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Hutchison M, Theriault KM, Seng K, Vanderploeg J, Conner KR. Youth Mobile Response and Stabilization Services: Factors Associated with Multiple Episodes of Care. Community Ment Health J 2023; 59:1619-1630. [PMID: 37347420 DOI: 10.1007/s10597-023-01153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Mobile response and stabilization services (MRSS) provide short-term, community-based, care to individuals in crisis. Minimal studies have explored which factors are associated with multiple episodes of MRSS care. We used a retrospective cohort design of MRSS electronic health records to explore demographic and clinical characteristics associated with multiple episodes of care among 2,641 youth ages 5-21 years old in New York, USA. Youth with multiple episodes of care (n = 585; 22.2%) were more likely to be non-Hispanic, have treatment histories including presenting problems related to adjustment, conduct, mood, or suicidal thoughts and behaviors, have high-level mental health visits, and more follow-up visits. Future research should examine the unmet needs of non-Hispanic populations and whether characteristics associated with multiple MRSS episodes are consistent across populations to inform procedures targeting unmet needs that prevent or minimize repeated use during crises.
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Affiliation(s)
- Morica Hutchison
- Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, United States.
| | - Kayla M Theriault
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Kagnica Seng
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Jeffrey Vanderploeg
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Kenneth R Conner
- Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, United States
- Department of Emergency Medicine, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY, 14642, United States
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Hoge MA, Vanderploeg J, Paris M, Lang JM, Olezeski C. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 2022; 58:1225-1239. [PMID: 35038073 PMCID: PMC8762987 DOI: 10.1007/s10597-022-00937-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
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Affiliation(s)
- Michael A. Hoge
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jeffrey Vanderploeg
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Manuel Paris
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jason M. Lang
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- grid.475976.eChild Health and Development Institute, Farmington, CT USA
- grid.208078.50000000419370394Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Christy Olezeski
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Fendrich M, Ives M, Kurz B, Becker J, Vanderploeg J, Bory C, Lin HJ, Plant R. Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs. Psychiatr Serv 2019; 70:881-887. [PMID: 31215355 DOI: 10.1176/appi.ps.201800450] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services. METHODS The authors examined two cohorts of youths: 2,532 youths who used mobile crisis services and a comparison sample of 3,961 youths who used behavioral health ED services (but not mobile crisis services) during the same fiscal year. Propensity scores were created to balance the two groups, and outcome analyses were used to examine subsequent ED use (any behavioral health ED admissions and number of behavioral health ED admissions) in an 18-month follow-up period. RESULTS A pooled odds ratio of 0.75 (95% confidence interval [CI]=0.66-0.84) indicated that youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with youths in the comparison sample. The comparable result for the continuous outcome of number of behavioral health ED visits yielded an incidence risk ratio of 0.78 (95% CI=0.71-0.87). CONCLUSIONS Using comparison groups, the authors provided evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs. Replication in other years and locations is needed. Nevertheless, these results are quite promising in light of current trends in ED use.
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Affiliation(s)
- Michael Fendrich
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Melissa Ives
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Brenda Kurz
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Jessica Becker
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Jeffrey Vanderploeg
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Christopher Bory
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Hsiu-Ju Lin
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
| | - Robert Plant
- School of Social Work, University of Connecticut, Hartford (Fendrich, Ives, Kurz, Becker, Lin); Connecticut Department of Mental Health and Addiction Services, Hartford (Ives, Lin); Child Health and Development Institute of Connecticut, Farmington (Vanderploeg); Beacon Health Options, Rocky Hill, Connecticut (Bory, Plant)
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Thornton WE, Moore TP, Pool SL, Vanderploeg J. Clinical characterization and etiology of space motion sickness. Aviat Space Environ Med 1987; 58:A1-8. [PMID: 3499891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An inflight, clinically-oriented investigation of SMS was begun on STS-4 and revealed the following: compared to motion sickness on Earth, autonomic signs are significantly different in space motion sickness (SMS) vs. motion sickness (MS) in that sweating is not present, pallor or flushing may be present, and vomiting is episodic, sudden, and brief. Nausea may be present but is more often absent. Onset ranges from minutes to hours, plateaus, and rapidly resolves in 8-72 h with 36 h as average. Postflight reactions have been mild unless deliberately provoked in the early period of re-exposure to gravity. Postflight there is a period of resistance to all forms of motion sickness. There is some evidence for individual reduction in sensitivity on repeated flights. Etiology could not be proven objectively; however, the sensitivity to angular motion, often pronounced in pitch, and theoretical considerations make an intravestibular conflict the most likely cause. Electro-oculogram (EOG), audio-evoked potentials, measurement of fluid shifts, and other studies are inconsistent with a transient vestibular hydrops or increased intracranial pressure as a cause.
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Affiliation(s)
- W E Thornton
- Astronaut Office, NASA/Johnson Space Center, Houston, Texas 77058
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