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Yu-Lefler HF, Wendt M, Umaña K, Sripipatana A. The Importance of Patient Experience in Obtaining Mental Health Care at HRSA-Funded Health Centers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01411-0. [PMID: 39302524 DOI: 10.1007/s10488-024-01411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
Timely mental health care prevents more complex and costly psychological problems, particularly for underserved individuals utilizing HRSA-funded health centers. Patient experience with care services and provider interactions may facilitate timely mental health care access. This study explored which elements of patient experience at health centers minimize delayed access to necessary mental health care. We used cross-sectional data on adult patients who needed mental health services from the 2022 Health Center Patient Survey (N = 1039). Multi-variable logistic regression analyses examined the influence of patient experience using measures drawn from the Consumer Assessment of Healthcare Providers and Systems on delayed mental health care, accounting for predisposing, enabling, and need factors. 82% of patients did not cite delayed mental health care. 60% or more of patients reported always or usually receiving responsive and coordinated care, with over 80% reporting always or usually receiving positive provider interactions. Lower odds of delayed mental health care was associated with always getting timely callback during business hours (adjusted odds ratio [aOR]: 0.26; 95% confidence interval [CI]: 0.09, 0.76), and that the provider always listened carefully (aOR: 0.33; CI: 0.14, 0.78), provided easy to understand recommendations (aOR: 0.31, CI: 0.12, 0.79), knew the patient's medical history (aOR: 0.33, CI: 0.15, 0.73), was respectful to the patient (aOR: 0.49, CI: 0.27, 0.90), or was easy to understand (aOR: 0.51, CI: 0.29, 0.88). Care responsiveness and positive provider communication are integral to facilitating timely mental health care access for vulnerable populations with mental health needs.
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Affiliation(s)
- Helen Fan Yu-Lefler
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, 5600 Fishers Lane, Rockville, MD, 20852, USA.
| | - Minh Wendt
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, 5600 Fishers Lane, Rockville, MD, 20852, USA
| | - Kelly Umaña
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, 5600 Fishers Lane, Rockville, MD, 20852, USA
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, 5600 Fishers Lane, Rockville, MD, 20852, USA
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Shafer PR, Yuan Y, Feyman Y, Price ME, Kabdiyeva A, Figueroa SM, Shen YJ, Nebeker JR, Ward MC, Strombotne KL, Pizer SD. Effect of mental health staffing inputs on initiation of care among recently separated Veterans. Health Serv Res 2024. [PMID: 38826037 DOI: 10.1111/1475-6773.14333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE To estimate a causal relationship between mental health staffing and time to initiation of mental health care for new patients. DATA SOURCES AND STUDY SETTING As the largest integrated health care delivery system in the United States, the Veterans Health Administration (VHA) provides a unique setting for isolating the effects of staffing on initiation of mental health care where demand is high and out-of-pocket costs are not a relevant confounder. We use data from the Department of Defense and VHA to obtain patient and facility characteristics and health care use. STUDY DESIGN To isolate exogenous variation in mental health staffing, we used an instrumental variables approach-two-stage residual inclusion with a discrete time hazard model. Our outcome is time to initiation of mental health care after separation from active duty (first appointment) and our exposure is mental health staffing (standardized clinic time per 1000 VHA enrollees per pay period). DATA COLLECTION/EXTRACTION METHODS Our cohort consists of all Veterans separating from active duty between July 2014 and September 2017, who were enrolled in the VHA, and had at least one diagnosis of post-traumatic stress disorder, major depressive disorder, and/or substance use disorder in the year prior to separation from active duty (N = 54,209). PRINCIPAL FINDINGS An increase of 1 standard deviation in mental health staffing results in a higher likelihood of initiating mental health care (adjusted hazard ratio: 3.17, 95% confidence interval: 2.62, 3.84, p < 0.001). Models stratified by tertile of mental health staffing exhibit decreasing returns to scale. CONCLUSIONS Increases in mental health staffing led to faster initiation of care and are especially beneficial in facilities where staffing is lower, although initiation of care appears capacity-limited everywhere.
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Affiliation(s)
- Paul R Shafer
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Yingzhe Yuan
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Yevgeniy Feyman
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Megan E Price
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Aigerim Kabdiyeva
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Stuart M Figueroa
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Yi-Jung Shen
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Jonathan R Nebeker
- Department of Veteran Affairs, Office of Health Informatics, Veterans Health Administration, Washington, DC, USA
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Merry C Ward
- Department of Veteran Affairs, Office of Health Informatics, Veterans Health Administration, Washington, DC, USA
| | - Kiersten L Strombotne
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Steven D Pizer
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
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Adams DR. Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic. Community Ment Health J 2024; 60:88-97. [PMID: 37097491 PMCID: PMC10127985 DOI: 10.1007/s10597-023-01127-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.
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Affiliation(s)
- Danielle R Adams
- Center for Mental Health Services Research, Brown School of Social Work and Public Health, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, USA.
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Yu-Lefler HF, Hsu YJ, Sen A, Marsteller J. Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:834-847. [PMID: 37382741 DOI: 10.1007/s10488-023-01282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 06/30/2023]
Abstract
Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic's data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.
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Affiliation(s)
- Helen Fan Yu-Lefler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Behavioral Psychology, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD, 21205, USA.
- Bureau of Primary Health Care, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20852, USA.
| | - Yea-Jen Hsu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aditi Sen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The Health Care Cost Institute, Washington, DC, USA
| | - Jill Marsteller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Cheng AL, Leo AJ, Calfee RP, Dy CJ, Armbrecht MA, Abraham J. Reply to Letter to the Editor: What Are Orthopaedic Patients' and Clinical Team Members' Perspectives Regarding Whether and How to Address Mental Health in the Orthopaedic Care Setting? A Qualitative Investigation of Patients With Neck or Back Pain. Clin Orthop Relat Res 2023; 481:1051-1052. [PMID: 36763511 PMCID: PMC10097568 DOI: 10.1097/corr.0000000000002594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Abby L. Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashwin J. Leo
- Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan P. Calfee
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher J. Dy
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa A. Armbrecht
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joanna Abraham
- Department of Anesthesiology & Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
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