Study Of Service Use Research Articles

A Prospective Study of Service Use in the Year After Birth by Women at High Risk for Antenatal Substance Use and Mental Health Disorders

Maternal substance use (SUD) and mental health disorders commonly co-occur and require complex treatment. Information on women’s use of appropriate services in the perinatal period is limited. Data from the New Zealand Infant Development, Environment and Lifestyle Study were used to examine the characteristics of women with high probability of substance use and/or psychiatric disorder and rates of service use at 1 and 12 months following birth (n = 221). The Substance Abuse Subtle Screening Inventory-3 and the Brief Symptom Inventory were used to identify risk of disorder. Despite a high proportion of mothers with disorder risk, rates of specialist treatment remained low across SUD and psychiatric groups at 1 (27–39%) and 12 months postnatal (25–42%). Very low rates of women with comorbid disorder received both mental health and substance use treatments (1 month, 4.5%; 12 months, 7.3%). There was no association between service use and risk for psychiatric disorder at 12 months after birth. The findings suggest that even when services are publicly funded, they may be under-utilised or under-resourced to provide effective treatment, despite the high and complex needs of this population.

The study of service use among homeless persons with mental illness: a methodological review

The objective of this paper is to critically review the methods used to study service use by homeless persons with mental illness, and discuss gaps in the evidence base and research implications. Searches were conducted of PsycINFO, MEDLINE, and PubMed to identify service use studies published between 2000 and 2014. Data were extracted on the types of services studied, quantification of service use, assessment tools, period of service use assessment, and analytic design. The review identified 27 studies described in 46 publications. The majority of the studies had observational designs that measured service use quantitatively as an outcome variable. Receipt or non-receipt and volume of use were the most common methods of quantifying service use. The types of services that have been examined primarily consist of formal mental health, primary health care, substance use, homelessness, and housing services. There is a considerable gap in the understanding of personal outcomes associated with use of services, as well as people’s experiences of using services. Specific to the homeless mentally ill population, there is an urgent need to better understand the role of service use in the attainment of stable housing and recovery from mental illness. In addition, less formal health and related services, such as peer support, have been largely excluded in service use research.

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England.

ObjectivesTo evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.MethodsAn observational study of service use and admissions to institutional care was undertaken for a prospectively‐sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent ‘high’ or ‘low’ levels of integrated working practice and patients were followed‐up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission.ResultsPatients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types.ConclusionsIntegrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient‐reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

Parents and Court-Ordered Services: A Descriptive Study of Service Use in Child Welfare Reunification

Child welfare-involved parents use court-ordered services to resolve their problems and reunify with children removed from their care. Often this requires the use of multiple service types, service providers, and service locations. Very little research takes this diversity into account: Most studies of service use examine only a single service area. As a result, the field lacks information to guide the development of interventions to increase reunification service use. This descriptive study examines service use across the array of services ordered for a sample of 223 parents attempting to reunify with their children. Most parents had a mixed pattern of service use, with different patterns emerging by parent age, ethnicity, gender, and custodial status. These findings suggest that targeted interventions or service adjustments may be needed.

Social networks as the context for understanding employment services utilization among homeless youth

Little is known about the factors associated with use of employment services among homeless youth. Social network characteristics have been known to be influential in motivating people's decision to seek services. Traditional theoretical frameworks applied to studies of service use emphasize individual factors over social contexts and interactions. Using key social network, social capital, and social influence theories, this paper developed an integrated theoretical framework that capture the social network processes that act as barriers or facilitators of use of employment services by homeless youth, and understand empirically, the salience of each of these constructs in influencing the use of employment services among homeless youth. We used the “Event based-approach” strategy to recruit a sample of 136 homeless youth at one drop-in agency serving homeless youth in Los Angeles, California in 2008. The participants were queried regarding their individual and network characteristics. Data were entered into NetDraw 2.090 and the spring embedder routine was used to generate the network visualizations. Logistic regression was used to assess the influence of the network characteristics on use of employment services. The study findings suggest that social capital is more significant in understanding why homeless youth use employment services, relative to network structure and network influence. In particular, bonding and bridging social capital were found to have differential effects on use of employment services among this population. The results from this study provide specific directions for interventions aimed to increase use of employment services among homeless youth.

Health Care and Community-based Interventions for War-traumatized People in Croatia: Community-based Study of Service Use and Mental Health

To explore the use of health care and community-based services in war-affected regions of Croatia and its relation to mental health. A sample of 719 adults exposed to at least one war-related traumatic event were selected by random-walk technique from three Croatian counties and interviewed for socio-demographic data, mental health status (Mini International Neuropsychiatric Interview), and service use (Matrix for the Assessment of Community and Healthcare Services) in the period from 1991 to 2006. Descriptive analysis of service use was performed. Relations between service use, current mental health, and recovery from posttraumatic stress disorder (PTSD) were analyzed using logistic regression models. The traumatized population used a wide range of health care and community-based services. Health care was the most frequently used service category, especially primary health care (92.5%), followed by accommodation support (57.9%), financial support (57.7%), and employment support (32.5%). Compared with participants without mental disorders, participants with current PTSD were more likely to use only legal support (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.15-3.99), while participants with other mental disorders were more likely to use social support and contacts (OR, 1.72; 95% CI, 1.08-2.75). Receiving accommodation support (OR, 2.05; 95% CI, 1.03-4.06) was the only significant predictor of recovery from PTSD, while seeking legal support (OR, 0.28; 95% CI, 0.08-0.92) was related to slower recovery. Although a wide range of services were organized to help the traumatized population in Croatia, only the solution of housing issue significantly predicted recovery. The organization of help services should take into consideration the existing infrastructure and local specificities, and respect the needs of people in war-affected areas.

Service Use and Cost in 2002 Among Clients in Community Settings Who Were Discharged From a State Hospital in 1989

This analysis is a follow-up of a 1992 study of service use and cost of care among patients discharged from a state hospital. This study documented utilization and cost of care in 2002. Study participants were 150 former long-stay patients who were discharged from a state psychiatric hospital in 1989. An integrated database of all mental health and medical services reimbursed by Medicaid and Medicare as well as state- and county-funded services was used to construct descriptive statistics on service use and unit cost measures. Data on mortality, homelessness and criminal arrests were obtained from vital statistics, jail records and shelter admissions. During 2002, 18% of study participants had a psychiatric hospital admission, with a mean length of stay of 60 days. Almost all participants (99%) received some form of outpatient mental health care, and 66% were living in publicly funded residential housing. The total annual cost per study participant for the 2002 service package was $89,699. Residential care accounted for 54% of the total cost. Between 1989 and 2005, 3% were admitted to county jails and 9% had experienced homelessness. Of the original discharged sample of 590 patients, 37% died between 1989 and 2002; the mean age at death was 63+/-15 years. This analysis suggests that individuals discharged from state psychiatric institutions have been integrated into community residential settings and are receiving psychiatric outpatient treatment on a regular basis. Cost estimates, using the consumer price index for 2002, were $78,773 in 1992 compared with $85,850 for the exact same service package in 2002.

Predictors of Service Use for Mental Health Problems Among British Schoolchildren.

Most previous studies of service use in relation to mental health have examined services in the USA. We wanted to provide up-to-date findings from a general population sample of British schoolchildren. A total of 2461 children aged 5-15 from the 1999 British Child and Adolescent Mental Health Survey were followed up for 3 years. We examine the relationship between a wide variety of potential predictors gathered in 1999 and the use of services over the following 3 years. Contact with most services was predicted by three factors: the impact of psychopathology; contact with teachers or primary health care; and parents' and teachers' perceptions that the child had significant difficulties. Other predictors were specific to each service. Education of parents, teachers and other important adults might increase the proportion of children with impairing psychiatric disorders reaching services.

A longitudinal study of service use in families of children adopted from Romanian orphanages

Post-adoption service use and unmet service needs were examined longitudinally in three matched groups of children: children adopted from Romanian orphanages following a minimum of eight months' institutional experience (RO: n = 36); children from Romania who were destined for orphanages but were adopted early in infancy (EA: n = 25); and Canadian born non-adopted children (CB: n = 42). Data were collected when the adoptees had been in their adoptive homes for 11 months, at age 4.5 years and 10.5 years. Results indicated higher rates of service use and unmet service needs across time in the RO group. Unmet service needs in the RO group may be due in part to the unique challenges faced by post-institutionalized adoptees. Service use in the EA group jumped significantly at Phase 3, suggesting that the impact of their lesser degree of early deprivation was seen later in development under the additional challenge and stress of the demands of school. Findings, particularly from the EA group, supported the suggestion that adoptive parents have a lower threshold for referring their children for clinical services than do non-adoptive parents. Service needs of adoptees changed over time and those with unmet needs experienced greater challenges than those whose service needs were met.

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global “any use” service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.

Patterns of rural mental health care: An exploratory study

In rural areas, it is important to calrify our understanding of how primary care and specialty mental health professionals organize care for those with mental disorders, and the role that linkages between specialty mental health and primary health care providers can play in the effectiveness of such care. Although these are issues that must be generally addressed, in rural areas fewer institutional and individual providers per capita accentuate problems of health care organization and delivery. This paper reports findings from an exploratory study of service use in two primary care sites in a rural, group-model HMO (Site A enrollment = 2,625; Site B = 6,019). We found that patients in the primary care site who had weaker mental health consultative linkages, higher rurality, and less availability of mental health specialty care used more mental health services by primary care providers (RR = 5.19 (3.78,6.61)), received more ambulatory care from joint mental health/primary care providers (RR = 1.68 (1.02,2.78)), and had more mental health hospital utilization (adjusted OR = 1.84 (0.54,6.23)). These findings point to the need for further study of primary care providers and their linkage relationships in rural areas, in this large and currently often underserved population.

Pregnant Teenagers: Deterrents to Service Use

This article reports the findings of a recent study of service use by pregnant adolescents. While medical prenatal care has gained increased acceptance among adolescents, nonmedical prenatal support services have been less successful in reaching this population. It is suggested that access, stigma, and informal support systems may be significant factors influencing service use. Further examination of the needs and desires of this population is required to enable service providers to develop appropriate and accessible programs that will reach and be reached by adolescents in need.