Association Between In-Home Treatment and Engagement in Psychosocial Services Among Medicaid-Enrolled Youth.

OBJECTIVE: Prior studies have identified low rates of engagement in mental health (MH) services in clinic settings among children enrolled in Medicaid. Yet, little is known about whether the delivery of in-home MH treatment (in which the clinician travels to the child's home) improves engagement for this population. This study examines the association between the delivery of in-home psychosocial treatment and engagement in services among Medicaid-enrolled youth. METHOD: We used 2010 to 2014 Georgia Medicaid claims data to identify 53,508 children and adolescents (aged 5-17 years) with a MH diagnosis that initiated new psychosocial treatment. We estimated regression models controlling for covariates to examine the relationship of the receipt of any in-home psychosocial treatment in the home setting with 3 outcome measures of engagement: receipt of at least 4 psychosocial visits during the first 12 weeks; total number of psychosocial visits during the first 12 weeks; and total duration of service use. RESULTS: Those who received any in-home psychosocial treatment (compared to those who did not) had 4.3 times the odds (odds ratio = 4.3, 95% CI = 4.0, 4.7) of receiving at least 4 visits during the first 12 weeks, had 4.5 (95% CI = 4.3, 4.7) more predicted visits during the first 12 weeks, and had a longer treatment episode duration (mean rate ratio = 1.54, 95% CI = 1.48,1.59). CONCLUSION: Although many Medicaid-enrolled youth do not receive a sufficient number of MH services to achieve positive outcomes, our findings suggest that providing in-home psychosocial treatment can improve service engagement and potentially help address this challenge.

Evaluating scenarios for school reopening under COVID19.

BACKGROUND: Thousands of school systems have struggled with the decisions about how to deliver education safely and effectively amid the COVID19 pandemic. This study evaluates the public health impact of various school reopening scenarios (when, and how to return to in-person instruction) on the spread of COVID19. METHODS: An agent-based simulation model was adapted and used to project the impact of various school reopening strategies on the number of infections, hospitalizations, and deaths in the state of Georgia during the study period, i.e., February 18th-November 24th, 2020. The tested strategies include (i) schools closed, i.e., all students receive online instruction, (ii) alternating school day, i.e., half of the students receive in-person instruction on Mondays and Wednesdays and the other half on Tuesdays and Thursdays, (iii) alternating school day for children, i.e., half of the children (ages 0-9) receive in-person instruction on Mondays and Wednesdays and the other half on Tuesdays and Thursdays, (iv) children only, i.e., only children receive in-person instruction, (v) regular, i.e., all students return to in-person instruction. We also tested the impact of universal masking in schools. RESULTS: Across all scenarios, the number of COVID19-related deaths ranged from approximately 8.8 to 9.9 thousand, the number of cumulative infections ranged from 1.76 to 1.96 million for adults and 625 to 771 thousand for children and youth, and the number of COVID19-related hospitalizations ranged from approximately 71 to 80 thousand during the study period. Compared to schools reopening August 10 with a regular reopening strategy, the percentage of the population infected reduced by 13%, 11%, 9%, and 6% in the schools closed, alternating school day for children, children only, and alternating school day reopening strategies, respectively. Universal masking in schools for all students further reduced outcome measures. CONCLUSIONS: Reopening schools following a regular reopening strategy would lead to higher deaths, hospitalizations, and infections. Hybrid in-person and online reopening strategies, especially if offered as an option to families and teachers who prefer to opt-in, provide a good balance in reducing the infection spread compared to the regular reopening strategy, while ensuring access to in-person education.

Homebound by COVID19: the benefits and consequences of non-pharmaceutical intervention strategies.

BACKGROUND: Recent research has been conducted by various countries and regions on the impact of non-pharmaceutical interventions (NPIs) on reducing the spread of COVID19. This study evaluates the tradeoffs between potential benefits (e.g., reduction in infection spread and deaths) of NPIs for COVID19 and being homebound (i.e., refraining from interactions outside of the household). METHODS: An agent-based simulation model, which captures the natural history of the disease at the individual level, and the infection spread via a contact network assuming heterogeneous population mixing in households, peer groups (workplaces, schools), and communities, is adapted to project the disease spread and estimate the number of homebound people and person-days under multiple scenarios, including combinations of shelter-in-place, voluntary quarantine, and school closure in Georgia from March 1 to September 1, 2020. RESULTS: Compared to no intervention, under voluntary quarantine, voluntary quarantine with school closure, and shelter-in-place with school closure scenarios 4.5, 23.1, and 200+ homebound adult-days were required to prevent one infection, with the maximum number of adults homebound on a given day in the range of 119 K-248 K, 465 K-499 K, 5388 K-5389 K, respectively. Compared to no intervention, school closure only reduced the percentage of the population infected by less than 16% while more than doubling the peak number of adults homebound. CONCLUSIONS: Voluntary quarantine combined with school closure significantly reduced the number of infections and deaths with a considerably smaller number of homebound person-days compared to shelter-in-place.

The impact of social distancing on COVID19 spread: State of Georgia case study.

As the spread of COVID19 in the US continues to grow, local and state officials face difficult decisions about when and how to transition to a "new normal." The goal of this study is to project the number of COVID19 infections and resulting severe outcomes, and the need for hospital capacity under social distancing, particularly, shelter-in-place and voluntary quarantine for the State of Georgia. We developed an agent-based simulation model to project the infection spread. The model utilizes COVID19-specific parameters and data from Georgia on population interactions and demographics. The simulation study covered a seven and a half-month period, testing different social distancing scenarios, including baselines (no-intervention or school closure only) and combinations of shelter-in-place and voluntary quarantine with different timelines and compliance levels. The following outcomes are compared at the state and community levels: the number and percentage of cumulative and daily new symptomatic and asymptomatic infections, hospitalizations, and deaths; COVID19-related demand for hospital beds, ICU beds, and ventilators. The results suggest that shelter-in-place followed by voluntary quarantine reduced peak infections from approximately 180K under no intervention and 113K under school closure, respectively, to below 53K, and delayed the peak from April to July or later. Increasing shelter-in-place duration from four to five weeks yielded 2-9% and 3-11% decrease in cumulative infection and deaths, respectively. Regardless of the shelter-in-place duration, increasing voluntary quarantine compliance decreased daily new infections from almost 53K to 25K, and decreased cumulative infections by about 50%. The cumulative number of deaths ranged from 6,660 to 19,430 under different scenarios. Peak infection date varied across scenarios and counties; on average, increasing shelter-in-place duration delayed the peak day by 6 days. Overall, shelter-in-place followed by voluntary quarantine substantially reduced COVID19 infections, healthcare resource needs, and severe outcomes.