Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs.

OBJECTIVE: Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services. METHODS: The authors examined two cohorts of youths: 2,532 youths who used mobile crisis services and a comparison sample of 3,961 youths who used behavioral health ED services (but not mobile crisis services) during the same fiscal year. Propensity scores were created to balance the two groups, and outcome analyses were used to examine subsequent ED use (any behavioral health ED admissions and number of behavioral health ED admissions) in an 18-month follow-up period. RESULTS: A pooled odds ratio of 0.75 (95% confidence interval [CI]=0.66-0.84) indicated that youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with youths in the comparison sample. The comparable result for the continuous outcome of number of behavioral health ED visits yielded an incidence risk ratio of 0.78 (95% CI=0.71-0.87). CONCLUSIONS: Using comparison groups, the authors provided evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs. Replication in other years and locations is needed. Nevertheless, these results are quite promising in light of current trends in ED use.

Measuring intention to refer: Older adults and social service agencies.

The public is encouraged to engage in socially responsible behaviors such as helping people get needed services, possibly by referring them. However, referral behavior is little researched. Informed by the theory of planned behavior, intent to refer older adults in need to the Connecticut's Gatekeeper Program (GP) which identifies elders at risk and connects them with community resources was studied and the Social Service Agency Referral Scale (SSARS) was developed. Senior center attendees, seniors who received GP training, and referrers to the state's GP were involved. SSARS and its subscales were internally consistent (Cronbach's α = .90, with α ≥ .733 for each subscale). SSARS was strongly correlated with a validated social responsibility scale (r = .48). Knowledge gained from the training enhanced the associated intention subscale. With little modification, SSARS could be used to elucidate similar efforts. Additionally, the process used to create SSARS could be replicated to develop related instruments.

Individual and organizational predictors of pediatric psychiatric inpatient admission in connecticut hospitals: a 6 month secondary analysis.

The objective of this study is to test the hypotheses that bipolar disorders or depressive disorders, minority status, and the presence of pediatric inpatient psychiatric unit will be individual predictors of pediatric psychiatric inpatient admission, and to provide a model that will evaluate which individual and organizational characteristics predict pediatric psychiatric inpatient. For this purpose, a secondary analysis of the medical records of 1,520 pediatric patient visits between January 1, 2008 and June 30, 2008, was conducted using univariate and multivariate logistic regression. Independent predictors of pediatric psychiatric inpatient admission were presence of bipolar and depressive disorders, greater average daily census, and increasing operating margin. Minority status was a significant predictor of not being admitted, as was presence of an anxiety disorder, greater total margin and older age. The results indicate that both individual and organizational factors impact disposition outcomes in particular subsets of pediatric patients who present to emergency departments for psychiatric reasons.

The concept of race in research: using composite variables.

Researchers who study differential outcomes based on racial classifications should acknowledge the sociopolitical forces that influence the concept of race. In this article, logistic regression findings based on a traditional methodological approach to race are compared to an approach that used a composite variable incorporating race/ethnicity and immigration status. Participants were 258 ethnically diverse low-income women drawn via convenience sampling from the Women, Infants, and Children's Program (WIC) in or near a northeastern city. The PrimeMD Patient Health Questionnaire was used to identify whether the women had subthreshold or major depressive syndrome. The analyses using the composite variable better account for the findings than the analyses using race as a separate variable. Researchers should strive to identify and utilize various dimensions of participants' social positions (e.g., immigration status, social economic status and language) that help explicate differential outcomes.