Unmet Need For Services Research Articles

Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men Who Have Sex With Men (Black MSM Initiative): Protocol for Program Evaluation

BackgroundThe HIV epidemic in the United States disproportionately affects Black communities. Nearly half of Black men who have sex with men (MSM) will be diagnosed with HIV in their lifetime. There is a significant unmet need for behavioral health care services among Black MSM, and untreated behavioral health needs make it less likely the person is retained in HIV care.ObjectiveThis paper offers a description of the Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men (Black MSM) Initiative, a program to integrate clinical care and behavioral health/supportive services for Black MSM with HIV. The Black MSM Initiative is funded through the Health Resources & Services Administration HIV/AIDS Bureau Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance.MethodsThe components of the Black MSM Initiative include providing technical assistance to 8 Initiative demonstration sites; conducting a comprehensive and culturally responsive, mixed method, multisite evaluation; and disseminating evaluation findings and lessons learned to the RWHAP community.ResultsAs of December 31, 2020, demonstration sites enrolled 809 clients in the multisite evaluation. The research team will continue evaluation data collection through December 2021 for analysis and dissemination starting in 2022. The Black MSM Initiative fully supports the US Department of Health and Human Services’ Ending the HIV Epidemic in the United States Initiative.ConclusionsIn order to succeed, providers and programs will need to engage populations traditionally considered “hard to reach,” like many people receiving RWHAP services. Findings and lessons learned from the Black MSM Initiative will expand the tool kit of solutions to support and retain Black MSM in HIV care, furthering the goals of the Ending the HIV Epidemic Initiative and the RWHAP.International Registered Report Identifier (IRRID)DERR1-10.2196/36025

Perceptions of rural high school teachers - on the frontline of youth suicide.

This study aimed to investigate the perceptions and beliefs of rural high school teachers about student suicide completion in their school and their perceived self-efficacy in identification of suicidality in students (suicidal ideation, plans and behaviours). A cross-sectional survey methodology. Gippsland and the Loddon Mallee regions of Victoria, Australia. Rural high school teachers. A survey that aimed to obtain participants' perceptions and self-reports about students who had died by suicide in their school within the last 5 years, their perceived self-efficacy in identifying suicidal students and barriers to helping students at risk. Two hundred and seventy-seven rural high school teachers participated and 86% reported that a student from their school had died by suicide within the last 5 years. Sixty-five per cent believed that more than one student had died by suicide and 70% perceived they were currently aware of students experiencing suicidality in their class. Receiving professional development about suicide and obtaining help from mental health clinicians predicted perceived self-efficacy in identification of suicidality in students. Participants perceived the barriers to help students at risk included insufficient numbers of school-based mental health professionals and community mental health services. Many rural high school teachers perceive they are at the front line of the youth suicide crisis due to unmet service need in youth mental ill health. Increased access to effective services immediately after teachers become aware of suicidality may assist in reducing youth suicide in rural areas.

Young Adults' Mental Health and Unmet Service Needs in the Context of the COVID-19 Pandemic Across Canada and France.

While young adults experienced mental health challenges during the COVID-19 pandemic, little is known about how their mental health needs were subsequently met through access to mental health services (MHS). From October to December 2020, we conducted an online survey of young adults (18–29 years) living in Canada and France to investigate factors associated with unmet MHS needs. Of the 3222 participants expressing a need to access MHS (50.7% of the total sample), 58.2% in Canada and 74.8% in France reported unmet MHS needs. In both countries, those who identified as men and those who lost income due to COVID-19, were more likely to report unmet MHS needs. In Canada, participants from Quebec, those living in rural areas, and those who experienced ethno-racial discrimination had higher odds of reporting such unmet needs. Urgent investments are needed to improve access to MHS for young adults during and after the COVID-19 pandemic.

Sensory integration therapy for children with autism and sensory processing difficulties: the SenITA RCT.

Carers report unmet need for occupational therapy services addressing sensory difficulties in autism, yet insufficient evidence exists to recommend a therapeutic approach. Our aim was to determine the clinical effectiveness and cost-effectiveness of sensory integration therapy for children with autism and sensory difficulties across behavioural, functional and quality-of-life outcomes. We carried out a parallel-group randomised controlled trial, incorporating an internal pilot and a process evaluation. Randomisation utilised random permuted blocks. Children were recruited via services and self-referral in Wales and England. Inclusion criteria were having an autism diagnosis, being in mainstream primary education and having definite/probable sensory processing difficulties. Exclusion criteria were having current/previous sensory integration therapy and current applied behaviour analysis therapy. The intervention was manualised sensory integration therapy delivered over 26 weeks and the comparator was usual care. The primary outcome was problem behaviours (determined using the Aberrant Behavior Checklist), including irritability/agitation, at 6 months. Secondary outcomes were adaptive behaviour, functioning and socialisation (using the Vineland Adaptive Behavior Scales); carer stress (measured using the Autism Parenting Stress Index); quality of life (measured using the EuroQol-5 Dimensions and Carer Quality of Life); functional change (according to the Canadian Occupational Performance Measure); sensory processing (determined using the Sensory Processing Measure™ at screening and at 6 months to examine mediation effects); and cost-effectiveness (assessed using the Client Service Receipt Inventory). Every effort was made to ensure that outcome assessors were blind to allocation. A total of 138 participants were randomised (n = 69 per group). Usual care was significantly different from the intervention, which was delivered with good fidelity and adherence and minimal contamination, and was associated with no adverse effects. Trial procedures and outcome measures were acceptable. Carers and therapists reported improvement in daily functioning. The primary analysis included 106 participants. There were no significant main effects of the intervention at 6 or 12 months. The adjusted mean difference between groups on the Aberrant Behavior Checklist - irritability at 6 months post randomisation was 0.40 (95% confidence interval -2.33 to 3.14; p = 0.77). Subgroup differences in irritability/agitation at 6 months were observed for sex of child (intervention × female = 6.42, 95% confidence interval 0.00 to 12.85; p = 0.050) and attention deficit hyperactivity disorder (intervention × attention deficit hyperactivity disorder = -6.77, 95% confidence interval -13.55 to -0.01; p = 0.050). There was an effect on carer stress at 6 months by region (intervention × South England = 7.01, 95% confidence interval 0.45 to 13.56; p = 0.04) and other neurodevelopmental/genetic conditions (intervention × neurodevelopmental/genetic condition = -9.53, 95% confidence interval -18.08 to -0.98; p = 0.030). Carer-rated goal performance and satisfaction increased across sessions (p < 0.001), with a mean change of 2.75 (95% confidence interval 2.14 to 3.37) for performance and a mean change of 3.34 (95% confidence interval 2.63 to 4.40) for satisfaction. Health economic evaluation suggests that sensory integration therapy is not cost-effective compared with usual care alone. Limitations included variability of the intervention setting (i.e. NHS vs. private), delay for some receiving therapy, an error in administration of Vineland Adaptive Behavior Scales and no measurement of comparator arm goal performance. The intervention did not demonstrate clinical benefit above standard care. Subgroup effects are hypothesis-generating only. The intervention is likely to be effective for individualised performance goals, although it is unclear whether effects were in addition to standard care or were maintained. Further investigation of subgroup effects is needed. This trial is registered as ISRCTN14716440. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 29. See the NIHR Journals Library website for further project information.

Internet Use among Patients with Schizophrenia and Depression

Background: The high and increasing prevalence of internet use in the general population and the significant burden of depression and schizophrenia urge us to investigate the patterns of internet use among patients with these illnesses. The aim of this study is to assess internet use and mental health-related internet use among patients suffering from schizophrenia and depression. Methods: A total of 104 patients with psychosis and 105 patients with depression were surveyed to assess their internet use and mental health-related internet use. Results: The majority of participants were internet users (87.6%), with 66.7% of internet users with psychosis and 71.4% of internet users with depression using it as a source of information on mental health. Participants with psychosis significantly more attributed the internet and mental health internet forums as helpful in coping with their mental illness and were more interested in the utilization of online mental health services than participants with depression. Conclusions: General internet use in patients with schizophrenia and depression corresponds with the internet use of the general population; however, they use it more often as a source of health information than the general population. Mental health service providers should offer more online interventions and treatment programs to patients with psychosis and depression, as our study suggests there is an unmet need for online mental health services for such patients.

Retraction to: Trends in mental health symptoms, service use, and unmet need for services among U.S. adults through the first 9 months of the COVID-19 pandemic.

Retraction to: Trends in mental health symptoms, service use, and unmet need for services among U.S. adults through the first 9 months of the COVID-19 pandemic.

Understanding Health Trajectories among Unpaid Cares in the United Kingdom

<strong>Context:</strong> There is very little research on the impact of caring on physical health, and the evidence that exists is mixed. There is also lack of evidence on the role of other factors including both socio-economic factors and the role played by care services and unmet needs for such services. <strong>Aims:</strong> This study aims to understand the association between physical health outcomes among unpaid carers in the United Kingdom compared to individuals who have not provided unpaid care, and investigate what is the role that time, and unmet needs for care services play in this relationship. <strong>Methods:</strong> We used four waves of the UK Household Longitudinal Survey, a large representative sample, covering the period 2015 to 2020. We performed Propensity Score Matching to compare health outcomes of carers against non-carers and Latent Class Analysis to identify different typologies of unpaid carers. <strong>Results:</strong> We found that the relationship between care provision and physical health is complex, that effects on health may differ between the short and medium run, and that deprivation levels and unmet need for services play an important role. <strong>Conclusion:</strong> This research contributes original insights into our understanding of the impact of different care trajectories on the health of the carer taking into consideration the characteristics of care-recipients, the effect of unmet needs, and external factors. This is crucial both in relation to their ability to provide support and in terms of their own care needs and is therefore of direct relevance to policy and practice to support unpaid carers.

Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences

IntroductionAccess to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in...

The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury

BackgroundThis exploratory study aimed to: (i) examine the relationship between health service use and quality of life, psychological wellbeing, global function and participation after discharge from brain injury inpatient rehabilitation, and (ii) determine the influence of personal factors, unmet need for services and service obstacles on the relationship between service use and these outcomes.MethodsUsing a prospective cohort design, 41 adults with acquired brain injury (median age = 46 years; 71% male; 61% severe traumatic injury) were followed for 6-months after discharge from specialist brain injury inpatient rehabilitation. Service use was continuously recorded and obtained through data linkage methods, focusing on the use of: outpatient medical services, outpatient nursing, outpatient allied health; medical acute services; incidents of re-hospitalization; and transitional rehabilitation service use. Outcome questionnaire measures were completed via telephone, at 6-months after discharge, and included: the EuroQol-5D; Depression Anxiety and Stress Scale, Mayo-Portland Adaptability Inventory and Sydney Psychosocial Reintegration Scale. Data were analyzed in a heterogeneous treatment effects framework, using Bayesian Additive Regression Trees.ResultsThere was weak evidence that transitional rehabilitation service use was associated with better psychological wellbeing scores. The posterior probability of lower depression, anxiety and stress scores was .87, .81 and .86, respectively (average treatment effect). There was also weak evidence that re-hospitalization was associated with worse independent living skills scores. The posterior probability of worse scores was .87. However, most re-hospitalizations were due to unavoidable medical complications. We did not find that place of residence at discharge, marital status, unmet need, or service obstacles affected the relationship between service use and the studied outcomes.ConclusionsThis study may highlight the importance of participation in transitional rehabilitation, in the 6-months after discharge from brain injury rehabilitation. Replication in a larger sample size is required to confirm these findings.

The New York City Department of Health and Mental Hygiene School Vision Program: A description of program expansion.

ObjectiveThis study describes how the School Vision Program (SVP) operates in NYC Public Schools, and how it has expanded to provide screening, follow-up, eye exams, and even glasses to more students in recent years.MethodsUsing administrative data from the SVP, we analyze a population sample of all public-school students with non-missing demographic variables in grades Pre-K through 12, focusing on the most recent year of data, 2018–19. We tabulate rates of screening and other results across students by grade and student characteristics, highlighting the expansion of SVP in community schools beginning in 2015–16.ResultsThe SVP screens about 87% of students in Pre-K through 1st Grade each school year. Of the 22% of screened students who failed the screening in 2018–19, 69% received follow-up efforts, and 39% completed eye exams. Among students with completed eye exams, 13% of students in Pre-K through 1st grade were diagnosed with amblyopia, and 70% needed glasses. Less advantaged students in terms of race, ethnicity, and socioeconomic status were less likely to pass vision screenings and less likely to receive eye exams after failing the screening. The SVP’s expansion to all grades in community schools and its provision of eye exams and glasses increased the rate of eye exams to 90% of students with a failed vision screening and distributed glasses to over 22,000 students in grades Pre-K to 12 in 2018–19.ConclusionThe expansion of SVP services in community schools suggests large potential benefits from school districts connecting students who fail vision screenings directly to eye doctors. Otherwise, low rates of follow-up eye exams in younger grades can lead to unidentified and unmet need for vision services in older grades, especially among disadvantaged students.

Studi Literatur: Kebutuhan Pelayanan Kesehatan yang Belum Terpenuhi pada Penyintas Kanker Ginekologi

There is an urgent increase of health care needs for cancer survivor nowadays caused by the escalations of global cancer survivor’s unmet need for cancer care health services. The purpose of this literature study was to identify the gynecology cancer survivor’s unmet need of health care services. A literature search was PRISMA for relevant research paper. Six database were searched: Proquest, Elsevier, Spinger, Wiley Online Library, and Google Scholar using keyword: “CaSUN”, “SCNS-SF34”, “Unmet need”,” Survivor cancer”, “Supportive care”, Cancer Gynecological”. The final review included 9 articles from 993 article that being identified from 2015 – 2020. The result of this study was minimum 1 unmet need found in every gynecology cancer survivor, psychological needs and information on health services, physical and sexual needs.

Postoperative Outcomes Associated With Procedural Sedation Conducted by Physician and Nonphysician Anesthesia Providers: Findings From the Prospective, Observational African Surgical Outcomes Study.

There is an unmet need for essential surgical services in Africa. Limited anesthesia services are a contributing factor. Nonphysician anesthesia providers are utilized to assist with providing anesthesia and procedural sedation to make essential surgeries available. There is a paucity of data on outcomes following procedural sedation for surgery in Africa. We investigated the postoperative outcomes following procedural sedation by nonphysicians and physicians in Africa. We hypothesized that the level of training of the sedation provider may be associated with the incidence of severe postoperative complications and death. A secondary analysis of a prospective cohort of inhospital adult surgical patients representing 25 African countries was performed. The primary outcome was a collapsed composite of inhospital severe postoperative complications and death. We assessed the association between receiving procedural sedation conducted by a nonphysician (versus physician) and the composite outcome using logistic regression. We used the inverse probability of treatment weighting propensity score method to adjust for potential confounding variables including patient age, hemoglobin level, American Society of Anesthesiologists (ASA) physiological status, diabetes mellitus, urgency of surgery, severity of surgery, indication for surgery, surgical discipline, seniority of the surgical team, hospital level of specialization, and hospital funding system using public or private funding. All patients who only received procedural sedation for surgery were included. Three hundred thirty-six patients met the inclusion criteria, of which 98 (29.2%) received sedation from a nonphysician provider. The incidence of severe postoperative complications and death was 10 of 98 (10.2%) in the nonphysician group and 5 of 238 (2.1%) in the physician group. The estimated association between procedural sedation conducted by a nonphysician provider and inhospital outcomes was an 8-fold increase in the odds of severe complications and/or death, with an odds ratio (95% confidence interval [CI]) of 8.3 (2.7-25.6). The modest number of observations in this secondary data analysis suggests that shifting the task of procedural sedation from physicians to nonphysicians to increase access to care may be associated with severe postoperative complications and death in Africa. Research focusing on identifying factors contributing to adverse outcomes associated with procedural sedation is necessary to make this practice safer.

Help-Seekers in an Early Detection of Psychosis Service: The Non-cases.

Purpose: Enhancing early help-seeking is important for early intervention in psychosis. However, knowledge is limited about those help-seekers who are not initially found to have psychotic symptoms when assessed in services aiming at psychosis detection and, thus, deemed ineligible for early intervention of psychosis programs. We aimed to examine clinical diagnostic and socioeconomic pathways of help-seekers accessing an early detection of psychosis service with referral-free access. Specific focus was on the help-seekers initially assessed not to have psychotic symptoms, considered the non-cases, and to examine potential differences and similarities between non-cases and cases (i.e., those initially assessed to have psychotic symptoms).Methods: We followed 450 help-seekers assessed by a free-of-referral early detection of psychosis team in national registers for up to 4 years. We examined clinical diagnoses and status of not in education, employment, or training (NEET) before and after contact with the team.Results: Of the non-cases, 46% were referred to mental health services by the early detection of psychosis team for evaluation of other mental disorders, and 15% of these were subsequently diagnosed with a non-affective psychotic disorder during follow-up of 12–52 months. Prior to current help-seeking, 39% (n = 174) of the help-seekers had had contact with other mental health services. Nearly a quarter of help-seekers were NEETs at the time of assessment; the number increased during follow-up, both for cases and non-cases. Of the cases, 58% were subsequently clinically diagnosed by mental health services. Those seeking help who had no previous contact with mental health services were more frequently diagnosed with a non-affective psychotic disorder during follow-up (p = 0.05).Conclusion: Referral-free services to promote early detection of psychosis seem a valuable add-on to established pathways, allowing early intervention in psychosis. Our results point to an unmet mental health service need among non-cases; overall, in our sample, independent of case status, social functioning was markedly affected. Our results have implications for future focus in early detection of psychosis. Offering intervention to non-cases within the service has the potential to be cost effective, e.g., if a timely and targeted intervention reduces repeated contacts in other mental health services and social services.

Perceived unmet substance use and mental health care needs of acute care patients who use drugs: A cross-sectional analysis using the Behavioral Model for Vulnerable Populations.

The perceived unmet service needs of acute care-seeking people who use illegal drugs (PWUD) have been poorly documented, despite evidence of frequent hospital utilisation. This study applies the Behavioral Model for Vulnerable Populations to investigate correlates of unmet service needs in this subpopulation. Survey data from 285 PWUD at three urban Canadian acute care centres were examined. The survey included the Perceived Need for Care Questionnaire, which measured service seeking and care satisfaction for mental health and substance use concerns across seven types of services, as well as barriers to having care needs met. The Behavioral Model for Vulnerable Populations was applied in hierarchical setwise logistic regression to examine associations between high unmet service need and socio-structural predictors (i.e. predisposing, enabling and need factors). Almost half (46%) of participants reported a high level of unmet service need, despite seeking services during the past year. Participants reporting recent criminal activity, adverse childhood experiences, transitory sleeping, having no community support worker, and meeting screening criteria for depression were more likely to report a high level of unmet service needs. Structural barriers to care (57%) were more commonly reported than motivational barriers (43%). Acute care-seeking PWUD experience high rates of unmet service needs for their mental health and substance use problems. Strategies that can help overcome structural barriers to care are necessary to help address the service needs of this population.

Exploring the unmet needs facing individuals with Alzheimer’s disease and related dementias during the COVID‐19 pandemic

BackgroundMany adults with ADRD rely on support from friends, family members, social service agencies, and their communities to meet their basic needs. It is unclear if COVID‐19 mitigation policies have made it more difficult for individuals with ADRD to receive this support. The objective of this study was to explore the types of unmet needs experienced by adults with ADRD in the United States during the COVID‐19 pandemic as well as the characteristics of adults with ADRD that are experiencing unmet needs.MethodWe performed a cross‐sectional analysis of the Medicare Current Beneficiary Survey (MCBS) summer and fall 2020 COVID‐19 supplemental surveys. The MCBS uses complex survey design to provide a nationally representative sample of Medicare beneficiaries. There were 20,800 survey participants in total and 4.07% have received a diagnosis with ADRD. Logistic regression was used to examine the characteristics of those reporting one or more unmet need.Result16.61% Medicare beneficiaries with ADRD reported having one or more unmet needs during the COVID‐19 pandemic (vs. 16.52% Medicare beneficiaries without ADRD, p=0.956). While beneficiaries with and without ADRD had no difference in unmet needs surrounding rent/mortgage, food, supplies, and medications, adults with ADRD had higher rates of unmet need for healthcare services (8.86% vs. 5.77%, p=0.008). Adults with ADRD were more likely to report having an unmet need between March‐June than between July‐November (18.10% vs. 7.84%, p<0.001). Among those with ADRD, individuals with depression (AOR=2.25, p=0.001) and multimorbidity (AOR=1.79, p=0.030) reported significantly higher unmet need, after controlling for age, sex, race/ethnicity, insurance, and geographic location. As compared with individuals without ADRD, individuals with co‐existing ADRD and depression (p<0.001) or co‐existing ADRD and multimorbidity (p<0.001) reported higher likelihood of having unmet needs.ConclusionMany adults with ADRD experienced unmet need during the first 4 months of the COVID‐19 pandemic. We also found that the ADRD patients with depression and complex health needs who require greatest number of healthcare services were more likely to voice unmet needs. The residual impact of unmet needs during the early pandemic months and on‐high risk subpopulations is currently unknown.

1.I. Workshop: Capturing access challenges in health care: can the vignette methodology help?

Abstract Access to health care is a key performance dimension for health systems. Around 3% of the EU27 population experienced unmet need for health services in 2019 (Eurostat 2021). However, this average hides significant differences across and within countries, between income groups, levels of education and socio-economic categories. While some of the reasons for unmet need are more personal (no time, fear of doctor, etc.), the most common factors are health system-related. Although self-reported unmet need and other existing indicators, including catastrophic spending and impoverishing out-of-pocket spending, provide a general picture of the state of accessibility in EU Member States in relation to factors such as age, income or education, they do not necessarily reveal specific gaps in access or coverage that are linked to other characteristics or specific services. This workshop discusses a new method to measure access to health care, which was developed by the Observatory on Health Systems and Policies to support the European Commission's DG SANTE and the Expert Group on Health Performance Assessment (HSPA) in developing their work on more refined performance measures for health care system access across Europe. The work builds on the findings of a 2019 survey by the Observatory and its Health System and Policy Monitor (HSPM) network on “Gaps in Coverage and Access in the European Union”, which identified a range of vulnerable groups facing access hurdles. The overall goal is to provide a ‘proof of concept' to see whether a vignette approach could add to existing indicators, particularly regarding the differentiation between population coverage and realised access to care. A vignette is a short case study of an individual designed to simulate key features of a real-world scenario, which is then presented to relevant professionals to solicit their hypothetical response. Our workshop first discusses the vignette method developed for this purpose (presentation 1) before sharing the interpretation of results of two of the four vignette pilots that were carried out, that is, the vignette on stroke (presentation 2) and the vignette on palliative care for cancer patients (Presentation 3). The workshop will conclude with a moderated audience discussion about the pros and cons of the vignette method as opportunities to scale up the vignette approach. Key messages The vignette approach can identify gaps in coverage and access as well as differences in treatment and quality not identified by other indicators. The vignette approach can help explain how access contributed to suboptimal health outcomes, enabling the formulation of targeted policies.

Trends in mental health symptoms, service use, and unmet need for services among US adults through the first 8 months of the COVID-19 pandemic.

The COVID-19 pandemic has led to rising morbidity, mortality, and social and economic disruption, likely impairing mental health. The purpose of this study was to track trends in mental health symptoms, use of services, and unmet need for services among US adults, and to delineate variation across demographic strata. Data were drawn from the 2020 US Household Pulse Survey from repeated cross-sectional online surveys collected between April 23 and November 23, 2020 from 1,302,455 US adults, weighted to represent the US population. Survey respondents self-reported their symptoms of anxiety and depression, use of medication and counseling services, and unmet need for services. Reports of probable anxiety and depression rose significantly through the study period, to prevalence rates of 37% and 29%, respectively, by November, 2020, rates more than four times higher than early 2019 US norms. Use of prescription medication, counseling services, and unmet need for mental health services also rose significantly. Prevalence rates of probable mental health disorders were highest among young, less educated, single parent, female, Black and multi-racial respondents, with some vacillation in such disparities over cohorts. Young, female, and moderately educated respondents also reported higher unmet needs for services. Disparities in estimates of mental health disorders and mental health treatment indicate a striking disequilibrium between the potential need for and the use of mental health services during the COVID-19 pandemic. Rising mental health challenges are being borne largely by young, less advantaged people of color and women, with the potential for expanded interruptions to optimal functioning and societal recovery from COVID-19.

The relationship between unmet need for home and community-based services and health and community living outcomes

BackgroundFew studies have examined user-reported perspectives about the quality and sufficiency of home and community-based services (HCBS) and their relationship to key health and community living outcomes. ObjectiveTo examine the association between unmet need for HCBS and health and community living outcomes in a multi-state, multi-program sample of Medicaid HCBS users. MethodsWe used data from the 2017–2018 National Core Indicators-Aging and Disability (NCI-AD) survey, collected among older adults and adults with physical disabilities who were receiving Medicaid HCBS across 13 states (N = 10,263). We conducted descriptive analysis on the demographic, functional, and health characteristics of the sample, and examined the prevalence of unmet need for HCBS across five domains: 1) assistance with daily activities, 2) assistive technology, 3) home modifications, 4) transportation, and 5) sufficiency of services for meeting user needs and goals. We used logistic regressions to estimate adjusted odds ratios for the association between unmet need for HCBS and health care utilization (ED visits, hospital/rehab stays, preventative care) and community living outcomes (active in the community, interacting with family/friends, satisfaction, control). ResultsAcross the five domains, prevalence of unmet need ranged from 21% (unmet need for assistance with self-care or other daily activities) to 54% (unmet need for assistive technology). Individuals who experienced unmet need had consistently worse health and community living outcomes than those who reported no unmet need, after adjusting for key user demographic, functional, and social characteristics (p < 0.05). ConclusionsUnmet need for HCBS is consistently and significantly associated with poor health and community living outcomes among Medicaid users.

Sexualized drug use and specialist service experience among MSM attending urban and rural sexual health clinics in England and Scotland.

Background: To date, evidence on whether sexualized drug use (SDU) and chemsex occur less frequently in rural compared to urban areas in Britain has been conflicting. This study aimed to better measure and understand whether attending urban versus rural sexual health clinics in the United Kingdom was associated with a difference in men who have sex with men’s (MSM) experience of SDU or their access to SDU support. Methods: Men from 29 sexual health services across England and Scotland were recruited by self-completing a waiting room survey. Results: A total of 2655 men (864 MSM) took part. There was no statistically significant difference in recent SDU or chemsex identified in MSM attending rural compared to urban clinics. Gamma-Hydroxybutyrate/Gamma-Butyrolactone (GHB/GBL) was the most commonly reported chemsex drug used in a sexual setting, with equal prevalence of use in urban and rural MSM attendees. Distance travelled for SDU was not significantly different for rural compared to urban MSM. Rural MSM reported a higher rate of unmet need for SDU specific services, although this difference was not statistically significant. Conclusion: Within this sample of MSM, there were no significant differences in sexualized drug use behaviours between those attending rural compared to urban sexual health settings.

Barriers to Respite Care for Children with Special Health Care Needs.

The objective of this study was to estimate time-specific, population-based prevalence of 14 specific barriers to respite services, as reported by parents of children with special health care needs (CSHCN) with and without emotional, behavioral, or developmental problems (EBDPs), and to identify individual, family, and environmental characteristics associated with the most common barriers to respite care for families of CSHCN. Descriptive, bivariate, and multivariable logistic regression analyses were used to examine data from the National Survey of Children with Special Health Care Needs for 2005/2006 and 2009/2010. Among families reporting unmet need for respite care services, service availability or transportation barriers (23.8%) and cost barriers (19.8%) were the most commonly reported obstacles among all CSHCN, followed by lack of knowledge about where to obtain respite services (12.1%) and inconvenient service times (11.3%). Reports of location or availability barriers decreased significantly from 2005 to 2009, but service time barriers increased simultaneously. All types of barriers to respite services were reported significantly more frequently by CSHCN with EBDPs than those without, even when other demographic factors were controlled for. CSHCN conditional severity and discontinuity in insurance were positively associated with cost barriers, whereas CSHCN public health coverage was associated with reduced rates of reported cost and information barriers to respite care. Increased understanding of parent-reported barriers to respite care for families of CSHCN is critical to creating structural and practice-oriented solutions that address obstacles and increase access to respite care for these vulnerable families.