Exploring Disparities in Behavioral Health Service Use in the Early Stages of the COVID-19 Pandemic.

BACKGROUND: Previous studies examined the impact of the COVID-19 pandemic on mental health, but few studies looked at associations between the pandemic and state-funded behavioral health service utilization. We aimed to examine behavioral health service utilization during the early phase of COVID-19 among individuals with psychiatric disorders (PD), substance use disorders (SUD), and co-occurring disorders (COD). METHODS: Using the last Adult Needs and Strengths Assessment (ANSA) completed in 2019 and 2020 in a Midwestern state, a column proportion test and Poisson regression model examined the associations of the pandemic year, age, gender, race/ethnicity, diagnostic type, and behavioral health needs. RESULTS: Between 2019 and 2020, the number of adults newly involved in behavioral health services increased from 11,882 to 17,385. The number of total actionable items (TAI) differed by gender and age group. Adults who were Black or American Indian were more likely to have a significantly higher number of needs that interfered with functioning (ß = 0.08; CI [0.06, 0.09]), (ß = 0.16; CI [0.08, 0.23]), respectively, than White peers. Individuals with COD showed the highest number of needs (ß = 0.27; CI [0.26, 0.28]) when compared to the needs of individuals with psychiatric disorders, after controlling for year, age, gender, and race/ethnicity. CONCLUSIONS: Additional research is needed to better understand the intersections of age, gender identity, race/ethnicity, the complexity of needs, and useful strengths. The involvement of practitioners, service organizations, researchers, and policymakers will be required to provide accessible, effective behavioral health services with cultural and developmental adaptations to support recovery.

Longitudinal Patterns of Strengths Among Youth with Psychiatric Disorders: A Latent Profile Transition Analysis.

A better understanding of variability in the strengths of youth with psychiatric disorders is critical as a strength-based approach can lead to recovery. This study aimed to identify subgroups of strengths among youth with mental disorders and determine whether subgroups changes were associated with mental health recovery. Youth with mental disorders (N = 2228) from a statewide database were identified in the state fiscal year of 2019. Using the latent profile analysis and latent transition analysis, we identified three strength profiles (i.e., essential, usable, and buildable). Over 90% of youth sustained or developed strengths over time. Positive transitions were associated with mental health recovery, symptom reduction, and personal recovery. Buildable strengths supported youth's personal recovery independent of improving mental health needs. The findings suggest that subgroups of strengths may be a promising source for planning and tracking youth's progress and guiding clinicians to more efficiently allocate community-based resources.

Predicting the Behavioral Health Needs of Asian Americans in Public Mental Health Treatment: A Classification Tree Approach.

Given the fact that experiencing pandemic-related hardship and racial discrimination worsen Asian Americans' mental health, this study aimed to identify unique characteristics of behavioral health needs among Asian Americans (N = 544) compared to White Americans (N = 78,704) and Black Americans (N = 11,252) who received publicly funded behavioral health services in Indiana before and during the COVID-19 pandemic. We used 2019-2020 Adults Needs and Strengths Assessment (ANSA) data for adults eligible for Medicaid or funding from the state behavioral health agency. Chi-squared automatic interaction detection (CHAID) was used to detect race-specific differences among demographic variables, the pandemic status, and ANSA items. Results indicated that, regardless of age, gender, or pandemic status, Asian Americans who received behavioral health services, struggled more with cultural-related factors compared to White and Black individuals. Within this context, intersections among behavioral/emotional needs (psychosis), life functioning needs (involvement in recovery, residential stability, decision making, medical/physical health), and strengths (job history, interpersonal, and spiritual) further differentiated the mental health functioning of Asian from White and Black Americans. Classification tree algorithms offer a promising approach to detecting complex behavioral health challenges and strengths of populations based on race, ethnicity, or other characteristics.

State-Community System of Care Development: an Exploratory Longitudinal Review.

The system of care (SOC) philosophy evolved into a framework to support access to effective behavioral health services for children. This study explored the use of the System of Care Implementation Survey (SOCIS) to monitor SOC development during one Midwestern state's federal planning and expansion grants. Utilizing a translational framework, results showed that despite fluctuations in SOC factor implementation over time, state and local SOCs had mid-level development. Further, inferential analysis of select factors indicated that outreach and access to services and the skilled provider network were significantly worse over time. Significant improvement in the treatment quality was documented but not sustained. Changes for Family Choice and Voice and Collaboration were not statistically significant. Variability in survey participation limited the evaluation. Refinement of evaluation methods is needed to monitor progress and to manage SOC development.