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Becker SJ, Janssen T, Shiller H, DiBartolo E, Fan Y, Souza T, Kelly LM, Helseth SA. Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209399. [PMID: 38762125 DOI: 10.1016/j.josat.2024.209399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/13/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Scant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART - a technology-assisted intervention for parents of adolescents in residential treatment - was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization. METHOD The study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization. RESULTS Both the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization. CONCLUSION Residential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.
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Affiliation(s)
- Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America.
| | - Tim Janssen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, United States of America
| | - Hannah Shiller
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America
| | - Emily DiBartolo
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America
| | - Yiqing Fan
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America
| | - Timothy Souza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, United States of America
| | - Lourah M Kelly
- Department of Psychiatry, Implementation Science and Practice Advances Research Center, University of Massachusetts Chan School of Medicine, United States of America
| | - Sarah A Helseth
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, United States of America
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Adams DR, Pérez-Flores NJ, Mabrouk F, Minor C. Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study. Psychiatr Serv 2024; 75:402-409. [PMID: 38018150 PMCID: PMC11062805 DOI: 10.1176/appi.ps.20230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker. METHODS In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed. RESULTS Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy. CONCLUSIONS Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.
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Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Nancy Jacquelyn Pérez-Flores
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Fatima Mabrouk
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
| | - Carolyn Minor
- Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis (Adams, Pérez-Flores); Silver School of Social Work, New York University, New York City (Mabrouk); American Blues Theater, Chicago (Minor)
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John-Baptiste AA, Li L, Isaranuwatchai W, Osuch E, Anderson KK. Healthcare utilization costs of emerging adults with mood and anxiety disorders in an early intervention treatment program compared to a matched cohort. Early Interv Psychiatry 2019; 13:1439-1446. [PMID: 30688032 DOI: 10.1111/eip.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/06/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
AIM The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care. METHODS We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and non-users, by cost category and overall. We performed risk-adjusted comparison of overall costs using generalized estimating equations. RESULTS FEMAP users (n = 366) incurred significantly lower costs compared to non-users (n = 660), for inpatient services (-$784, 95% confidence interval [CI] -$1765, -$28), ambulatory care services (-$90, 95% CI -$175, -$14) and drug benefit claims (-$47, 95% CI -$115,-$4) and significantly higher physician services costs ($435, 95% CI $276, $581) over 1 year. The unadjusted difference in overall costs was not significant (-$853, 95% CI -$2048, $142). Following adjustment for age, sex and age at first mental health diagnosis, the difference of -$914 (95% CI (-$2747, $919)) was also not significant. CONCLUSIONS FEMAP was associated with significantly lower costs of inpatient and ambulatory care services, and higher costs of physician services, however we are unable to conclude that FEMAP is cost-saving overall.
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Affiliation(s)
- Ava A John-Baptiste
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Interfaculty Program in Public Health, Western University, London, Ontario, Canada.,Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI Centre), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Lihua Li
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Ontario, Canada.,Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elizabeth Osuch
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Platt R, Pustilnik S, Connors E, Gloff N, Bower K. Severity of mental health concerns in pediatric primary care and the role of child psychiatry access programs. Gen Hosp Psychiatry 2018; 53:12-18. [PMID: 29702377 DOI: 10.1016/j.genhosppsych.2018.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the clinical severity of patients for whom Primary Care Providers (PCPs) requested consultation from Maryland's Child Psychiatry Access Program (CPAP), and examine the proportion and associated characteristics of severe cases being managed alone by PCPs versus co-managed with mental health specialists. METHODS Data were collected for 872 cases based on calls received between October 2012 and December 2016. Severity was measured by consultant-assigned Clinical Global Impression-Severity (CGI-S) score. The unadjusted odds of a PCP managing a case alone for select patient and provider characteristics was calculated in a sub-sample of 229 severe cases. RESULTS 73.8% of cases were categorized as mild-moderate (CGI-S 1-4) and 26.3% as severe (CGI-S 5-7). 67.3% of severe cases were managed by a PCP alone; 32.8% were co-managed. The unadjusted odds of a severe case managed alone was lower for cases with greater numbers of psychotropic medications (OR 0.76, 95% CI 0.6, 0.96), prescription of antidepressants (OR 0.51, 95% CI 0.28, 0.95), or antipsychotics (OR 0.45, 95% CI 0.22, 0.94) compared to co-managed cases. CONCLUSIONS PCPs manage patients with severe mental health concerns, often without assistance from specialists. CPAPs should systematically consider how to support the PCPs' role managing clinically severe cases.
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Affiliation(s)
- Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine/Johns Hopkins Bayview Medical Center, 5500 East Lombard Street, Room 1214, Baltimore, MD 21224, United States.
| | - Sean Pustilnik
- Medstar Georgetown Department of Psychiatry, Medstar Georgetown University Hospital, 2115 Wisconsin Avenue NW, suite 200, Washington, DC 20007, United States.
| | - Elizabeth Connors
- University of Maryland School of Medicine, 737 West Lombard Street, 426, Baltimore, MD 21201, United States
| | - Nicole Gloff
- University of Maryland School of Medicine, 737 West Lombard Street, 426, Baltimore, MD 21201, United States
| | - Kelly Bower
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Pinkard Bldg 452, Baltimore, MD 21205, United States.
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Gross D, Belcher HME, Budhathoki C, Ofonedu ME, Uveges MK. Does Parent Training Format Affect Treatment Engagement? A Randomized Study of Families at Social Risk? JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:1579-1593. [PMID: 29713137 PMCID: PMC5918300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined whether parent engagement in parent training (PT) differed based on PT format (parent group-based with video versus mastery-based individual coaching with child) in an economically disadvantaged sample of families seeking behavioral treatment for their preschool children in an urban mental health clinic. Parents (N=159; 76.1% mothers, 69.8% African American, 73% low-income) were randomized to one of two interventions, Chicago Parent Program (parent group + video; CPP) or Parent Child Interaction Therapy (individualized mastery-based coaching; PCIT). Parent engagement indicators compared were PT attendance and completion rates, participation quality, and parent satisfaction. Risk factors predictive of PT attrition (parent depression, psychosocial adversity, child behavior problem severity, length of wait time to start PT) were also compared to determine whether they were more likely to affect engagement in one PT format versus the other. No significant differences were found in PT attendance or completion rates by format. Clinicians rated parents' engagement higher in PCIT than in CPP while satisfaction with PT was rated higher by parents in CPP compared to PCIT. Never attending PT was associated with more psychosocial adversity and externalizing behavior problems for CPP and with higher baseline depression for PCIT. Parents with more psychosocial adversities and higher baseline depression were less likely to complete PCIT. None of the risk factors differentiated CPP completers from non-completers. Delay to treatment start was longer for PCIT than CPP. Strengths and limitations of each PT format are discussed as they relate to the needs and realities of families living in urban poverty.
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Affiliation(s)
- Deborah Gross
- School of Nursing, Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21205, 410-614-5311
| | - Harolyn M E Belcher
- Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute, 716 Broadway, Baltimore, MD 21205, 443-923-5933
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21205, 410-614-5320
| | - Mirian E Ofonedu
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, 1750 E. Fairmont Avenue, 443-923-9200
| | - Melissa K Uveges
- School of Nursing, Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21205, 410-614-5311
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Păsărelu CR, Dobrean A. A video-based transdiagnostic REBT universal prevention program for internalizing problems in adolescents: study protocol of a cluster randomized controlled trial. BMC Psychiatry 2018; 18:101. [PMID: 29653523 PMCID: PMC5899379 DOI: 10.1186/s12888-018-1684-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 04/03/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Internalizing problems are the most prevalent mental health problems in adolescents. Transdiagnostic programs are promising manners to treat multiple problems within the same protocol, however, there is limited research regarding the efficacy of such programs delivered as universal prevention programs in school settings. Therefore, the present study aims to investigate the efficacy of a video-based transdiagnostic rational emotive behavioral therapy (REBT) universal prevention program, for internalizing problems. The second objective of the present paper will be to investigate the subsequent mechanisms of change, namely maladaptive cognitions. METHODS A two-arm parallel randomized controlled trial will be conducted, with two groups: a video-based transdiagnostic REBT universal prevention program and a wait list control. Power analysis indicated that the study will involve 338 participants. Adolescents with ages between 12 and 17 years old, from several middle schools and high schools, will be invited to participate. Assessments will be conducted at four time points: baseline (T1), post-intervention (T2), 3 months follow-up (T3) and 12 months follow-up (T4). Intent-to-treat analysis will be used in order to investigate significant differences between the two groups in both primary and secondary outcomes. DISCUSSION This is the first randomized controlled trial that aims to investigate the efficacy and mechanisms of change of a video-based transdiagnostic REBT universal prevention program, delivered in a school context. The present study has important implications for developing efficient prevention programs, interactive, that will aim to target within the same protocol both anxiety and depressive symptoms. TRIAL REGISTRATION ClinicalTrials.gov: NCT02756507 . Registered on 25 April 2016.
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Affiliation(s)
- Costina Ruxandra Păsărelu
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Republicii St., No. 37, 400015 Cluj-Napoca, Romania
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Republicii St., No. 37, 400015 Cluj-Napoca, Romania
| | - Anca Dobrean
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Republicii St., No. 37, 400015 Cluj-Napoca, Romania
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Republicii St., No. 37, 400015 Cluj-Napoca, Romania
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Care burden and its predictive factors in parents of newly diagnosed children with acute lymphoblastic leukemia in academic hospitals in China. Support Care Cancer 2017; 25:3703-3713. [DOI: 10.1007/s00520-017-3796-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022]
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