Mental Health Care Access Using Geographic Information Systems: An Integrative Review.

A decade after the Mental Health Parity and Addiction Equity Act was implemented to ensure access to mental health and substance abuse services for U.S. citizens, accessing mental health care still is problematic for many needing services. More than 123 million Americans reside in federally-designated Mental Health Professional Shortage Areas (MHPSA) compared to 84 million living in similarly-designated primary care shortage areas and 62 million in dental health shortage areas. Health professional shortage areas are geographic areas that have a shortage of primary medical, dental, or mental health providers. Geographic Information Systems (GIS) with spatial analysis approaches provide tools to understand the ever-changing distribution of health care, outcomes, and delivery to improve care. The aim of this integrative review is to describe and synthesize the literature on GIS approaches to improve access to mental health care services. GIS Bibliography, PubMed, CINAHL, PsycINFO, Academic Search Premier, Social Sciences Citation Index, and Oalster were searched for articles between January 1, 1998 and January 1, 2018 that met established inclusion/exclusion criteria. Among the 138 articles reviewed, 18 met criteria and were included in the review. GIS approaches to improve access to mental health care can be categorized as (1) type of care (integrated, community), (2) contributions to access (distance, time, cost, perception of traveling, inequalities), and (3) the utilization of services. Results from the literature suggest closer examination of measures used to assess geographic variations in accessibility is needed for ultimately improving quality of care for people in MHPSA.

The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Centers.

OBJECTIVE: The National Health Service Corps (NHSC) is a federal program to increase the supply of health professionals in underserved communities, but its role in enhancing the capacity of community health centers (CHCs) has not been investigated. This study examined the role of NHSC clinicians in improving staffing and patient care capacity in primary, dental, and mental health care in CHCs. METHODS: Using 2013-2016 administrative data from CHCs and the NHSC, we used a generalized estimating equation approach to examine whether NHSC clinicians [staff full-time equivalents (FTEs)] complement non-NHSC clinicians in CHCs and whether their productivity (patient visits per staff FTE) was greater than that of non-NHSC clinicians in primary, dental, and mental health care. RESULTS: Each additional NHSC clinician FTE was associated with a significant gain of 0.72 non-NHSC clinician FTEs in mental health care in CHCs and an increase of 0.04 non-NHSC FTEs in primary care in CHCs with more severe staffing shortages. On average, every additional NHSC clinician was associated with an increase of 2216 primary care visits, 2802 dental care visits, and 1296 mental health care visits per center-year. The adjusted visits per additional staff for NHSC clinicians were significantly greater in dental (difference=992) and mental health (difference=423) care, compared with non-NHSC clinicians. CONCLUSIONS: The NHSC clinicians complement non-NHSC clinicians in primary care and mental health care. They help enhance the provision of patient care in CHCs, particularly in dental and mental health services, the 2 major areas of service gaps.

Psychology input to an orthognathic clinic: Patients' perception of service quality.

AIMS: The aim of this study was to assess patient satisfaction with a clinical psychology service, integrated within an inter-disciplinary orthognathic planning clinic. METHOD: A self-report, custom-designed questionnaire was sent to patients who had completed orthognathic treatment within the last three years. Of the 60 patients approached, 49 responded. RESULTS: The great majority of patients agreed that there was a need for a psychological assessment and that its purpose was adequately explained. Most patients were happy with the information given during their appointment and found the experience helpful. A number of patients felt that additional appointments would have been helpful shortly before, and after, surgery. CONCLUSIONS: The group of orthognathic patients studied found the pre-treatment psychology assessment, provided for them through the combined clinic, to be very acceptable and beneficial. Some suggested that further appointments, throughout the treatment journey, as well as supportive literature, might also have been helpful.

A proposed one-stop-shop approach for the delivery of integrated oral, mental, sexual and reproductive healthcare to adolescents in Nigeria.

The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.

Critical services for our children: integrating mental and oral health into primary care.

Grantmakers have long been interested in improving children's access to health care. Yet, a number of services critical to children's healthy growth and development--such as mental health and oral health services--fall outside the traditional primary care model. This fragmentation of services has contributed to access barriers and has compromised the quality of pediatric care. Growing awareness of the importance of mental health and oral health has resulted in a variety of innovative efforts to integrate these services into children's health care.

Connecting the dots: developing a holistic picture of children's health.

Current definitions of child health transcend the historical biomedical model, which largely equated health with the absence of disease. Scientific evidence indicates that child health is best defined as the optimization of a child's developmental potential and functional capacity with interventions focused on maximizing protective factors and minimizing risk factors. This approach to child health recognizes the interplay among physical, cognitive, social, and emotional development and stresses the lifelong consequences of deficits in these developmental areas.

Experiences of three states implementing the Medicaid health home model to address opioid use disorder-Case studies in Maryland, Rhode Island, and Vermont.

PURPOSE: The United States is facing an unprecedented opioid epidemic. The Affordable Care Act (ACA) included several provisions designed to increase care coordination in state Medicaid programs and improve outcomes for those with chronic conditions, including substance use disorders. Three states-Maryland, Rhode Island, and Vermont - adopted the ACA's optional Medicaid health home model for individuals with opioid use disorder. The model coordinates opioid use disorder treatment that features opioid agonist therapy provided at opioid treatment programs (OTPs) and Office-based Opioid Treatment (OBOT) with medical and behavioral health care and other services, including those addressing social determinants of health. This study examines state approaches to opioid health homes (OHH) and uses a retrospective analysis to identify facilitators and barriers to the program's implementation from the perspectives of multiple stakeholders. METHODS: We conducted 28 semi-structured discussions with 70 discussants across the three states, including representatives from state agencies, OHH providers (OTPs and OBOTs), Medicaid health plans, and provider associations. Discussions were recorded, transcribed, and analyzed using NVivo. In addition, we reviewed state health home applications, policies, regulatory guidance, reporting, and other available OHH materials. We adapted the Exploration, Preparation, Implementation, and Sustainment (EPIS) model as a guiding framework to examine the collected data, helping us to identify key factors affecting each stage of the OHH implementation. RESULTS: Overall, discussants reported that the OHH model was implemented successfully and was responsible for substantial improvements in patient care. Contextual factors at both the state level (e.g., legislation, funding, state leadership, program design) and provider level (OHH provider characteristics, leadership, adaptability) affected each stage of implementation of the OHH model. States took a variety of approaches in designing and implementing the model, with facilitators related to gathering stakeholder input, receiving guidance and technical assistance, and tailoring program design to build on the state's existing care coordination initiatives and provider infrastructure. The OHH model constituted a substantial change for almost all OHH providers in the study, who reported that facilitators to implementation included having goals and workplace culture that were compatible with the OHH model, and having technical support from the state or non-governmental organizations. Some of the main barriers to implementation reported by OHH providers include shortages of primary care providers, dentists, and other providers willing to accept referrals of patients with opioid use disorder; limited community resources to address social determinants of health; challenges related to state-specific program design, such as staffing requirements and reimbursement methodology; care coordination limitations due to confidentiality restrictions and technological barriers; and internal capacity of providers to adopt the new model of care. CONCLUSIONS: The OHH model appears to have the potential to effectively address the complex needs of individuals with opioid use disorder by providing whole-person care that integrates medical care, behavioral health, and social services and supports. The experiences of Maryland, Rhode Island, and Vermont can guide development and implementation of similar OHH initiatives in other states.

Israel: Health System Review.

Israel is a small country, with just over 8 million citizens and a modern market-based economy with a comparable level of gross domestic product per capita to the average in the European Union. It has had universal health coverage since the introduction of a progressively financed statutory health insurance system in 1995. All citizens can choose from among four competing, non-profit-making health plans, which are charged with providing a broad package of benefits stipulated by the government. Overall, the Israeli health care system is quite efficient. Health status levels are comparable to those of other developed countries, even though Israel spends a relatively low proportion of its gross domestic product on health care (less than 8%) and nearly 40% of that is privately financed. Factors contributing to system efficiency include regulated competition among the health plans, tight regulatory controls on the supply of hospital beds, accessible and professional primary care and a well-developed system of electronic health records. Israeli health care has also demonstrated a remarkable capacity to innovate, improve, establish goals, be tenacious and prioritize. Israel is in the midst of numerous health reform efforts. The health insurance benefits package has been extended to include mental health care and dental care for children. A multipronged effort is underway to reduce health inequalities. National projects have been launched to measure and improve the quality of hospital care and reduce surgical waiting times, along with greater public dissemination of comparative performance data. Major steps are also being taken to address projected shortages of physicians and nurses. One of the major challenges currently facing Israeli health care is the growing reliance on private financing, with potentially deleterious effects for equity and efficiency. Efforts are currently underway to expand public financing, improve the efficiency of the public system and constrain the growth of the private sector.

A comparison study of an elementary school-based health center: effects on health care access and use.

OBJECTIVE: To assess the effects of an elementary school-based health center (SBHC) on access to and the use of physical and mental health services by children aged 4 to 13 years. STUDY DESIGN: A retrospective cohort analysis of parent surveys from a comparable intervention (SBHC) and a comparison of urban elementary schools. INTERVENTION: Elementary SBHC services, including preventive physical health care; the care of minor short-term illnesses, injuries, and stable ongoing medical conditions, dental screenings; and mental health counseling. PARTICIPANTS: All parents of students at both schools were asked to complete a survey. Return rates on the survey were 78.3% (570/728) and 77.0% (440/571) at the intervention and comparison schools, respectively. MAIN OUTCOME MEASURES: The use of health services, access to health services, and health service satisfaction. RESULTS: Compared with respondents at comparison schools, respondents whose children had access to an SBHC had less difficulty (P = .01) receiving physical health care for their children, ie, treatment of illnesses and injuries, immunizations, and physical examinations (odds ratio, 0.66; 95% confidence interval, 0.48-0.91). Access to an SBHC was independently and significantly related to less emergency department use (odds ratio, 0.63; 95% confidence interval, 0.40-0.99; P<.05), a greater likelihood of having had a physician's visit since the school year began (odds ratio, 1.92; 95% confidence interval, 1.39-2.65; P<.01), and a greater likelihood of having had an annual dental examination (odds ratio, 1.36; 95% confidence interval, 1.01-1.83; P<.05). Measured by a 12-item scale, respondents who reported the SBHC as their most-used health service were significantly more satisfied with their service than respondents who mostly used community clinics (z=-5.21; P<.01) or hospital clinics (z=-4.03; P<.01). CONCLUSIONS: Independent of insurance status and other confounding variables, underserved minority children with SBHC access have better health care access and use than children without SBHC access, signifying that SBHCs can be an effective component of health delivery systems for these children.

Early assessments of SCHIP's effect on access to care for adolescents.

PURPOSE: To examine implementation issues and challenges affecting access to care for adolescents during the first year of SCHIP operation in five states (California, Connecticut, Maryland, Missouri, and Utah). METHODS: Information was obtained through on-site interviews with senior SCHIP program staff members, medical directors, and other key staff members from managed care organizations; key staff members from behavioral health subcontractors or the state's behavioral health plans; a variety of physical and mental health providers; and families. Analysis of relevant SCHIP documents and available enrollment, capitation, and quality data was also conducted. RESULTS: The five states generally have focused little attention in the start-up phase to the unique service needs of adolescents. Although primary care was readily available, concerns were raised about training and experience in serving this population and the availability of multidisciplinary practice arrangements. Access to family planning did not appear to be a problem. However, access to mental health services and dental services was seriously affected by limited provider participants. CONCLUSIONS: Because adolescents constitute a sizeable proportion of the SCHIP population, states and managed care organizations need to consider ways to increase the participants of adolescent providers and to identify various financial and other incentives to address the serious shortages in mental health services and dental care.

Assessment, prevention, and intervention activities in a school-based program for children experiencing homelessness.

Children who experience homelessness are at increased risk for a range of health and mental health problems. In spite of this increased risk, they are often less likely to receive appropriate services. School-based programs offer considerable potential to reduce the gap between needs and appropriate services for these youth; however, there are few examples of such programs in the published literature. This article provides information from a mental and physical health prevention program and needs assessment for at-risk children, who were experiencing homelessness or were from very low-income families, which was piloted during a summer camp program in an urban school. Results of the needs assessment indicated that children residing in homeless shelters reported less consistent access to medical and dental care than children residing with their families. It is interesting that children experiencing homelessness were more likely to report that they had participated in counseling than did children from low-income families. Satisfaction ratings of prevention activities conducted in the program were positive for students and teachers.

Caring for older people. Community services: health.

Many frail or disabled elderly people are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for older people in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental, and dietetic services. In many areas, services are evolving to meet needs and some examples of innovative practice are included.

Outcomes of an integrated telehealth network demonstration project.

An integrated telehealth network that linked three hospitals, a federally qualified health care clinic with six sites, a county dental clinic, and patient homes was developed and implemented using both private and federal funding. The goal of the network was to deliver 10 different medical, dental, and behavioral health services to a rural community. The network served patients from nine different counties and two states. Outcomes from the disease management programs for congestive heart failure and diabetes, as well as crisis telehealth and teledental health, were reported. Results for the diabetes disease management program increased the number of diabetics who brought their blood sugar under control. Additionally, based on hospital days per patient per year with and without intervention, and the cost of intervention by telehealth, it was projected that the national cost of care for CHF hospitalizations could be reduced from 8 billion dollars to 4.2 billion dollars. This telehealth network can serve as a model for integrating health services in each county of the state. Once each county had an integrated telehealth network, the county networks could be linked to provide regional services and coordination on a statewide basis.