Chronic pelvic pain (CPP) is a medically complex, multifaceted gynecological condition associated with psychological comorbidities and sexual trauma among women. Low rates of positive treatment outcomes underscore the need to better understand complex relationships between CPP, trauma exposure, and the psychosocial context of patients' lives. We conducted a secondary analysis of English and Spanish qualitative interviews with female-identity patients (N = 48) about CPP's impact on psychosocial well-being. Interviews were coded and analyzed in accordance with reflexive thematic analysis. We generated 4 themes regarding CPP and psychosocial well-being: navigating pain-filled relationships, multiple burdens of mental health challenges and marginalization, sexual trauma exposure embedded in illness experience, and harnessing hope in healing and dealing with CPP. We used insights from these findings to generate a list of treatment recommendations for trauma-informed, CPP-specific integrated care. Patients described the importance of social support and how psychological comorbidities and trauma exposure contributed to CPP's psychosocial toll. Findings provide insight into the burden of CPP-related minority stress and the role of hope on patients' well-being. Patients with CPP endorse the integration of psychosocial support into their CPP treatment plans. The authors encourage the incorporation of behavioral health providers into integrated care teams to deliver trauma-informed, culturally responsive methods for engaging patients with CPP in psychosocial interventions addressing multiple domains of well-being.

This study sought to understand how young adults (age 18-25) with histories of mental health disorders are coping with disrupted transitions to adulthood during the COVID-19 pandemic. A cross-sectional web survey was conducted in March-June 2021 of 967 US young adults with pre-pandemic psychiatric disability to assess their current psychiatric status, interrupted transitions, and associations with social determinants including income, community participation, and social context. Mental health was assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and PTSD Checklist-Civilian Version. Social determinants were identified with the Epidemic-Pandemic Impacts Inventory. Interrupted transitions were measured with the Young Adult Disrupted Transitions Assessment. Multivariable logistic regression models predicted four types of transition disruptions and associations with current mental health, social determinants, and demographic factors. Disruptions were reported by 81.1% including interrupted education completion (38.3%), employment careers (37.6%), residential independence (27.7%), and intimate partner relationships (22.9%). Many screened positive for major depressive disorder (81.7%), PTSD (85.5%), or GAD (58.6%). Disruption in establishing intimate partner relationships was associated with depression, anxiety, and PTSD. Interrupted residential independence was associated with anxiety. Interrupted education completion was associated with PTSD. Interrupted employment was associated with anxiety. Social determinants significant in these models included social connections, community participation, income, and racial/ethnic identification. Results illuminate ways that current mental health and social determinants affect transition interruptions during the pandemic. Findings suggest the need for interdisciplinary approaches, integrated models of care, and assistance accessing treatment, rehabilitation, and community support services from adult service systems.

Research demonstrates a positive impact of Peer Based Recovery Support Services (PBRSS) facilitated by peer recovery specialists (PRS), who are people in recovery from behavioral health conditions (e.g., substance use disorders [SUD] and mental health conditions). This study investigated PBRSS, their impact on client outcomes (e.g., substance use, health), and the factors (e.g., self-efficacy, perceived relationship with/helpfulness of PRS) mediating the relationship between services and outcomes while controlling for sociodemographic information (e.g., age). Data were collected across 58 sites within 25 agencies providing PBRSS in a state located in Northeastern USA. Cross-lagged panel models were used to examine 12 longitudinal mediational models in a sample of N = 412. Models were examined over two time periods (i.e., T1 and T2). After alpha correction (p = .00417), most results were nonsignificant. However, several findings indicated that constructs were significantly related across time in all models (e.g., self-efficacy at T1 significantly predicted self-efficacy at T2), while many point-in-time associations were also significant (e.g., number of services received was positively related to relationship/helpfulness of PRS at T1 and T2). Better PRS relationship/helpfulness at T1 significantly predicted a lower number of services received at T2, while receiving more services at T1 significantly predicted better PRS relationship/helpfulness at T2. Being older significantly predicted a worse overall health at T2 in some models. While no mediation was found, this study is important as it assists in building models with respect to the mechanisms by which PRS may effect change or not.

This cross-sectional study aimed to assess the demographic and geographic variations in the visit rate for first-episode psychosis (FEP), identify trends and diagnostic patterns, and explore factors associated with FEP visits in Nebraska. Inpatient and emergency department data spanning 2017-2021 were collected by the Nebraska Hospital Association (NHA). The study focused on Nebraska residents aged 14-35 admitted for FEP, identified through specific ICD-10 codes. The sample was derived using a multi-step process, and the data included patient demographics, Behavioral Health Regions, rural vs. urban residency, and neighborhood characteristics. Mann-Kendall tests were used to test for significant trends over time. T-tests and chi-squared tests were used to assess differences in each of the measures between patients with and without psychotic disorders. The study findings revealed a significant increase in visits related to psychotic disorders from 2017 to 2021. In 2021, the FEP visit rate was 116 per 100,000 individuals, varying considerably by age, gender, and Behavioral Health Region. Schizoaffective disorder bipolar type was the most frequent psychotic disorder. Patients with psychotic disorders tended to be older, predominantly male, and treated in acute care settings. The rising trend underlines the need for continued investment in early intervention programs and highlights challenges in rural areas, necessitating targeted interventions. The findings provide valuable insights to inform planning, advocate for funding, and address the specific needs of diverse populations. Future research should explore additional influencing factors and extend the study period to understand FEP trends comprehensively.

Rates of depression among youth and emergency department (ED) visits for un- or under-treated symptoms are on the rise. Early identification and treatment of depression is imperative at the patient, program, system, and population levels. This paper examines the individual and cumulative impact of Project ECHO and the inclusion of IBH services in pediatric primary care practices on mental health-related ED rates among youth diagnosed with depression for those practices. Twenty-eight practices participated and provided data on 5,388 patients diagnosed with depression who were seen between 2019 and 2022. A binominal mixed effect model was used to examine the impact of Project ECHO and IBH on mental health-related ED rates among youth diagnosed with depression per month within each practice. Compared to practices without an IBH program, those who implemented IBH had a significantly lower rate of mental health-related ED visits among this patient population (Incident Rate Ratio (IRR) = 0.80, p = .005, 95% Confidence Intervale (CI) = 0.68, 0.93). No significant differences were found between practices regardless of participation in Project ECHO, nor was there a significant interaction effect between practices that employed Project ECHO and IBH in combination. This study shows promising results with IBH having a positive impact on practice outcomes compared to treatment as usual, while Project ECHO in isolation or combined with IBH did not significantly affect rates of mental health-related ED visits.

Families in low- and middle-income countries (LMICs) face significant mental health and psychosocial care gaps. In recent years, researchers and practitioners have addressed these gaps by task-sharing evidence-based mental health and psychosocial support (MHPSS) interventions to nonspecialist community providers. Supervision and training approaches are intended to prepare nonspecialists to deliver evidence-based interventions with quality. However, there is still little research exploring nonspecialist experiences with training and supervision and how, if at all, their training and supervision experiences result in fidelity and competence in delivering the intervention. This qualitative study uses data from a cluster-randomized trial of a family strengthening and violence prevention program in Rwanda, known as Sugira Muryango. In semi-structured interviews, the nonspecialists provided examples of using skills such as rapport-building, empathy, and active listening to deliver Sugira Muryango effectively. Because nonspecialists were serving in their own communities, they found that it was easier to earn trust with friends and neighbors, and this facilitated effective delivery of Sugira Muryango. Nonspecialists discussed how training, monthly supervision, in-person monitoring visits, and the use of the manual and audio recorders equipped them to deliver Sugira Muryango with quality. Nonspecialists also provided examples of barriers to quality of delivery, including supervisor lack of availability, delayed compensation, and technology issues. Preparedness was consistent across gender; however, nonspecialists serving in a better-resourced district had previous experiences delivering evidence-based interventions and felt more prepared at the beginning of Sugira Muryango.

Childhood attention-deficit/hyperactivity disorder (ADHD) is common and is associated with lifelong adverse outcomes. Little is known about factors associated with mental health service use (MHSU) among children with ADHD from adolescence to early adulthood. This retrospective cohort study aims to investigate factors associated with MHSU among children with ADHD from adolescence to early adulthood using secondary data from Waves I to III of the National Longitudinal Study of Adolescent Health (n = 554). Multivariable Poisson regression and Generalized Estimating Equation were used to estimate adjusted relative risks and 95% confidence intervals. Results indicate that factors significantly associated with MHSU from adolescence to early adulthood included race/ethnicity, a routine physical exam last year, and a history of suicidal ideation or attempt. Findings of the study extend the current understanding by identifying predictors and barriers for MHSU and inform the development of targeted intervention programs for increasing MHSU among children with ADHD.

Medications for alcohol use disorder (MAUD) and opioid use disorder (MOUD) are underutilized evidence-based treatments. While patients often receive treatment in multiple medical treatment settings, it is unknown whether certain treatment settings or combinations of settings are associated with increased receipt of MAUD or MOUD. Data from the cross-sectional 2019 National Survey on Drug Use and Health were used to identify treatment settings where adult respondents received any past year alcohol treatment (n = 476, 33% female) or, separately, opioid treatment (n = 337, 38% female). Three-stage latent class analysis assessed the patterns of treatment settings utilization and their associations with receipt of MAUD or MOUD, adjusting for potential confounders. Only 10.9% of those in alcohol treatment received MAUD while 40.9% of those in opioid treatment received MOUD. Analyzing different treatment settings visited by respondents, a four-class model best fit the MAUD sample while a three-class model best fit the MOUD sample. There were significant differences in receipt of MAUD by treatment setting classes in unadjusted models (p < 0.05). There were no significant differences in receipt of MOUD across treatment utilization classes, but MOUD receipt was associated with severity of opioid use in all treatment setting classes. People in treatment for alcohol or opioid use were more likely to receive medication if their use was more severe, and were more likely to receive MAUD if they accessed care in many settings. As MOUD and especially MAUD are underutilized, these findings highlight opportunities to increase access to evidence-based care for alcohol and opioid use disorders.

The purpose of this study was to explore the experiences of LGBTQ + young people in mental healthcare and to understand their perspectives on what affirmative mental healthcare practice should look like. Between June and September of 2023, interviews were conducted with LGBTQ + young people ages 18-26 years in Los Angeles and Seattle. Interviews lasted 30 to 60 min and were transcribed verbatim for thematic analysis (N = 28). Four themes were developed from analysis of the interviews: (1) disconnection from community and self as an impetus for seeking formal mental healthcare; (2) marginalization during mental health service encounters; (3) the therapeutic power of belonging and mattering in the mental healthcare system; and (4) mutual human connection as the foundation for affirming mental healthcare experiences. Affirmative mental healthcare was defined by LGBTQ + young adults as free of judgment with priority placed on the therapeutic power of genuine human connection. The need for trans-specific mental healthcare was also highlighted. Participants also expressed a preference for providers with shared identities and experiences to alleviate feelings of isolation and increase feelings of connectivity. Mental health providers should emphasize connectivity and empathy to offer affirming care with LGBTQ + clients, such asking about client preferences for care, developing knowledge about sexuality and gender identity, and acknowledging provider limitations or knowledge gaps. Improving access to affirmative mental healthcare for LGBTQ + young adults (e.g., workforce development, training requirements) is needed to address the disparities in mental healthcare.

The Institute of Medicine (2001) describes quality health care as safe, effective, patient-centered, efficient, equitable, and timely. Although this definition highlights the necessity of continuous program evaluation to ensure that these goals are being addressed, there is a notable lack of industry-wide standards and benchmarks, and many clinical programs lack the ability to continually and rigorously evaluate their own performance with data. This might be particularly true in the case of ensuring service members and veterans with posttraumatic stress disorder (PTSD) obtain treatment, as several systemic barriers exist, such as long wait times and lack of equitable treatment for individuals with minoritized identities. The current study examines the impact of a clinic-wide intake redesign for a massed PTSD treatment program to shift the intake process to a small, dedicated team rather than a responsibility shared across all clinicians. The redesign led to significantly shorter wait times for treatment and reduced some types of pre-treatment dropout. On average, patients received an acceptance/rejection decision 1 week sooner, attended the program almost 2 months sooner, and saw a roughly 60% reduction in the odds of dropout at the point of receiving an acceptance/rejection decision. Some disparities in wait times for those who were not partnered, women, and individuals who financially supported more family members remained after the redesign. Results are discussed in light of the importance of continuous program evaluation to address IOM's holistic definition of quality health care.

Substance use disorder (SUD) is increasing among primary Spanish-speaking populations, and treatment use is disproportionately low. Patient-provider Spanish language concordance is associated with SUD treatment initiation and better outcomes. Recent geographic shifts within primary Spanish-speaking populations are important considerations in identifying gaps in SUD service delivery in Spanish. This national epidemiologic study used the Mental Health and Addiction Treatment Tracking Repository (2022; N = 9336 facilities) and US census data to pinpoint the location of SUD treatment facilities that offer services in Spanish, and used multilevel models to determine whether access to Spanish services is keeping up with the influx of primary Spanish-speaking populations in new areas that have not historically had a large Spanish language presence. Twenty-two percent of SUD treatment facilities provided services in Spanish. For every 10% increase in the percentage of a census tract speaking Spanish, the odds of SUD treatment facilities offering services in Spanish increased by 30% (aOR = 1.03, 95% CI = 1.02-1.04, p < 0.0001), indicating that Spanish language services were more common in places where people who speak Spanish already live. In contrast, the study team identified no association between the availability of Spanish services and increases in community-level Spanish between 2010 and 2022 (aOR = 1.00, 95% CI = 0.99-1.01, p = 0.87), indicating that access to services is not keeping up with demand as populations move and the Spanish language grows in new areas. SUD treatment services are lagging behind as the location of where primary Spanish-speaking families choose to live changes. Local health policies and ambitious interventions are needed that target the unique needs of SUD treatment clients who speak Spanish.

The Institute of Medicine (2001) describes quality healthcare as safe, effective, patient-centered, efficient, equitable, and timely. Although this definition highlights the necessity of continuous program evaluation to ensure that these goals are being addressed, there is a notable lack of industry-wide standards and benchmarks, and many clinical programs lack the ability to continually and rigorously evaluate their own performance with data. This might be particularly true in the case of ensuring service members and veterans with posttraumatic stress disorder (PTSD) obtain treatment, as several systemic barriers exist, such as long wait times and lack of equitable treatment for individuals with minoritized identities. The current study examines the impact of a clinic-wide intake redesign for a massed PTSD treatment program to shift the intake process to a small, dedicated team rather than a responsibility shared across all clinicians. The redesign led to significantly shorter wait times for treatment and reduced some types of pre-treatment dropout. On average, patients received an acceptance/rejection decision 1 week sooner, attended the program almost 2 months sooner, and saw a roughly 60% reduction in the odds of drop out at the point of receiving an acceptance/rejection decision. Some disparities in wait times for those who were not partnered, women, and individuals who financially supported more family members remained after the redesign. Results are discussed in light of the importance of continuous program evaluation to address IOM's holistic definition of quality healthcare.

Growing mental health treatment access disparities elevate the urgency for identifying and implementing innovative approaches for delivering evidence-supported interventions. Work-related cognitive behavioral therapy (WCBT), a technology-assisted CBT (t-CBT) designed to address social anxiety and employment outcomes among job seekers at vocational service centers and for delivery by vocational service professionals, offers a promising way to increase access to needed mental health care. This qualitative study, guided by the Organizational Transformation Model (OTM), explored factors related to WCBT's implementation at two Jewish Vocational Services (JVS) Human Service sites in Detroit, MI and Los Angeles County, CA. Twenty-seven staff-stakeholders across the two JVS sites completed in-depth, semi-structured interviews focused on their experiences with WCBT over the four-year study period. Thematic analysis identified five core codes that most broadly captured participants' perceptions of WCBT implementation and the factors influencing implementation, including: (1) Need, (2) Buy-in and engagement, (3) Communication, (4) Sustainability concerns, and (5) Implementation facilitators. Core codes aligned with OTM factors related to impetus to transform, improvement initiatives, integration across boundaries, alignment from top to bottom, and leadership. Findings identify implementation strategies likely to optimize uptake and sustainability of WCBT within JVS sites that can be tested in a larger, multi-site implementation trial.

Up to 33% of American adults will experience a diagnosable anxiety disorder in their lifetime. Approximately one-third of anxiety diagnoses assigned by mental health providers in outpatient settings are unspecified. The tendency of many providers to use an unspecified anxiety diagnosis may negatively impact the provision of evidence-based treatments for specific anxiety disorders. This study examines the perspectives of mental health providers working in an integrated and stepped health care system, asking how their roles and responsibilities shape their practices related to diagnosing specific anxiety disorders. The authors conducted semi-structured interviews with 32 Veteran Health Administration (VHA) mental health providers to understand their perspectives on diagnosing anxiety disorders. Matrix analysis was used to identify different roles and responsibilities articulated. Thematic analysis was used to highlight themes across providers' discussion of their roles in diagnosing and treating patients. The results show that, for most providers, assigning a specific diagnosis is a component of duties but rarely their focus. Second, it is unclear in which clinic setting a specific anxiety diagnosis should be made. Finally, among different types of mental health professionals, there is no clear designation on who should be providing a specific anxiety diagnosis. Altogether, results indicate that many providers feel making a specific diagnosis for anxiety is the responsibility of others-either those in other clinic settings or with other credentials. Findings call for clearer guidelines that specify individual clinician accountability for obtaining a specific anxiety diagnosis in a team-based environment.

Timely receipt of community-based follow-up after inpatient psychiatric discharge is associated with positive outcomes. This retrospective cross-sectional study aimed to identify socio-demographic and clinical factors associated with failure to receive community mental health follow-up within 7 days. Routinely collected hospital and community mental health data were linked for all inpatients discharged with a mental health condition in 2017 to 2019 in a local health district in New South Wales, Australia. Of the 8780 patients discharged, 28% (n = 2466) did not have 7-day follow-up. Males were significantly more likely than females to fail follow-up. Adjusted logistic regression analyses revealed that both male and female patients aged 65 years and older were generally less likely to fail follow-up than those who were younger; conversely, patients referred to a hospital by a law enforcement agency and those who left the hospital at their own risk were more likely to fail follow-up. Other factors significantly related to failure to follow-up varied between the sexes. Improved outcomes may be achieved by enhancing the transition from inpatient to outpatient care through targeted strategies aimed at patients who are more likely to disengage with care.

Model adherence indicates the degree to which a program or intervention is delivered as intended. In integrated primary care, where mental health services are embedded into primary care clinics, appraisal of model adherence provides insight into whether these services align with key features of this unique practice environment (e.g., brief, interdisciplinary care). To date, such evaluations have emphasized system and provider factors. This study is a preliminary evaluation of whether a novel patient-facing measure, the Primary Care Behavioral Health Provider Adherence Questionnaire-Patient Version (PPAQ-Patient), can provide insight into adherence to the Primary Care Behavioral Health (PCBH) model of integrated primary care. Survey data were collected from 281 veterans who received PCBH care. Exploratory factor analyses evaluated the data structure. Results suggest that 19 items spanning three temporally-referenced subscales may feasibly capture patient perspectives on PCBH adherence at various stages of treatment. Future work is needed to refine the measure.