Latin America, access to specialized treatment for eating disorders (EDs) remains limited. Despite advances in detection and diagnosis, there are still major gaps in the availability of intensive and appropriate services, particularly outside large urban centers. Most existing treatment models were developed in high-income countries and do not always reflect the sociocultural, economic, and structural realities of the region. Objective: this report aims to document the implementation and evaluation of a scalable intermediate care model for EDs, with implications for adoption in public health systems across Latin America. Methods: the model integrates outpatient care and partial hospitalization through a structured three-phase therapeutic program focused on symptom interruption, cognitive-behavioral restructuring, and relapse prevention. The interdisciplinary team includes professionals in psychology, psychiatry, nutrition, and internal medicine, using evidence-based approaches adapted to the Mexican context. Since 2000, the program has treated over 700 patients diagnosed with anorexia nervosa, bulimia nervosa, binge eating disorder, and other ED presentations. Results: clinical data from a subsample of 502 patients indicate significant improvements in ED symptoms and psychological functioning, maintained at 6- and 12-month follow-up. Conclusion: this experience demonstrates the feasibility, effectiveness, and sustainability of an intensive outpatient model tailored to Latin American contexts. Its implementation may help bridge the treatment gap for EDs in middle-income countries and support the development of more equitable and accessible mental health systems in the region.

Borderline personality disorder (BPD) is a burdensome and diagnostically challenging condition. There is a need to identify its risk factors, yet prior studies are scarce and small-scale. We aimed to describe the prevalence of psychiatric comorbidities and the level of mental health resource utilization during adolescence in patients with BPD. We conducted a retrospective descriptive study of 938 participants (aged 18-26 years) with BPD at a large, multi-site, integrated health maintenance organization (HMO) system in Southern California. Data were collected from January 2010 to September 2020. Comorbidities of interest were other psychiatric conditions diagnosed before age 18. Healthcare utilization data included age of first psychiatry encounter, age at first psychiatric hospitalization, number of psychiatric hospitalizations per year, number of sessions of intensive outpatient group therapy and partial hospitalization, number of visits with a psychiatrist, number of crisis calls, and number of psychotherapy sessions. The analytic cohort included 816 (87.0%) female patients with a mean age of 22 years. BPD prevalence in the overall population was 0.1% (n=2,287). Comorbidities with the highest prevalence included depressive and anxiety disorders at 83.5% (n=783) and 69.6% (n=653), respectively. Suicidal ideation and suicide attempts were prevalent at 38.6% (n=362) and 0.5% (n=5). Before the age of 18 years, 70.7% (n=663) had a psychiatric visit, 86.7% (n=813) had psychotherapy, and 34.8% (n=326) had a psychiatric hospitalization. The findings of this study suggest high psychiatric comorbidity and healthcare utilization in patients with BPD. Given lower rates of adolescent suicidality, early intervention may decrease BPD-associated mortality. Psychiatric comorbidities may predict the risk of developing BPD. Future comparative analyses should validate the statistical significance of these predictors and whether screening improves BPD outcomes.

The therapeutic alliance, long regarded as a cornerstone of effective behavioral health treatment, remains difficult to measure and operationalize across diverse levels of care. This study examines how provider attachment style and related interpersonal characteristics—assessed through the Care Predictor Index (CPI), a 234-item psychometric instrument—predict patient retention outcomes across five behavioral health organizations. Drawing upon attachment theory, alliance research, and data from over six months of clinical practice, the study evaluates how therapist CPI scores correlate with treatment completion and discharges against medical advice (AMA) within detoxification, residential, partial hospitalization, intensive outpatient, and outpatient settings. The CPI integrates elements from the Adult Attachment Questionnaire (AAQ), the Counselor Activity Self-Efficacy Scales (CASES), and the Analog to Multi-Broadband Inventories (AMBI) to generate multidimensional provider profiles that capture attachment, confidence, and personality traits empirically linked to alliance formation. Findings demonstrate that therapists with CPI scores above 70 achieved higher treatment completion and lower AMA rates, underscoring the predictive validity of attachment-informed provider assessment. Beyond identifying measurable therapist level predictors, this analysis situates relational competence as a central determinant of program retention and proposes the CPI as a scalable mechanism for workforce development, quality improvement, and outcome optimization across the continuum of behavioral health care.