Unmet Behavioral Health Research Articles

Bridging the Evidence and Practice Gap in Chronic Kidney Disease: A System Thinking Approach to Population Health.

Chronic kidney disease (CKD) is common, costly, and life-limiting, requiring dialysis and transplantation in advanced stages. Although effective guideline-based therapy exists, the asymptomatic nature of CKD together with low health literacy, adverse social determinants of health, unmet behavioral health needs, and primary care providers' (PCP) limited understanding of CKD result in defects in screening and diagnosis. Care is fragmented between PCPs and specialty nephrologists, with limited time, expertise, and resources to address systemic gaps. In this article, the authors define how they classified defects in care and report the current numbers of patients exposed to these defects, both nationally and in their health system Accountable Care Organization. They describe use of the health system's three-pillar leadership model (believing, belonging, and building) to empower providers to transform CKD care. Believing entailed engaging individuals to believe defects in CKD care could be eliminated and were a collective responsibility. Belonging fostered the creation of learning communities that broke down silos and encouraged open communication and collaboration between PCPs and nephrologists. Building involved constructing a fractal management infrastructure with transparent reporting and shared accountability, which would enable success in innovation and transformation. The result is proactive and relational CKD care organized around the patient's needs in University Hospitals Systems of Excellence. Systems of excellence combine multiple domains of expertise to promote best practice guidelines and integrate care throughout the system. The authors further describe a preliminary pilot of the CKD System of Excellence in primary care.

Disparities in accessing specialty behavioral health services during the COVID-19 pandemic and why we need pediatric integrated primary care.

Youth unmet behavioral health needs are at public health crisis status and have worsened since the onset of the coronavirus disease 2019 pandemic (Covid-19). Integrating behavioral health services into pediatric primary care has shown efficacy in addressing youth behavioral health needs. However, there is limited guidance on facilitating equitable access to care in this setting, including in triaging access to co-located services (i.e., onsite outpatient behavioral health services with only the behavioral health provider) or to specialty behavioral health services in other clinics within larger health systems. A retrospective, comparative study was conducted to examine variability in access to co-located and specialty behavioral health (SBH) services for a pre-Covid-19 cohort (April 2019 to March 2020; n = 367) and a mid-Covid-19 cohort (April 2020 to March 2021; n = 328), while accounting for integrated primary care consultation services. The sample included children 1-18 years old served through a large, inner-city primary care clinic. Logistic regression models were used to examine the association between scheduled and attended co-located and SBH visits, pre- and mid-Covid-19 effects, and sociodemographic factors of race and ethnicity, language, health insurance (SES proxy), age, and sex. The majority of youth were not directly scheduled for a co-located or SBH visit but the majority of those scheduled attended their visit(s). The odds of not being directly scheduled for a co-located or SBH visit were greater for the mid-Covid-19 cohort, Black youth, and older youth. Accounting for integrated primary care consultation visits addressed these disparities, with the exception of persisting significant differences in scheduled and attended co-located and SBH visits for Black youth even while accounting for IPC consultation. Findings from the current study highlight the effective role of integrated primary care consultation services as facilitating access to initial behavioral health services, especially given that referrals to integrated primary care co-located and SBH services within the larger health system often involve barriers to care such as longer wait-times and increased lack of referral follow through. Ongoing research and equitable program development are needed to further this work.

Examining the emergence of a learning collaborative: a framework to support complex program implementation

To address unmet behavioral health needs of children and youth, the system of care (SOC) philosophy was developed and evolved into a framework to support community-based coordinated networks that provide an array of effective services and supports. There is limited elaboration of the actual implementation processes and intricacies of SOC development, particularly, in terms of the roles of local SOC coordinators (local coordinators). Limited published research has addressed the necessary knowledge and roles of local coordinators, and the theoretical underpinnings and structure of their learning, skill development, and capacity building. Utilizing an archival approach and reflexive thematic analysis, this qualitative study examined records of three forums involving 50 local SOC coordinators (11% male, 89% female, 93% white, ages between 27 and 66 years) between 2017 and 2018. The analysis revealed varying levels of experience, knowledge, and skills, and uncovered several SOC development strategies utilized by coordinators. The study illustrates the inception of a learning collaborative that served as a bridge and implementation driver for SOC development and socio-professional support for local coordinators. The findings provide an empirical base and emerging framework for SOC coordinators’ training and professional development. The value of learning collaboratives in facilitating exposure to a diverse knowledge base and the importance of fostering supportive spaces for coordinators as they strive to develop SOCs are evident. Incorporating supportive learning collaboratives for local change agents could be a dynamic strategy to support the effective implementation of system-wide changes or enhancements in behavioral health services.

Follow the LEAD

If we are ever going to be successful at reducing the footprint of the criminal legal system response to people with unmet behavioral health issues, or those living in extreme poverty we need true up-stream solutions. Solutions that include allowing police, system actors and community members an approach that recognizes harm, addresses the needs of people in a humane way, and increases public safety. Law Enforcement Assisted Diversion/Let Everyone Advance with Dignity (LEAD) is that response. Established in 2011 in Seattle in response to the failed War on Drugs, and its disparate impact on people of color, LEAD seeks to stop the ineffective and often harmful responses of the criminal legal system, while increasing public safety. Instead of continuing the cycle of arrest, LEAD diverts people out of the criminal legal system and into a long-term system of care coordination. A collaborative view of public safety, LEAD initiatives coordinate high level system players while engaging communities in ensuring better outcomes on an individual and community level. LEAD has been established in jurisdictions across the United States and continues to expand. An evidence-based practice, LEAD has been evaluated in multiple sites and proven an effective response to public safety. LEAD provides the upstream response to system change that is needed in all communities.

Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California

BackgroundSubstance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades.MethodsData are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher’s exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades.ResultsMost participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049).ConclusionsWe identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women.Trial registrationNCT, NCT 21–34,978. Registered January 19, 2022.

Stakeholder Perspectives on Implementing a Police-Mental Health Collaborative to Improve Pathways to Treatment.

High rates of criminal justice involvement among individuals with mental illness have led to collaborative efforts between law enforcement agencies and mental health providers to improve crisis responses and pathways to treatment. The development and implementation of these police-mental health collaborations (PMHCs) have received little attention in the literature, but these processes are crucial in understanding feasibility and sustainability. The PMHC discussed here is an interagency effort to identify individuals involved with law enforcement who have unmet behavioral health needs and engage them in services. Perspectives from leaders, service providers, and clients highlight the importance of developing PMHCs that support individuals with serious mental illness at multiple points, from initial crisis to independent management of treatment. In an environment where police responses to individuals with mental health and substance use disorders are increasingly scrutinized, it is critical to highlight and evaluate ways that behavioral health and law enforcement agencies work together to collaboratively address these problems.

Effective Partnership Care Models with Advanced Practice Psychiatric Nurses.

The unmet behavioral health treatment needs of children and adolescents have become a public health crisis in the United States, with only 20% of youths obtaining assessment and intervention when indicated. Workforce shortages, including mental health professionals who can provide pharmacologic intervention within an appropriate biopsychosocial context, directly impede our ability to address this crisis. The authors examine the history, education, regulation, and practice of advanced practice psychiatric nurses and consider models of collaborative practice that can be beneficial across treatment settings in order to provide better care of vulnerable youth in ways that foster partnership rather than competition.

Employing telehealth within HIV care: advantages, challenges, and recommendations.

Employing telehealth within HIV care: advantages, challenges, and recommendations.

Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.

Opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment needs of transgender and gender diverse adults

BackgroundLimited research has explored risk factors for opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment (BHTx) needs of transgender and gender diverse (TGD) adults. MethodsIn 2019, TGD adults (N = 562) in Massachusetts and Rhode Island were purposively recruited and completed a psychosocial and behavioral health survey (95 % online; 5% in-person). Multivariable logistic regression was used to examine factors associated with past 12-month opioid pain medication misuse and unmet BHTx needs. ResultsOverall, 24.4 % of participants were trans women; 32.0 % trans men; and 43.6 % were non-binary. Past-year substance misuse included: marijuana (56.8 %), hazardous drinking (37.5 %), hallucinogens (9.8 %), benzodiazepines (8.2 %), and opioid pain medication (8.0 %). Among participants with past-year substance misuse and BHtx need (n = 326), 81.3 % received BHtx and 18.7 % had unmet BHtx needs. Being a trans woman, having HIV, stigma in healthcare, and number of substances misused were associated with increased odds of past-year opioid pain medication misuse; high social connectedness was associated with decreased odds of opioid pain medication misuse (p-values<0.05). Younger age, stigma in healthcare, and misusing opioid pain medications were associated with increased odds of unmet BHTx needs; post-traumatic stress disorder and family support were associated with decreased odds of unmet BHtx needs (p-values<0.05). ConclusionsAddressing disparities in opioid pain medication misuse among TGD people requires systematic improvements in healthcare access, including efforts to create TGD-inclusive BHtx environments with providers who are equipped to recognize and treat the social and structural drivers of TGD health inequities, including opioid pain medication misuse.

Assessing Traumatic Experiences of Justice-Involved Latinx Youth: A Systematic Review

Traumatic experiences have been linked to the unmet behavioral health needs of justice-involved youth. Unmet behavioral health needs are some of the most salient predictors of initial justice involvement and recidivism. Latinx youth are one of the most overrepresented ethnic and racial minority groups in the Juvenile Justice System in the United States.

Caregiver and Child Behavioral Health Service Utilization Following Pediatric Traumatic Brain Injury.

Given sparse literature examining receipt of behavioral health service in children and caregivers following traumatic brain injury (TBI), we sought to identify predictors of unmet need. We performed an individual participant data meta-analysis using generalized linear mixed-effect models to examine predictors of behavioral health service use and unmet need. We included 572 children, ages 3 to 18, who were hospitalized overnight following complicated mild to severe TBI between 2002 and 2015. Caregivers completed ratings of depression and distress, child behavior problems, family functioning, and behavioral health service utilization. For children, unmet behavioral health service need was defined as an elevation on one or more child behavior problem scales without receipt of behavioral health services. For caregivers, unmet need was defined as an elevation on either a depression or distress scale without behavioral health service utilization. Among those with behavioral health needs, rates of unmet need were high for both children (77.8%) and caregivers (71.4%). Poorer family functioning was related to more unmet need in children (F(1, 497) = 6.57, p = 0.01; OR = 1.8) and caregivers (F(1, 492) = 17.54, p < 0.001; OR = 2.7). Children with unmarried caregivers also had more unmet behavioral health service need than those with married caregivers (F(1, 497) = 12.14, p < 0.001; OR = 2.2). In conclusion, unmet needs are common after pediatric TBI and relate to family factors. The findings underscore the importance of monitoring service needs following pediatric TBI and point to disparities in service use.

Which Model Fits? Evaluating Models of Integrated Behavioral Health Care in Addressing Unmet Behavioral Health Needs among Underserved Sociodemographic Groups

ABSTRACT Unmet behavioral health care needs are especially pronounced among underserved sociodemographic groups based on socioeconomic status, race/ethnicity, English language proficiency, sex, and age. To increase access to care, it is necessary to utilize evidence-based strategies to effectively expand provision of behavioral health services outside of traditional settings to contexts in which help-seeking for child behavioral health care needs is taking place. We retrospectively examined two specific models (consultation and colocation) that comprised an integrated behavioral health program in an inner-city pediatric primary care clinic in order to better understand strategies to feasibly and effectively increase access to care among underserved populations. Results from program evaluation data (that included a sample of 188 patients) support a multi-tiered integrated behavioral health care program of (1) joint consultation encounters delivered by primary care providers (PCPs) and behavioral health clinicians and (2) colocation of behavioral health services. Variations in feasibility, workforce and space considerations, and recommendations for integrating behavioral health programs in inner-city pediatric primary care clinics are discussed.

Unmet mental health and substance use treatment needs among older homeless adults: Results from the HOPE HOME Study.

To examine the prevalence of and factors associated with unmet need for mental health and substance use treatment in older homeless adults. Among 350 homeless adults aged ≥50, we examined prevalence of mental health and substance use problems and treatment. Using logistic regression, we examined factors associated with unmet treatment need. Among those with a mental health problem, being aged ≥65 was associated with an increased odds, while having a regular healthcare provider and case manager were associated with a decreased odds of having unmet need for mental health treatment. A first homelessness episode at age ≥50 was associated with increased, while spending time in jail/prison or having a case manager was associated with decreased odds of unmet needs for substance use treatment. Older homeless adults have a high prevalence of unmet behavioral health treatment need. There is a need for targeted services for this population.

884-P: Mi Puente: A Care Transitions Intervention for At-Risk Hispanics with Multiple Cardiometabolic Conditions

Hispanics are disproportionately affected by chronic cardiometabolic conditions (e.g., obesity, diabetes). Unmet behavioral health needs (e.g., mental health problems, stress, lack of health care) contribute to these disparities. Sustainably reducing Hispanic health disparities demands innovative, cost-effective interventions that address both behavioral and physical health. A randomized controlled trial is underway to evaluate Mi Puente - i.e., a Behavioral Health Nurse (BHN) + volunteer Community Mentor (CM) intervention designed to reduce readmissions in N = 560 Hispanics with ≥ 2 cardiometabolic conditions and ≥ 1 behavioral health concern(s) hospitalized at a safety-net hospital near the U.S./Mexico border in San Diego, CA. Qualifying patients at high-risk for readmission are identified via automated electronic medical record reports. The BHN triages patients’ needs, provides education, and conducts tailored coaching and goal-setting. Post-discharge, the BHN conducts telephone follow-up at 1-week, and CMs provide referrals to community resources and transition support via phone for up to 1-month. Prevalent behavioral health concerns were: chronic stress (52.5%), health-related distress (37.3%), and lack of routine medical care (19.8%). Preliminary process data indicated that the BHN met with 82.5% of participants prior to discharge; challenges related to medication adherence (28.7%) and access to outpatient care (41.1%) were common. Approximately 80% received ≥1 CM phone call (M = 1.7± 1.1); the transition home and follow-up appointment(s) were frequently addressed (both 97.9%). Findings reveal high levels of unmet behavioral health needs among hospitalized Hispanics, and the feasibility of a sustainable, low-cost, team model that builds upon personnel commonly found in hospital settings - i.e., nurses and volunteers. Important “lessons learned” will be presented to inform future care transitions programs in high-risk, underserved groups. Disclosure J.I. Bravin: None. M.L. Anderson: None. T. Clark: None. K.L. Savin: None. D. Lara Ledesma: None. J.A. Euyoque: None. A.L. Fortmann: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc. L. Gallo: None. Funding National Institutes of Health

Suicide Screening and Behavioral Health Assessment in the Emergency Department

ABSTRACT Suicide is a leading cause of death among our young patients. Healthcare providers in acute care settings like the emergency department have an opportunity to identify and intervene with those at risk in order to prevent death from suicide, future psychiatric emergencies, and the considerable morbidity that patients with unmet behavioral health needs experience. This article describes the current state of depression and suicide among young people and the strategies for implementing and improving screening in the emergency department. Finally, the article will articulate how to prepare for the challenges that emergency care providers face, as we work to reduce barriers for all patients to access behavioral health resources and receive needed care.

2438 Community-based research networks: Providing infrastructure for clinical and translational research in the State of Michigan

OBJECTIVES/SPECIFIC AIMS: As the sole Clinical and Translational Science Award (CTSA) site in Michigan, the Michigan Institute for Clinical &amp; Health Research (MICHR) at the University of Michigan (UM) is working to develop community networks that drive clinical and translational research on community-identified health priorities. METHODS/STUDY POPULATION: These CBRNs will be modeled from successful work that has been accomplished in Jackson, MI where stakeholders from the local healthcare community, County Health Department, Health Improvement Organization, and grassroots community members created a Community of Solution to address the unmet behavioral health and social needs of community members. The CBRN’s will focus on identifying community health priorities by receiving input from community members in underserved communities using deliberative software called Choosing All Together (CHAT). RESULTS/ANTICIPATED RESULTS: In the fall of 2017, 3 focus groups were held in Northern Michigan to identify community health priorities. The top 5 community health priorities include; (1) mental wellness, (2) long-term illness, (3) alcohol and drugs, (4) air, water, and land, and (5) affording care. Additional focus groups are scheduled for the winter in 2 additional geographic areas. DISCUSSION/SIGNIFICANCE OF IMPACT: Future work for the creation of CBRNs includes building leadership groups comprised of clinicians, community leaders, public health leaders, health system leaders and researchers to inform the leadership groups of community-identified health priorities. In addition, the team is working to identify a platform to connect academic investigators across UM and community partners on shared research priorities in real time. In order to measure and map relationships within the networks, we are planning to utilize Social Network Analysis as an evaluation tool.

Supporting Latinx Student Success via Family–School Partnerships: Preliminary Effects of Conjoint Behavioral Consultation on Student and Parent Outcomes

ABSTRACTLatinx students are the largest ethnic minority school-age population, yet they have some of the lowest reading proficiency levels and highest rates of school dropout and experience significant unmet behavioral health needs. School-based interventions addressing behavioral challenges and parent engagement are recommended to support Latinx students. Conjoint behavioral consultation is an evidence-based intervention that supports behavioral improvements and home–school partnerships for students. The purpose of this study was to examine the effects of CBC for a subsample of Latinx students enrolled in two large-scale randomized efficacy trials. ANCOVA and t-test analyses revealed generally positive effects for CBC on Latinx student and parent outcomes and parent-teacher relationships. These findings suggest CBC may be a promising school-based intervention addressing gaps in educational and behavioral health services for Latinx students. Given the small sample size, further research is needed to evaluate the efficacy of CBC for Latinx students and their families.

Recruitment and retention of young adult veteran drinkers using Facebook.

The objective of this study was to describe the feasibility of using Facebook as a platform to recruit and retain young adult veteran drinkers into an online-alcohol use intervention study. Facebook’s wide accessibility and popularity among the age group that comprises the majority of veterans from the conflicts in Iraq and Afghanistan make it a compelling resource through which research can extend its reach to this otherwise hard-to-reach group. We developed a series of Facebook advertisement campaigns to reach veteran drinkers not specifically searching for alcohol treatment. In doing so, we recruited 793 valid veteran participants in approximately two weeks for an advertising cost of $4.53 per obtained participant. The study sample consisted primarily of male veterans, between 19 and 34 years of age, who were drinking at moderate to heavy levels. Although about half of the sample reported mental health comorbidity, few had received any mental health or substance use treatment in the past year. Facebook appears to be a valuable mechanism through which to recruit young veterans with unmet behavioral health needs, although more specific efforts may be needed to engage certain types of veterans after initial study enrollment.

Juvenile Justice-Translating Research Interventions for Adolescents in the Legal System (JJ-TRIALS): a multi-site, cooperative implementation science cooperative

Juvenile Justice-Translating Research Interventions for Adolescents in the Legal System (JJ-TRIALS): a multi-site, cooperative implementation science cooperative