Patterns Of Service Use Research Articles

Understanding the emergency accommodation use patterns of homeless families

This paper examines homeless families' shelter stay records to better understand their patterns of service use and how they exit, or remain, within emergency accommodation. Little is known of how homeless families' stay patterns vary from the general homeless population, or how such variation might be explained by structural or individual factors. The paper utilises a cluster analysis of homeless families stay records from 2012 to 2016 in Dublin, Ireland. The data (n = 2356) is drawn from the ‘Pathway Accommodation and Support System,’ which provides ‘real-time’ information on homeless presentation and bed occupancy. The results demonstrate that family homelessness is a significant problem in Ireland, arising from wider challenges in the Irish housing system. However, the majority of homeless families experience a relatively small number of homeless episodes for short periods of time. Most do not exhibit the kinds of complex needs that might necessitate additional social services, but simply require support in accessing affordable housing. Inter-cluster differences were found on the basis of household composition, migrant status, race/ethnicity and the type of emergency accommodation placement. The findings have implications for the operation of homeless accommodation in Ireland, and have relevance for policymakers in similar housing-welfare regimes.

Tracking and Profiling Repeated Users Over Time in Text-Based Counseling: Longitudinal Observational Study With Hierarchical Clustering.

Due to their accessibility and anonymity, web-based counseling services are expanding at an unprecedented rate. One of the most prominent challenges such services face is repeated users, who represent a small fraction of total users but consume significant resources by continually returning to the system and reiterating the same narrative and issues. A deeper understanding of repeated users and tailoring interventions may help improve service efficiency and effectiveness. Previous studies on repeated users were mainly on telephone counseling, and the classification of repeated users tended to be arbitrary and failed to capture the heterogeneity in this group of users. In this study, we aimed to develop a systematic method to profile repeated users and to understand what drives their use of the service. By doing so, we aimed to provide insight and practical implications that can inform the provision of service catering to different types of users and improve service effectiveness. We extracted session data from 29,400 users from a free 24/7 web-based counseling service from 2018 to 2021. To systematically investigate the heterogeneity of repeated users, hierarchical clustering was used to classify the users based on 3 indicators of service use behaviors, including the duration of their user journey, use frequency, and intensity. We then compared the psychological profile of the identified subgroups including their suicide risks and primary concerns to gain insights into the factors driving their patterns of service use. Three clusters of repeated users with clear psychological profiles were detected: episodic, intermittent, and persistent-intensive users. Generally, compared with one-time users, repeated users showed higher suicide risks and more complicated backgrounds, including more severe presenting issues such as suicide or self-harm, bullying, and addictive behaviors. Higher frequency and intensity of service use were also associated with elevated suicide risk levels and a higher proportion of users citing mental disorders as their primary concerns. This study presents a systematic method of identifying and classifying repeated users in web-based counseling services. The proposed bottom-up clustering method identified 3 subgroups of repeated users with distinct service behaviors and psychological profiles. The findings can facilitate frontline personnel in delivering more efficient interventions and the proposed method can also be meaningful to a wider range of services in improving service provision, resource allocation, and service effectiveness.

Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study

BackgroundSuicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20–64 from 2009 to 2021, emphasizing disparities related to SES.MethodsThis is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions.ResultsOur results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women.ConclusionMental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

Patterns of service needs and use by subgroups of youth experiencing homelessness

ABSTRACT Service use predicts exit from homelessness and improvements in physical and mental health among youth experiencing homelessness (YEH). However, service use among YEH remains low. This study uniquely examined youths’ reported needs and patterns of service use during and after the COVID-19 pandemic. Baseline data were examined from a large opioid prevention project conducted in a midwestern, service-rich metropolitan area. YEH (n = 240), between the ages of 18–24 years, were recruited from a drop-in center and other non-service locations. Youth completed self-report questionnaires about their service needs and utilization over the prior three months. The most common services YEH needed were housing (n = 233, 97.5%), drop-in center (n = 194, 81.2%), identification and birth certificates (n = 118, 49.6%), medical care (n = 110, 46.0%), dental care (n = 106, 44.4%), employment counseling (n = 97, 40.6%) and mental health and emotional life counseling (n = 91, 38.1%). Most service needs were unfulfilled. Youth showed extreme service need overall, but other than drop-in centers, the youth reported limited use of most services. The limited use of needed services underscores the importance of future efforts toward improving service use for those in need.

The demographic and diagnostic profile of women with intellectual disability and mental health disorder in New South Wales and patterns of service use: A data linkage study

AbstractBackgroundCurrent evidence indicates that intellectual disability and gender are both factors in differential usage of services. However, there are limited data about the demographic and service usage patterns of people with intellectual disability who use mental health services. This is particularly true in relation to women with intellectual disability with mental ill health. Interrogation of large‐scale linked data sets can provide valuable insights into patterns of service usage among marginalised groups.MethodA large collaborative data linkage project was assembled with the overarching aim of providing an epidemiological profile of the health (including mental health), health service use, mortality and other service system contacts of people with intellectual disability in New South Wales (NSW), Australia. These linked data were used to interrogate the demographic, diagnostic and service use profiles of women with intellectual disability who have sought mental health support in NSW.ResultsThe linked data demonstrated important differences in patterns of diagnosis and service use for women with intellectual disability and mental health disorders, when compared to women without intellectual disability and men with and without intellectual disability, with mental health disorders. The diagnostic profile of women with intellectual disability reflected the gendered nature of diagnoses found in the wider population. Women with intellectual disability also experienced higher rates of diagnostic instability than other groups.ConclusionsThe intersection between gender, intellectual disability and mental health has an effect on diagnostic profile and patterns of service use for women with intellectual disability. These differences are important and may impact targeted service delivery and planning for women with intellectual disability who have sought mental health support.

Family Service Use and Outcomes for Youth With Disabilities

Families of youth with disabilities often access services to promote youth’s transitions to adulthood. Such services can be oriented toward the youth or family. Using descriptive statistics and regression modeling of survey and administrative data, we explored patterns of service use and the association between outcomes for 9,013 youth with disabilities who enrolled in a demonstration project. Those randomly assigned to a treatment group used family services more frequently than those in a control group, and youth in families using family services were more likely to use services themselves. The use of family and youth services together was associated with better youth employment. Because few programs offer family services, policymakers and practitioners might consider ways to connect families to such services.

THE USE OF AMBULATORY VERSUS EMERGENCY SERVICES AMONG SENIOR ADULTS WITH LIMITED ENGLISH PROFICIENCY

Abstract Senior adults who are immigrants with limited English proficiency may have difficulty accessing health and social services. However, identifying patients with LEP in large databases such as insurance claims has historically been challenging. We overcome this with two strategies. First, we conducted focus groups among older Spanish and Chinese speakers. Based on the findings we hypothesize that 1) we can expect distinct patterns of service use associated with a common language and 2) Chinese speakers are more likely than Spanish speakers to use ambulatory services and less likely to use emergency services because Chinese speakers feel more confident in their ability to navigate formal systems. Next, we obtained data on Spanish and Chinese speakers aged 60 and older and living in Philadelphia from a regional health information exchange, including routinely collected data on patients’ primary language and English proficiency. We are using the data to test our hypotheses regarding these specific LEP populations. The data will be used as pilot for a study to further investigate attitudes and perceptions of formal care providers in these two LEP communities.

PRINCIPAL COMPONENT ANALYSIS OF GENERATIONAL PREFERENCES REGARDING OVERTHE- TOP SERVICES – A HUNGARIAN CASE STUDY

The rise of video streaming services has not only increased the popularity of the platforms available, but has also changed the way households consume content, displacing the options offered by traditional television. The orientation was to apply a specific interdisciplinary scientific approach, combining economics and sociology, due to the research area of the study. The advantages/disadvantages of streaming platforms may play a role in the perceptions of different age groups of users by the service provider they choose. The aim of the research is to focus on the different video streaming consumption habits of the various generations (Generation X, Generation Y, Generation Z) as customers of Netflix, HBO Max, and Disney+, the widely known video streaming providers as reflected in the literature review. A Likert-scale questionnaire survey was considered the most appropriate method to achieve this objective. In order to test the hypothesis on the relationship between generations and video streaming usage a principal component analyses by generation was applied. The separation of variables resulted in the establishment of two groups, namely manipulation (indicating the influence of the traditional way of life) and enjoyment (influencing the choice and customer retention of service providers). The results of the study indicate that the generational characteristics of consumers partly show different patterns of service use, and that the impact of service use on traditional lifeways differs between generations. The analysis highlights the importance of further researches in this area, as the factors explored can be extended to other important issues in the future.

The relationship between region of residence, socio-demographic factors, and healthcare utilization among Saudi citizens: insights from the 2013 Saudi Health Interview Survey.

There is a dearth of research on the nature and extent of variation in patterns of health service use in Saudi Arabia. This is an important gap in knowledge, given ongoing efforts to improve service provision and delivery. This study examined the relationship between the region of residence and socio-demographic factors and patterns of health service use in Saudi Arabia. Data were taken from the 2013 Saudi Health Interview Survey (SHIS), a national multistage survey of individuals aged 15 years and above in Saudi Arabia. Data included measures of service use, respondent health, socio-demographic characteristics, and region or area of residence. Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were used to describe the data and examine the likelihood of a respondent visiting a doctor or healthcare professional in the preceding 12 months. In addition, the analyses examined the role of health and socio-demographic characteristics within selected regions. The increased likelihood of using health services in terms of visiting a doctor or healthcare professional was related to poor health status, being female, married, having a low income, and residing in particular regions. Respondents aged <65 and who lived furthest from service providers were less likely to visit a doctor or other health professionals (p < 0.01). Residents who lived in Riyadh, Al Medina, Baha, or Aseer demonstrated a higher likelihood of service utilization compared to respondents residing in other regions (p < 0.05). In sub-group analyses, there was variation between regions with respect to socio-demographic status and distance to service. Region of residence and income level, in particular, may help to explain the likelihood of primary care use in Saudi Arabia and the distinct patterns of service use in relation to regional and socio-demographic characteristics. The relationship between regional variation in service utilization and the socio-demographic characteristics of respondents may reflect differences with respect to population need, enabling, and predisposing factors as represented in Anderson's Behavioral Model (ABM) of health service use. The findings from this study underscore the importance of considering region or area of residence when seeking to understand the utilization of health services, particularly primary care services.

Identifying user profiles of healthcare, social and employment services in a working-age population: A cluster analysis with linked individual-level register data from Finland.

A thorough understanding of the use of services in the population is important in order to comprehend the varying service needs of different groups. This explorative study aimed to find distinct user profiles in a working-age population based on individuals' annual use of healthcare, social and employment services and to explore socio-demographic and morbidity-related predictors of the user groups. Administrative register data on the use of various services and individual-level covariates from year 2018 were linked for all residents aged 18-64 of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their frequency of using 22 distinct healthcare, social and employment services during 2018. Multinomial logistic regression models were utilized to assess the associations of cluster assignment with socio-demographic and health-related covariates (sex, age, marital status, education, occupational class, income, days in employment, chronic disease and receipt of different social benefits). Five distinct clusters were identified in terms of service use, labelled low to moderate users of healthcare (82.0%), regular employment services users with moderate use of healthcare (9.6%), supported employment services users with moderate use of healthcare with an emphasis on preventive care (2.9%), frequent users of healthcare, social and employment services (2.9%), and rehabilitation, disability services and specialized healthcare users (2.6%). Each cluster not only showed different patterns of service use but were also differently associated with demographic, socio-economic and morbidity-related covariates, creating distinct service user types. Knowledge on the different user profiles and their determinants may help predict future need and use of services in a population, plan timely, coordinated and integrated services, and design early interventions and prevention measures. This is important in order to save costs and improve the effectiveness of services for groups with different care needs.

Clustering users of healthcare, social and employment services: a register study from Finland

Abstract Background Understanding the population's overall use of healthcare, social and employment services is important for comprehending service needs and improving the coordination of services. The aim of this exploratory study was to find separate groups in a working-age population based on individuals’ use of various healthcare, social and employment services during one year and to investigate sociodemographic and health-related predictors of user groups. Methods Administrative register data on the use of 22 distinct healthcare, social and employment services and on socio-demographic and health-related covariates from year 2018 were linked for all working-age residents of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their yearly frequency of using each service. Multinomial logistic regression was used to assess the associations of sociodemographic and health-related covariates with cluster assignment. Results Five distinct clusters were identified, labelled ‘low to moderate users of healthcare’ (82%), ‘regular employment services users with moderate use of healthcare’ (10%), ‘supported employment services users’ (3%), ‘frequent users of healthcare, social and employment services’ (3%) and ‘disability and specialized services users’ (3%). Each cluster showed different patterns of service use and was also uniquely associated with sociodemographic and health-related covariates, reflecting distinct service user types. Conclusions The study identified five distinct groups of healthcare, social and employment services users in a working-age population. Knowledge of different user profiles and their determinants can help predict future need and use of services, coordinate and integrate services, and plan early interventions and prevention measures. This is important in order to save costs and improve the overall quality and effectiveness of services for groups with different care needs. Key messages • In terms of their use of healthcare, social and employment services, the working-age population can be classified into distinct groups, uniquely associated with various determinants. • Understanding the population’s use of different services can help predict future needs and improve coordination, integration and effectiveness of services in groups with different needs.

Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults.

Describe use of home-based clinical care and home-based long-term services and supports (LTSS) using a nationally representative sample of homebound older Medicare beneficiaries. Cross-sectional study. Homebound, community-dwelling fee-for-service Medicare beneficiaries participating in the 2015 National Health and Aging Trends Study (n= 974). Use of home-based clinical care [ie, home-based medical care, skilled home health services, other home-based care (eg, podiatry)] was identified using Medicare claims. Use of home-based LTSS (ie, assistive devices, home modification, paid care, ≥40hours/wk of family caregiving, transportation assistance, senior housing, home-delivered meals) was identified via self or proxy report. Latent class analysis was used to characterize patterns of use of home-based clinical care and LTSS. Approximately 30% of homebound participants received any home-based clinical care and about 80% received any home-based LTSS. Latent class analysis identified 3 distinct patterns of service use: class 1, High Clinical with LTSS (8.9%); class 2, Home Health Only with LTSS (44.5%); and class 3, Low Care and Services (46.6% homebound). Class 1 received extensive home-based clinical care, but their use of LTSS did not meaningfully differ from class 2. Class 3 received little home-based care of any kind. Although home-based clinical care and LTSS utilization was common among the homebound, no single group received high levels of all care types. Many who likely need and could benefit from such services do not receive home-based support. Additional work focused on better understanding potential barriers to accessing these services and integrating home-based clinical care services with LTSS is needed.

Use of urgent, emergency and acute care by mental health service users: A record-level cohort study.

People with serious mental illness experience worse physical health and greater mortality than the general population. Crude rates of A&E attendance and acute hospital admission are higher in people with serious mental illness than other hospital users. We aimed to further these findings by undertaking a standardised comparison of urgent and emergency care pathway use among users of mental health services and the general population. Retrospective cohort analysis using routine data from 2013-2016 from the CUREd dataset for urgent and emergency care contacts (NHS 111, ambulance, A&E and acute admissions) and linked mental health trust data for Sheffield, England. We compared annual age- and sex-standardised usage rates for each urgent and emergency care service between users of mental health services and those without a recent history of mental health service use. We found marked differences in usage rates for all four urgent and emergency care services between the general population and users of mental health services. Usage rates and the proportion of users were 5-6 times and 3-4 times higher in users of mental health services, respectively, for all urgent and emergency care services. Users of mental health services were often more likely to experience the highest or lowest acuity usage characteristics. Current users of mental health services were heavily over-represented among urgent and emergency care users, and they made more contacts per-person. Higher service use among users of mental health services could be addressed by improved community care, more integrated physical and mental health support, and more proactive primary care. A complex pattern of service use among users of mental health services suggests this will need careful targeting to reduce avoidable contacts and optimise patient outcomes.

A comparative examination of the role of need in the relationship between dental service use and socio-economic status across respondents with distinct needs using data from the Scottish Health Survey

BackgroundDisparities in oral health and distinct patterns in service use related to socio-economic status have been shown to exist in the United Kingdom. A number of studies have used the Andersen behavioural model to better understand the factors that influence utilization and thereby inform policies aimed at improving service uptake. As the nature of need may differ across distinct types of patients, however, so too may the distribution of enabling and pre-disposing factors and observed relationships between need, other factors and service use. In this study we compare samples with distinct self-assessed needs in terms of their characteristics and patterns of service use to compare application of the Andersen model to dental services among respondents to a population based survey.Materials and methodsData were taken from the Scottish Health Survey, for 2019. Data on service use, oral hygiene habits, perceived treatment need, and socio-demographic characteristics were extracted. Data were analysed using descriptive statistics, t-tests and ordered logistic regression analyses.ResultsTwo thousand one hundred forty-eight usable responses were obtained from the survey, 74.95% of the sample had visited the dentist less than a year ago, 11.82% between 1 year and up to 2 years ago, 7.12% between 2 and 5 years ago and 6.10% more than 5 years. Descriptive statistics, t-tests and ordered logistic regression analyses revealed distinct patterns of service use when the sample was partitioned based on perceived treatment need. Specifically those with self-assessed treatment need were older, more likely to smoke, be male and be less likely to have a degree than those who did not. While service use was positively related to age (predisposing) among those who did not have self-assessed treatment need, it was negatively related for those with perceived treatment need. Distinct patterns were also evident with respect to sugar exposure (need) and ease with which time off work could be organised (enabling).DiscussionThe study shows common and distinct patterns of service use related to enabling and predisposing factors across groups differentiated by self-perceived treatment need. If inequalities in health and healthcare use are to be addressed, it is important to understand their origins. Conflation of distinct types of need that may correlate with predisposing and enabling factors complicates this.ConclusionIn applying the Andersen model, it is important to take account of potential differences in the types of need expressed where possible to understand the role of other variables in service use.

THE ROLE OF FAMILIES IN FACILITATING USE OF HOME-BASED SERVICES

Abstract Homebound older adults rely on home-based clinical services (e.g., home based medical care) and long-term services and supports (e.g., caregiving support, environmental modifications) to remain living at home, however patterns of service use are unknown. Using data from the 2015 National Health and Aging Trends Study linked to Medicare Claims Data, we identified a population of homebound older adults enrolled in fee-for-service Medicare (n=1066). Latent class analysis identified 3 distinct patterns of home-based service use: low (36%), medium (51%), and high (13%) service use. High family caregiving support was particularly prevalent in the medium service group (35% with over 40 hours of family care per week), but receipt of home-based medical care was minimal in this group. Additional support to connect family caregivers with other home-based services may improve care and outcomes for older adults living at home.

Challenges facing interventions to promote equity in the early years: exploring the ‘impact’, legacy and lessons learned from a national evaluation of Children’s Centres in England

ABSTRACT This paper discusses the challenges facing a national evaluation of an early years intervention programme, Sure Start Children’s Centres (SSCCs), that was implemented across England in the first decade of the 21st century. The paper describes the rationale for the evaluation’s mixed methods research design and the ecological theoretical approach adopted. It investigates the SSCC policy aim of combatting the ‘impact’ of multiple disadvantage on outcomes for families, parents and children. Based on a clustered sample (2,600 families) it provides evidence of statistical effects for different user groups, including non-users. It points to the complexities in evaluation in non-experimental interventions where there was an emphasis on services to meet local needs and where families could choose which services to access and change patterns of service use over time. The paper synthesises findings and considers how complex, volatile and uncertain environments affected SSCC provision, particularly linked to a change of government and austerity policies after 2010. The paper identifies lessons learned, explores implications for future early years interventions in uncertain times, and proposes alternative approaches to evaluation (a realist approach based on mixed methods and theoretically driven models) where randomised experimental designs are inappropriate for the evaluation of certain complex policies.

Predictors of amounts of child and adolescent mental health service use

The aim of this study was to build evidence about how to tailor services to meet the individual needs of young people by identifying predictors of amounts of child and adolescent mental health service use. We conducted a secondary analysis of a large administrative dataset from services in England was conducted using the Mental Health Services Data Set (years 2016–17 and 2017–18). The final sample included N = 27,362 episodes of care (periods of service use consisting of at least two attended care contacts and less than 180 days between care contacts) from 39 services. There were 50–10,855 episodes per service. The descriptive statistics for episodes of care were: Mage = 13 years, SDage = 4.71, range = 0–25 years; 13,785 or 50% male. Overall, there were high levels of heterogeneity in number of care contacts within episodes of care: M = 11.12, SD = 28.28, range = 2–1529. Certain characteristics predicted differential patterns of service use. For example, young people with substance use (beta = 6.29, 95% CI = 5.06–7.53) or eating disorders (beta = 4.30, 95% CI = 3.29–5.30) were particularly more likely to have higher levels of service use. To build on this, evidence is needed about predictors of child and adolescent mental health treatment outcome and whether the same characteristics predict levels of improvement as well as levels of service use.

Exploring a novel linked dataset and building linked data analytics skills in Public Health Intelligence teams in Sussex.

ObjectivesPublic health intelligence teams in Sussex wanted to use newly linked health and social care data, to gain insights into local patterns of multi-morbidity, service use, service provision and socio-demographic data. In this study we report initial exploration of this new linked dataset, in a partnership between university and local authority analysts. ApproachThe Sussex Integrated Dataset (SID) comprises person-level health and social care data on residents and services users across Sussex. During a 6-month secondment, two analysts evaluated the number of data sources available for each individual, evaluated data quality for identifying long-term conditions, developed presentation methods to compare SID outputs on demographics and condition prevalence with open source or expected distributions, and identified the skills-mix and infrastructure required in local authorities for future work. They worked alongside the SID data processing team to inform and improve data quality; and with university data-scientists to learn prediction modelling. ResultsAnalysts established an efficient querying system to investigate the breadth of data available, more thoroughly focusing on encounters and demographic data in all sources. Long-term conditions were identified through code lists in a range of NHS data sources, to enable consideration of multi-morbidity by demographic. A range of quality issues were identified, such as non-current patients being uploaded into the SID, distorting prevalence estimates, and GP practice populations that did not match expected figures published by NHS digital. Results were represented in multi-morbidity plots, maps, and theographs. Through this data exploration, we have been able to identify the skills-mix needed for local Public Health Intelligence teams to maximise the use of linked data to achieve Public Health objectives. ConclusionWe have made many conceptual breakthroughs, particularly in understanding data quality, however still need a more complete understanding of quality issues in SID for public health outputs to have meaningful use. Further investigation into the patterns of service use, as well as modelling of multi-morbidity to make predictions and target interventions, will be key next steps.

Early intervention and special education in New York City: Patterns of service use and disparities affecting children of colour.

Compliance with the requirements of the Individuals with Disabilities Education Act (IDEA) in the United States is monitored through review of cross-sectional reports from three discrete, age-defined programmes (early intervention [EI], early childhood special education [ECSE)] and school-age special education [SE]) to promote the timely, efficient and effective delivery of appropriate services to all eligible children. Analysis of longitudinal data is required to discern how children use services across programmes to provide the necessary context for IDEA oversight and to identify areas for programme or policy interventions to reduce barriers to service use and promote equity. We applied sequence analysis to a data linkage across five public record systems among 15 626 New York City children born in 1998 who had records from birth through third grade. Five predominant patterns of service use were identified: (1) multiple therapies across EI/ECSE/SE (13%), (2) EI without transition to Department of Education schools or services (24%), (3) EI and intermittent ECSE/SE (16%), (4) older entry into EI and both speech and occupational therapy throughout ECSE/SE (9%) and (5) limited EI use and mostly speech therapy in ECSE/SE (38%). Each pattern had distinct demographics (e.g., pattern 2 was disproportionately White and from low poverty neighbourhoods; pattern 4 was disproportionately male and Black; pattern 5 was disproportionately Latino) and academic outcomes (e.g., pattern 1 had largest proportion in a SE school and not tested in third grade; pattern 3 had third grade tests scores that were similar to overall citywide mean scores). The differences in demographic profiles across the five patterns of service use illustrate the systemic inequities in the delivery of these important services. Delayed entry and limited use of EI services among children of colour underscore the need for equity goals to increase early referral and optimize service use.

Patterns of Service Use in Intensive Case Management: A Six Year Longitudinal Study

An Intensive Case Management (ICM) intervention has been developed in Lausanne, Switzerland. It aims to promote access to care for people with severe mental disorders who have difficulties to engage with mental health services because of the severity of their disorders and/or their marginality. ICM embrace components of assertive community treatment and critical time intervention. It is time limited and focused on critical phases of recovery. The goal of this study was to examine the heterogeneity of service use patterns of people who required ICM interventions and identify differences in patterns of duration and timing of the intervention. Records of 471 patients from the Department of Psychiatry of Lausanne University Hospital for whom the ICM team intervention was requested were analysed over a 6 year period with discrete sequential-state analysis. Trajectories could be split between six meaningful clusters including service light use and critical time intervention (58.0%), transition to long-term regular ambulatory-care (11.3%), partial transition to ambulatory care (14.4%), alternative to hospitalization (10.4%), continued ICM (4.9%) and long hospital stays (1.1%). Diagnoses of substance abuse were overrepresented among heavy users and diagnoses of schizophrenia were the most frequent diagnostic overall. Profiles of service use for ICM patients were very diverse. Long term interventions were frequently not necessary. A time-limited intervention was likely sufficient to stabilize the situation and/or engage the patient in care. A small number of situations required a sustained and long-term investment and did not always allowed for a reduction in the need for hospitalization. A general reflection on alternatives to hospitalization must be pursued, in particular for these patients.