Group Well-Child Care and Health Services Utilization: A Bilingual Qualitative Analysis of Parents’ Perspectives

Maternal and Child Health Journal - Objective Alternative primary care structures such as group well-child care (GWCC) may enhance care for families, particularly those subject to structural...     

Pediatric Primary Care Providers’ Relationships with Mental Health Care Providers: Survey Results

Background

As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental health providers would differ in their care of patients with mental health concerns when compared to PPCPs not in such relationships.

Objective

To explore differences between PPCPs who have relationships with mental health care providers and those who do not with regard to their care of children with mental health concerns.

Methods

Seventy-two PPCPs completed a mailed survey addressing topics such as comfort levels diagnosing and managing patients with behavioral health disorders, perceived barriers to care, activity related to prescribing psychotropic medications, and availability of consultation with mental health specialists. More than one-third (19 providers) of providers reported no specialized training in behavioral pediatrics and nearly 45 % (32 providers) indicated having a relationship or partnership with a mental health specialist.

Results

Those providers who reported relationships indicated greater availability of consultation and communication with psychiatric providers as well as telephone consultation with non-psychiatric mental health providers. All providers were more comfortable assessing as opposed to treating children with disorders, with the exception of attention disorders, which providers were comfortable with both treating and assessing. For all conditions, there was no main effect for partnership.

Conclusion

While partnerships may be associated with greater availability of consultation and communication, for this sample of PPCPs there was no evidence of advantage with respect to diagnosis and management. The paper concludes with a discussion of study limitations, the need for further research, and suggestions for practice.     

Siege and Response: Reception and Benefits of Residential Children’s Mental Health Services for Parents and Siblings

This paper presents the results of a qualitative study with 29 parents of children who have been in residential mental health care. It examines three main patterns identified by parents: (a) the importance of respite, (b) feeling welcomed and understood, and (c) improved personal and family functioning. It argues that benefits for parents and siblings of placed children deserve equal valuation with the needs of children in residential care and that the processes of achieving such gains are independent considerations from creating systems of care for troubled children or engaging family members in treatment plans for these children.

Children’s Receipt of Health Care Services and Family Health Insurance Patterns

PURPOSE Insured children in the United States have better access to health care services; less is known about how parental coverage affects children’s access to care. We examined the association between parent-child health insurance coverage patterns and children’s access to health care and preventive counseling services.METHODS We conducted secondary analyses of nationally representative, cross-sectional, pooled 2002–2006 data from children (n = 43,509), aged 2 to 17 years, in households responding to the Medical Expenditure Panel Survey (MEPS). We assessed 9 outcome measures pertaining to children’s unmet health care and preventive counseling needs.RESULTS Cross-sectionally, among US children (aged 2 to 17 years) living with at least 1 parent, 73.6% were insured with insured parents, 8.0% were uninsured with uninsured parents, and the remaining 18.4% had discordant family insurance coverage patterns. In multivariable analyses, insured children with uninsured parents had higher odds of an insurance coverage gap (odds ratio [OR] = 2.45; 95% confidence interval [CI], 2.02–2.97), no usual source of care (OR = 1.31; 95% CI, 1.10–1.56), unmet health care needs (OR = 1.11; 95% CI, 1.01–1.22), and having never received at least 1 preventive counseling service (OR = 1.20; 95% CI, 1.04–1.39) when compared with insured children with insured parents. Insured children with mixed parental insurance coverage had similar vulnerabilities.CONCLUSIONS Uninsured children had the highest rates of unmet needs overall, with fewer differences based on parental insurance status. For insured children, having uninsured parents was associated with higher odds of going without necessary services when compared with having insured parents.     

Integration of Oral Health Care and Mental Health Services: Dental Hygienists’ Readiness and Capacity for Secondary Prevention of Eating Disorders

Often the first to observe overt health effects of eating disorders, dentists and dental hygienists play a fundamental role in the secondary prevention of eating disorders. The purpose of this study was to explore readiness and capacity for integration of oral health and mental health services. Employing a randomized cross-sectional study based upon the Transtheoretical and Health Belief Models, data were collected from 378 dental hygienists. Results reveal that the majority do not currently engage in secondary prevention practices. Only 18% of respondents indicated referring patients exhibiting oral manifestations of eating disorders to treatment. Significantly increasing the likelihood of assessment, referral, and case management included modifying factors regarding greater perceived self-efficacy, and knowledge of oral cues of disordered eating, as well as the individual’s perception pertaining to severity of eating disorders. Implications for bridging dental care to mental health services include increasing behavioral capacity among dental hygienists via consciousness raising and improved self-efficacy. Stacey B. Plichta ScD, is an associate professor of School of Community and Environmental Health, Old Dominion University, 140c Spong Hall, Norfolk, VA 23529, USA. Lisa A. Tedesco PhD, is a vice president and secretary of The University of Michigan, 2014 Fleming Administration Building, 503 Thompson Street, Ann Arbor, MI 48109-1340, USA. Wendy E. Kerschbaum, RDH, MPH, is an associate professor and director of Dental Hygiene in the Department of Periodontics, Prevention, & Geriatrics, University of Michigan, School of Dentistry, 1011 N. University, Ann Arbor, MI 48109-1078, USA.     

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Objectives. We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.Methods. We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.Results. Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated.Conclusions. Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries.The integration of primary care and public health is a key strategy, recommended nationally and internationally, for assisting underserved populations; it encourages community-focused initiatives and transdisciplinary approaches to practice. Integration allows health providers (e.g., physicians, nurses, health workers) to use individual- and community-level interventions to influence, respectively, individual behavior and community health.1–3 Brazil’s Sistema Único de Saúde (Unified Health System) was created as a result of Brazil’s 1988 federal constitution and the 1990 Lei Orgânica da Saúde (Organic Health Law). This law aimed to establish a large, decentralized health system offering free, universal care from medical consultations to organ transplants, health campaigns, and sanitation.4 This system struggles with access, quality, and service coordination (e.g., scheduling, monitoring) mainly because it is incorporated under a single legal structure that contradicts decentralization and affects the integration of services that different sectors of the Sistema Único de Saúde, such as hospitals, provide.5To integrate primary care and public health, the Sistema Único de Saúde employs the Estratégia Saúde da Família (ESF; Family Health Strategy), a transdisciplinary approach used by health providers. ESF reflects “the new public health” paradigm, positing that integration best addresses health and environmental issues affecting communities.6–8 The World Health Organization recommends that diverse providers pursue community-level outcomes and medical cost reductions through service integration.9 Established in 1994 as the Programa de Saúde da Família, today the ESF consolidates a model of assistance operationalized by professional teams, including nurses, physicians, and community health workers (CHWs), that serve about 4000 individuals per team.10,11In Brazil, service integration is accomplished by transdisciplinary collaboration—providers delivering primary care alongside public health interventions (e.g., disease prevention campaigns).11–14 Providers strive to engage in evidence-based practice (EBP), which is characterized by providers assessing the impact of environmental issues (e.g., water supply) on health and by incorporating patient input and research findings into diagnosis and treatment. EBP is encouraged by training local providers in integration methods.15,16 ESF has improved adult patients’ awareness of their diagnoses and prognoses and their adherence to children’s immunization schedules and has decreased infant mortality, hospitalizations, and medication costs.10,11,17–19     

Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health,Substance Use,and HIV

Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems—binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse—comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed.     

Health Promotion and Psychosocial Services and Women’s Assessments of Interpersonal Prenatal Care in Medicaid Managed Care

Objectives: If prenatal health promotion and psychosocial support services are to remain accessible to Medicaid eligible women, evidence is needed as to whether the services improve care and benefit women in ways that matter to health plans. The aims of this study are to determine whether prenatal health promotion and psychosocial services are associated with better interpersonal care and greater satisfaction with care; and whether the effects on interpersonal care help explain satisfaction with care. Research Design: A telephone survey of 363 African American, Latina (US and nonUS-born) and White women receiving prenatal care in four Medicaid public health plans in California in 2001. Multivariate regression analyses were done with adjustments for potentially confounding variables. Measures: Independent variables included dichotomous variables for health promotion advice (five separate areas) and composite scales for psychosocial assessment (six areas combined). Dependent variables included satisfaction with care, and indices for interpersonal care (communication, decision-making, and interpersonal style). Results: Women who report receiving health promotion or psychosocial services also report receiving better interpersonal care and rate their satisfaction with care higher. Receiving either type of support service is associated with higher quality communication, decision-making and interpersonal style. The effects of the support services on satisfaction are, in turn, explained by the effects on interpersonal care. Conclusions: Prenatal health promotion and psychosocial services have associated benefits to enrollees that should matter to Medicaid health plans and their providers.     

The Influence of Concerns About a Child’s Sexual Orientation on Mental Health Among Parents of Lesbian,Gay, and Bisexual Children in Hong Kong

Archives of Sexual Behavior - Sexual minority stress affects not only lesbian, gay, and bisexual (LGB) individuals, but also their families. Due to the pervasiveness of stigma and discrimination,...     

Outreach,Mental Health,and Case Management Services: Can They Help to Retain HIV-Positive and At-Risk Youth and Young Adults in Care?

Objectives: To assess the impact of outreach, mental health, and case management services on retention in primary care of HIV+ and at-risk youth and young adult clients of the Boston HAPPENS program, a comprehensive adolescent HIV prevention and care network of agencies. Methods: Providers at 8 urban sites used standard data forms at each visit to collect background and service receipt information on at-risk clients aged 12–24 years. Data were aggregated across all visits for each client to create summary variables for the number of times each client received each type of service. The retention measure was the number of days between a client's first and last visits during the 4-year data collection period. Kaplan–Meier survival curve and Cox proportional hazards regression analyses were used to assess the association between receipt of the support services of interest and the retention measure. Results: The median retention times were 21 days for male clients (range, 0–1406, N = 512), and 26 days for female clients (range, 0–1577, N = 914). Among males, 45% were retained beyond a month, 24% beyond a year, and 10% beyond 2 years. Similar proportions of females were retained beyond a month and a year, but more females were retained beyond 2 years (15%). After adjusting for other covariates, both male and female clients had significantly longer retention times if they received q2 outreach contacts, or case management at q3 visits. Among males, receipt of mental health counseling at q2 visits also increased retention times. Conclusions: These findings suggest that provision of outreach, mental health, and case management services can improve retention in care of at-risk youth and young adults.     

Racial and Ethnic Disparities in the Continuation of Community-Based Children’s Mental Health Services

This paper examines racial and ethnic disparities in continuation of mental health services for children and youth in California and how English language proficiency moderates the effect of race/ethnicity on the continuation of service. While previous research indicated racial/ethnic or geographic disparities in accessing mental health services among children and youth, few studies specifically focused on the continuation of mental health care. The authors used administrative data from California county mental health services users under age 25. Applying logistic regression, English language proficiency was found to be the major determinant of continuation of mental health services in this age group. With the exception of children of Asian descent, non-English speaking children and youth of diverse racial/ethnic background were significantly less likely to continue receiving mental health services compared with White English-speaking peers, even after controlling for sociodemographic, clinical and county characteristics.     

“Can I Ask That?”: Perspectives on Perinatal Care After Resettlement Among Karen Refugee Women,Medical Providers,and Community-Based Doulas

This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social contextual model and focused on women’s questions about and opinions of perinatal care in Buffalo and on providers’ experiences caring for Karen patients. Karen women expressed gratitude for and understanding of perinatal care in Buffalo, and providers described Karen patients as agreeable but shy. Karen doulas offered an alternative view that exposed women’s many questions and concerns, and described how doula training empowered them as patients’ advocates. Low self-efficacy, trauma histories, and cultural expectations may contribute to Karen women’s seeming agreeability. Doulas/interpreters possess insider knowledge of women’s concerns and facilitate communication between patients and the care team.     

Family Medicine Physicians’ Perspectives Regarding Rural Behavioral Health Care: Informing Ideas for Increasing Access to High-Quality Services

Primary care settings often function as the front lines for behavioral health services in rural areas. The lack of formal behavioral health care in rural areas is also well documented. Rural family practice physicians were interviewed regarding the state of behavioral health care in their communities and their ideas for increasing access to quality care. Thirteen family practice physicians in rural locations participated in in-depth semi-structured interviews. Interviews were transcribed, coded, and analyzed following a phenomenological design. Physicians described a lack of quality behavioral health services and challenges for integrating and collaborating with those that do exist. Participants also described the changing role of stigma, service delivery strategies that are currently working, and the unique role primary care plays in rural behavioral health care. Several ideas for increasing access to and efficacy of services are discussed; these ideas are informative for future research and interventions.

     

Money,Case Complexity,and Wait Lists: Perspectives on Problems and Solutions at Children’s Mental Health Centers in Ontario

Senior managers of children’s mental health centers across Ontario, Canada were interviewed regarding the challenges and solutions of access and delivery of care. The central challenges—funding, case complexity, waitlists, staffing, and system integration—revealed a complex interplay between the policies and financing of children’s mental health services and the provision of clinical services at the agency level and within the community. The desire for integration and collaboration was countered by competition for funding and service demands. A need for policies that allow for local solutions while providing leadership for sustained improvements in the ease and timeliness of access to care and effective clinical services emerged.

Koreans’ Use of Medical Services in Seoul, Korea and California

This study assessed the types of health care services used by Korean immigrants, and differences in use between different countries, genders, health insurance status, acculturation status, and cardiovascular risk. Participant selection used probability sampling to represent the adult populations of California, United States, and Seoul, Republic of Korea. A telephone survey was administered to 2830 adult Korean-Californians and 500 adult Koreans living in Seoul. Female gender was significantly associated with higher use of outpatient services, ER usage, and hospitalization. Californian residence was significantly associated with higher outpatient usage and lower hospitalization rates. Health insurance was associated with higher allopathic health care utilization, and lower traditional health care usage, and acculturation with lower traditional health care usage. Higher self-reported cardiac risk factors were associated with lower allopathic and higher traditional health care. This suggests barriers to allopathic health care, but not traditional health care, for Koreans living in California without health insurance.