Assessing the safety and efficacy of prescribing psychologists in New Mexico and Louisiana.

This study aimed to compare patient outcomes between prescribing psychologists, psychiatrists, and primary care physicians (PCPs). Private insurance claims (2005-2021; n = 307,478) were used to conduct an active comparator, new user longitudinal cohort study developed using target trial emulation. Inverse propensity for treatment weighting was used to adjust for baseline differences in a range of sociodemographic, clinical, and contextual patient factors. Differences in the 1-year rate of health care visits for adverse drug events (ADEs), psychiatric emergency department (ED) utilization, medication adherence, and psychotropic polypharmacy were identified between prescribing psychologists and the other provider types using doubly robust Cox proportional hazards models. Compared to patients of psychiatrists, patients of prescribing psychologists had a 24% lower rate of ADEs (95% CI [0.60, 0.96]), a 20% lower rate of psychotropic polypharmacy (95% CI [0.74, 0.86]), and similar rates of psychiatric ED utilization and medication nonadherence. Compared to patients of PCPs, patients of prescribing psychologists had 138% higher rates of psychiatric ED utilization (95% CI [1.67, 3.39]), 175% higher rates of psychotropic polypharmacy (95% CI [2.53, 2.99]), 28% lower rates of medication nonadherence (95% CI [0.66, 0.78]), and similar rates of ADEs. Using robust pharmacoepidemiological methods, we noted that among mental health specialists, prescribing psychologists appear to be as safe and efficacious as psychiatrists in a large sample of privately insured patients. Notable differences in safety and efficacy when compared to PCPs may be attributable to differences between specialty and primary care. Future research on prescribing psychologists should move toward studies of care quality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Facilitators and Barriers to Shared Decision-Making Communication Between Latina Mothers and Pediatric Mental Healthcare Providers.

This study assessed communication factors influencing shared decision-making (SDM) between language-congruent clinicians and Latina mothers of pediatric mental health patients. The sample comprised Latinx youth up to 22 years old who were enrolled in mental healthcare and attended mental health-related sessions with their parent. One hundred transcripts depicting mental health visits were coded using the Conversation Analysis framework. Coding included inductive coding that came from analyzing the structure, or orderliness, of the visits and content discussed that affects SDM. Thematic qualitative analysis revealed that facilitators to SDM included collaborative engagement, parents being active in tailoring session content, and integrating the preferences, roles, and next steps for treatment among all participants. Barriers included unskilled interpersonal interactions undermining rapport, off-topic conversations becoming the session's focus, poor time management, and irregularly integrating parent/patient preferences into the clinician's decisions regarding the child's treatment. Additionally, visit content, structure, tone, and interpersonal engagement were factors that variably facilitated or served as barriers to patient participation in SDM and were integral to collaborative, family-centered care. These findings delineated characteristics of pediatric mental health conversations and identified areas to strengthen communication between parents, patients, and clinicians to shift toward more effective SDM and improve patient outcomes among Latinx families.

Scope-of-Practice Expansions Associated with Reduced Racial Disparities in Pediatric Mental Health Care.

To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children's Health (2016-2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access.

A pre-visit video/question prompt list intervention to increase youth question-asking about attention deficit hyperactivity disorder during pediatric visits.

OBJECTIVE: To conduct a pragmatic randomized controlled trial to test the effectiveness of an ADHD question prompt list with video intervention to increase youth question-asking and provider education about ADHD during visits. METHODS: English-speaking youth ages 11-17 with ADHD and their caregivers were enrolled from two pediatric clinics. Youth were randomized to intervention or usual care groups. Intervention group adolescents watched the video and then completed an ADHD question prompt list before their visits. Multivariable regression was used to analyze the data. RESULTS: Twenty-one providers and 102 of their patients participated. Intervention group youth were significantly more likely to ask one or more questions about ADHD and its treatment than usual care youth (odds ratio=5.4, 95 % Confidence Interval (CI)= 1.8, 15.9). Providers were significantly more likely to educate youth who asked one or more questions during visits about more ADHD medication areas (unstandardized beta=0.98, 95 % CI=0.31 to 1.64) and more non-medication strategies for ADHD (unstandardized beta=0.50, 95 % CI=0.13 to 0.88). CONCLUSION: The intervention increased youth question-asking about ADHD and its treatment. Providers provided more education to youth who asked one or more questions about ADHD and its treatment. PRACTICE IMPLICATIONS: Providers and practices should consider having youth complete ADHD question prompt lists and watch the video before visits to increase youth question-asking during visits.

Impacts of early deprivation on behavioral and neural measures of executive function in early adolescence.

Children reared in institutional settings experience early deprivation that has lasting implications for multiple aspects of neurocognitive functioning, including executive function (EF). Changes in brain development are thought to contribute to these persistent EF challenges, but little research has used fMRI to investigate EF-related brain activity in children with a history of early deprivation. This study examined behavioral and neural data from a response conflict task in 12-14-year-olds who spent varying lengths of time in institutional care prior to adoption (N = 84; age at adoption - mean: 15.85 months, median: 12 months, range: 4-60 months). In initial analyses, earlier- and later-adopted (EA, LA) youth were compared to a group of children raised in their biological families (non-adopted, NA). NA youth performed significantly more accurately than LA youth, with EA youth falling in between. Imaging data suggested that previously institutionalized (PI) youth activated additional frontoparietal regions, including dorsolateral prefrontal cortex, as compared to NA youth. In addition, EA youth uniquely activated medial prefrontal regions, and LA uniquely activated parietal regions during this task. A separate analysis in a larger group of PI youth examined whether behavioral or brain measures of EF varied with the duration of deprivation experienced. Duration of deprivation was negatively associated with activation of default mode network (DMN) regions. Overall, results suggest that there are lasting effects of deprivation on EF, but that those who are removed from institutional care earlier may be able to recruit additional neural resources as a compensatory mechanism.

Disseminating a health information website to teens using a three-pronged approach with social media outreach.

Objective: To disseminate iuveo.org, a new health information website, primarily to teens in the United States using a three-pronged approach of social media, in-person, and emails. Methods: Dissemination methods included a combination of in-person, email, and social media campaigns starting in August 2022 to reach teens and stakeholders focused on teen health. Following the Social Marketing Theory framework, a social media campaign was implemented utilizing Instagram and X (formerly Twitter). Website analytics, including monthly usage of iuveo, was measured utilizing Google Analytics. The intrinsic analytics from X and Instagram were also tracked. Results: From August 2022-July 2023, iuveo attracted 1338 unique users to the website. In the same time frame, 1085 accounts were reached on Instagram, and 14,367 impressions were received on X. Most website users (84.8%) were classified as 'direct' acquisition, meaning that they directly typed in the URL or clicked on a link, and 7.3% of users visited iuveo from a social media platform. Conclusion: A three-pronged dissemination strategy is beneficial when disseminating a new health information website. Innovation: Utilizing a three-pronged approach with a social media campaign based on Social Marketing Theory, a health information website was disseminated to youth in the United States.

An evaluation of the cost-effectiveness of population genetic screening for familial hypercholesterolemia in US patients.

BACKGROUND AND AIMS: Familial hypercholesterolemia is an underdiagnosed genetic metabolic condition limiting the clearance of low-density lipoprotein cholesterol and increasing lifetime risk of cardiovascular disease. Population genetic screening in unselected individuals could quickly identify cases of familial hypercholesterolemia and enable early prevention, but the economic impact of widespread screening on patients has not been studied. METHODS: We assessed the cost-effectiveness of population genetic screening for familial hypercholesterolemia in 20 and 35-year-old adults in the United States from the perspective of patients. We developed a decision tree Markov hybrid model to examine diagnoses, cardiovascular disease, cardiac events, quality of life, and costs under population genetic screening compared to family-based cascade testing. RESULTS: While population genetic screening increased diagnoses and reduced incidence of cardiovascular disease, population genetic screening was not cost-effective compared to cascade testing at current levels of willingness to pay. Lower genetic testing costs, combined screening with other genetic conditions, and support to maintain lipid-lowering therapy use over time could improve the cost-effectiveness of population genetic screening. CONCLUSIONS: Future research is needed to examine how cost-sharing strategies may affect the cost-effectiveness of screening to patients and how families and providers experience the clinical and economic outcomes of population screening.

Demographics and clinical characteristics of patients of prescribing psychologists, psychiatrists, and primary care physicians.

To describe the characteristics of patients receiving psychotropic medication from prescribing psychologists, psychiatrists, and primary care physicians. This descriptive study was conducted using private insurance claims of patients from New Mexico and Louisiana receiving psychotropic medications (anticonvulsants, antidepressants, antipsychotics, hypotensive agents, anxiolytics/sedatives/hypnotics, and stimulants) from 2004 to 2021 (N = 307,478). Patient characteristics were captured during the 6 months prior to their first psychotropic medication using administrative information, diagnosis and procedure codes, and medication data. Logistic regression models estimated the associations of patient characteristics with prescriber type. Additional logistic regression models estimated the association of prescriber type with medication classes prescribed. Patients were most likely to see specialists (psychologists or psychiatrists) if they had bipolar disorder (average marginal effect and 95% CI 0.214 [0.196, 0.231]), schizophrenia/psychotic disorders (0.118 [0.097, 0.138]), or had 1-4 visits of psychotherapy (0.267 [0.258, 0.026]). Specialist patients were most likely to see a prescribing psychologist if they had 1-4 visits of psychotherapy (0.196 [0.183, 0.210]) or had insomnia (0.309 [0.203, 0.415]). Prescribing psychologists were more likely to prescribe antidepressants (0.028 [0.011, 0.045]) and less likely to prescribe antipsychotics (-0.016 [-0.020, -0.012]) than psychiatrists. Primary care physicians were less likely to prescribe all psychotropic medications except antidepressants (0.011 [0.002, 0.019]) and anxiolytics (0.074 [0.067, 0.080]). Prescribing psychologists treat patients who are more similar to those of psychiatrists than patients of primary care physicians; they are less likely to prescribe antipsychotics and more likely to prescribe antidepressants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pediatric Mental Health Care and Scope-of-Practice Expansions.

To examine the association between psychologist and nurse practitioner scope-of-practice (SoP) regulations and pediatric mental health service access. A nationally representative sample of children with mental health needs was identified using 5 years of National Survey of Children's Health (2016-2020). Utilization was measured in two ways: (1) unmet mental health care needs and (2) receipt of mental health medication. Expanded SoP for psychologists and nurse practitioners was measured based on the child's state of residence and the year of the survey. The associations between both SoP expansion and both outcomes were assessed using logistic regression models adjusted for multiple covariates. The probability of having unmet mental health needs was 5.4 percentage points lower (95% CI - 0.102, - 0.006) for children living in a state with psychologist SoP expansion; however, there was no significant difference in unmet mental health needs between states with and without NP SoP expansion. The probability of receiving a mental health medication was 2.0 percentage points higher (95% CI 0.007, 0.034) for children living in a state with psychologist SoP expansion. Conversely, the probability of receiving a mental health medication was 1.5 percentage points lower (95% CI - 0.023, - 0.007) for children living in a state with NP SoP expansion. Expanded SoP for psychologists is associated with improved access to pediatric mental health care in terms of both unmet need and receiving medication. Expanded SoP for NPs, however, was not associated with unmet need and lower receipt of medication.

Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs.

This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.

North Carolina Medicaid System Perspectives on Substance Use Disorder Treatment Policy Changes During the COVID-19 Pandemic.

OBJECTIVE: This study aimed to describe perspectives from stakeholders involved in the Medicaid system in North Carolina regarding substance use disorder (SUD) treatment policy changes during the coronavirus disease 2019 pandemic. METHODS: We conducted semistructured interviews in early 2022 with state agency representatives, Medicaid managed care organizations, and Medicaid providers (n = 22) as well as 3 focus groups of Medicaid beneficiaries with SUD (n = 14). Interviews and focus groups focused on 4 topics: policies, meeting needs during COVID, demand for SUD services, and staffing. RESULTS: Overall, policy changes, such as telehealth and take-home methadone, were considered beneficial, with participants displaying substantial support for both policies. Shifting demand for services, staffing shortages, and technology barriers presented significant challenges. Innovative benefits and services were used to adapt to these challenges, including the provision of digital devices and data plans to improve access to telehealth. CONCLUSIONS: Perspectives from Medicaid stakeholders, including state organizations to beneficiaries, support the continuation of SUD policy changes that occurred. Staffing shortages remain a substantial barrier. Based on the participants' positive responses to the SUD policy changes made during the coronavirus disease 2019 pandemic, such as take-home methadone and telehealth initiation of buprenorphine, these changes should be continued. Additional steps are needed to ensure payment parity for telehealth services.

Family Support Services and Reported Parent Coping Among Caregivers of Children with Emotional, Behavioral, or Developmental Disorders.

OBJECTIVE: Caregivers of children with special health care needs (CSHCN) experience substantial strain caring for their child's special needs because of high needs for health and other support services. Caregivers of CSHCN with emotional, behavioral, or developmental problems (EBDPs) report stress and poor mental health at higher rates than caregivers of other CSHCN. Although family support services are associated with caregiver mental health and well-being among families of CSHCN, the association of these factors with caregiver coping has been underexamined. METHOD: Using the Double ABCX Model of Family Adaptation to guide variable selection, this study uses 2016 to 2019 data from the National Survey of Children's Health. Univariate, bivariate, and multivariate logistic analyses examined the association between caregivers' receipt of adequate care coordination and emotional support services and their reported coping with the day-to-day strains of parenting. These relationships are compared between caregivers of CSHCN with and without EBDPs. RESULTS: Receipt of adequate care coordination was associated with higher rates of caregiver-reported positive coping for all caregivers of CSHCN who have no source of emotional support. Receipt of emotional support services was associated with increased reports of positive coping for caregivers for all CSHCN as well. Caregivers reporting only informal sources of emotional support, however, also reported higher rates of positive coping when compared with caregivers with no source of emotional support. CONCLUSION: Mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.

Patterns of Mental Health Service Use During the Transition to Adulthood Among Autistic Adolescents and Young Adults.

Background: The time of transition into adulthood, especially when leaving school, is a time when many autistic adolescents and young adults (AYA) may stop receiving mental health services that they have relied on, leading to worse mental health outcomes. The purpose of this study was to describe patterns of mental health service use during transition to adulthood among autistic AYAs. Methods: We performed a cross-sectional study using electronic health records from years 2015 to 2019 from one large university health care system. We included autistic individuals ages 11-27 with at least one clinical encounter annually in the cohort. Outcomes included psychotropic medications and psychotherapy received, psychotropic polypharmacy, psychiatric emergency department (ED) visits, and adverse drug events. Results: Almost half of the 529 patients in the cohort received polypharmacy. The most common treatment was medication only (56.9%), followed by no treatment (22.7%), medication plus psychotherapy (18.7%), and psychotherapy only (data masked). The 17-21 age group had the highest odds of a psychiatric ED visit, whereas the 22-27 age group had the highest odds of receiving psychotropic medications and polypharmacy. Black AYA were more likely to receive psychotherapy and less likely to receive psychotropic polypharmacy than non-Hispanic Whites. Conclusion: Autistic individuals may benefit from more support from the health care system for their transition into adulthood to maintain use of beneficial mental health services as they leave school and to reduce the frequency of adverse outcomes. Access to providers experienced treating the complex needs of autistic individuals is important to reduce disparities.

Why is this an important issue?: Autistic adolescents and young adults often do not receive the mental health care services they need. As they transition into adulthood, they may lose important mental health services they relied on during childhood. Losing services may negatively affect their health and produce bad outcomes such as emergency department visits. Previous studies have suggested that autistic individuals often stop receiving important services as they leave school and lose access to school-based services. What was the purpose of this study?: The purpose was to describe patterns of mental health service use during the transition to adulthood among autistic adolescents and young adults. Underutilized services might indicate areas where the health care system needs to improve. What did the researchers do?: We used data from electronic health records from a large university health system in the southeastern United States. We identified autistic adolescents and young adults ages 11­27 in the data. We analyzed whether they received medication and/or psychotherapy for their mental health, and whether they had emergency department visits and adverse drug events. We also examined polypharmacy, meaning the use of multiple medications of different classes for mental health. What were the results of the study?: Almost half of the 529 included patients experienced polypharmacy. The majority received medication only, whereas smaller percentages received medication plus psychotherapy or psychotherapy alone. Emergency department visits were most common in the 17­21 age group, and psychotropic medications and polypharmacy were most used in the 22­27 age group. Black individuals were more likely to receive psychotherapy and less likely to receive psychotropic polypharmacy than non-Hispanic Whites. What do these findings add to what was already known?: These findings show that providers are relying heavily on medication, often including polypharmacy, to treat mental health issues in autistic adolescents and young adults. What are potential weaknesses of the study?: The study used only one health care system in one state and may not reflect what happens in other states with different policies. Data may include a high number of patients with complex medical conditions, which may not reflect the typical patient's experience. Medications prescribed by providers outside this particular health system may not be captured. How will these findings help autistic adults now or in the future?: These findings reveal potential areas for improvement for providers and health systems in treating autistic adults. Ensuring that autistic adolescents can continue to receive important mental health services as they age into adulthood can improve their health.

Psychotropic Medication Prescribing Across Medical Providers, 2016-2019.

OBJECTIVE: The authors sought to provide updated estimates of the proportion of psychotropic medications prescribed by different medical providers. METHODS: This pooled cross-sectional study used data from the Medical Expenditure Panel Survey (2016-2019). Nationally representative estimates of the percentages of all psychotropic medications prescribed by each provider type were calculated, and analyses stratified by medication type, insurance type, and age were conducted. RESULTS: Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals were analyzed. More than 60% of psychotropic medications were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants. This distribution varied significantly by medication, insurance, and patient age. CONCLUSIONS: Most psychotropic medication prescribing occurs in primary care; however, notable differences by medication, insurance, and age were observed, suggesting areas for future research.

A Multilevel Examination of Cognitive Control in Adolescents With Nonsuicidal Self-injury.

Background: Nonsuicidal self-injury (NSSI), a transdiagnostic behavior, often emerges during adolescence. This study used the Research Domain Criteria approach to examine cognitive control (CC) with a focus on response inhibition and urgency relative to NSSI severity in adolescents. Methods: One hundred thirty-eight adolescents, assigned female sex at birth, with a continuum of NSSI severity completed negative and positive urgency measurements (self-report), an emotional Go/NoGo task within negative and positive contexts (behavioral), and structural and functional imaging during resting state and task (brain metrics). Cortical thickness, subcortical volume, resting-state functional connectivity, and task activation focused on an a priori-defined CC network. Eighty-four participants had all these main measures. Correlations and stepwise model selection followed by multiple regression were used to examine the association between NSSI severity and multiunit CC measurements. Results: Higher NSSI severity correlated with higher negative urgency and lower accuracy during positive no-inhibition (Go). Brain NSSI severity correlates varied across modalities and valence. For right medial prefrontal cortex and right caudate, higher NSSI severity correlated with greater negative but lower positive inhibition (NoGo) activation. The opposite pattern was observed for the right dorsolateral prefrontal cortex. Higher NSSI severity correlated with lower left dorsal anterior cingulate cortex (ACC) negative inhibition activation and thicker left dorsal ACC, yet it was correlated with higher right rostral ACC positive inhibition activation and thinner right rostral ACC, as well as lower CC network resting-state functional connectivity. Conclusions: Findings revealed multifaceted signatures of NSSI severity across CC units of analysis, confirming the relevance of this domain in adolescent NSSI and illustrating how multimodal approaches can shed light on psychopathology.

Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study.

Background: For patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the core elements of care coordination interventions, and lack of standardized processes for assessing patients' needs has made it challenging for providers to optimize care coordination based on patient needs and preferences. Further, ensuring providers have reliable and timely means of communicating about care plans, patients' full spectrum of needs, and transitions in care is important for overcoming potential care fragmentation. In the Veterans Health Administration (VA), several initiatives are underway to implement care coordination processes and services. In this paper, we describe our study underway in the VA aimed at building evidence for designing and implementing care coordination practices that enhance care integration and improve health and care outcomes for Veterans with complex care needs. Methods: In a prospective observational multiple methods study, for Aim 1 we will use existing data to identify Veterans with complex care needs who have and have not received care coordination services. We will examine the relationship between receipt of care coordination services and their health outcomes. In Aim 2, we will adapt the Patient Perceptions of Integrated Veteran Care questionnaire to survey a sample of Veterans about their experiences regarding coordination, integration, and the extent to which their care needs are being met. For Aim 3, we will interview providers and care teams about their perceptions of the innovation attributes of current care coordination needs assessment tools and processes, including their improvement over other approaches (relative advantage), fit with current practices (compatibility and innovation fit), complexity, and ability to visualize how the steps proceed to impact the right care at the right time (observability). The provider interviews will inform design and deployment of a widescale provider survey. Discussion: Taken together, our study will inform development of an enhanced care coordination intervention that seeks to improve care and outcomes for Veterans with complex care needs.

Examining Psychologist Prescriptive Authority as a Cost-Effective Strategy for Reducing Suicide Rates.

Six states (NM, LA, IL, IA, ID, CO) grant prescriptive authority to qualified psychologists, and research has shown that these policies are associated with a reduction in suicides. In this study, we assess the cost-effectiveness of these policies in reducing suicide rates. This study used a Markov Model with a time horizon of 20 years to estimate the incremental net monetary benefit (INMB) of the policy from the societal perspective with a simulated cohort of 100,000 people. Transition probabilities and utilities were collected from the literature, and costs were assessed using a mixed macro-micro costing approach. Using this approach, we found that the 20-year INMB for the policy was estimated to be $12.81 million ($USD) per quality-adjusted life year (QALY). The probability of cost-effectiveness was greater than 50% at a willingness-to-pay threshold as low as $10,000 per QALY. The probability of cost-effectiveness was only modestly associated with the implementation costs of the policy, but was sensitive to the estimated effect of the policy intervention. The models estimated in this study support prescriptive authority for psychologists as a cost-effective strategy for reducing state-level suicide rates. A considerable amount of research is needed to understand the impact of this policy with finer granularity.

Co-designing a website with and for youth, so they can better manage their health.

Objective: To co-design a website aimed to empower youth to ask questions to encourage productive, meaningful conversations with their health care providers. Methods: The research team recruited adolescent stakeholders (ages 11-17) through flyers distributed at local Young Men's Christian Association (YMCA) locations, clinics, and school nurses. Eleven adolescents who had at least one chronic medical condition were selected as members of the two youth advisory boards. Youth participated in five co-design meetings to give input on website content and refinement over a two-and-a-half-year period. The youth reviewed the website in various stages of development. Results: Youth wanted a website with simple, straightforward language that would be understood by someone between the ages of 11-17 years with a reputable URL. The website content includes ADHD, asthma, vaping/smoking, diabetes, seizures, anxiety, panic disorder, depression, addiction, stimulants, bullying, eating disorders, and sexually transmitted infections. Youth wanted general background content, helpful resources, question prompt lists, and videos encouraging youth involvement in care. Conclusions: A credible co-designed website with information on different health topics that contains question prompt lists and videos for utilization during health care visits has the potential to increase adolescent involvement in their care. Innovation: This website is an innovative intervention aimed at informing and encouraging youth to be more actively involved in their care across a range of healthcare conditions.

Realigning theory with evidence to understand the role of care coordination in mental health services research.

Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.

Reduced Hippocampal Volumes in Children with History of Hypoxic Ischemic Encephalopathy after Therapeutic Hypothermia.

Hypoxic ischemic encephalopathy (HIE) remains a significant cause of disability despite treatment with therapeutic hypothermia (TH). Many survive with more subtle deficits that affect daily functioning and school performance. We have previously shown an early indication of hippocampal changes in infants with HIE despite TH. The aim of this study was to evaluate the hippocampal volume via MRI and memory function at 5 years of age. A cohort of children followed from birth returned for a 5-year follow-up (n = 10 HIE treated with TH, n = 8 healthy controls). The children underwent brain MRI and neurodevelopmental testing to assess their brain volume, general development, and memory function. Children with HIE had smaller hippocampal volumes than the controls despite no differences in the total brain volume (p = 0.02). Children with HIE generally scored within the average range on developmental testing. Though there was no difference in the memory scores between these groups, there was a positive within-group correlation between the hippocampal volume and memory scores in children with HIE (sentence recall r = 0.66, p = 0.038). There was no relationship between newborn memory function and 5-year hippocampal size. Children with HIE treated with TH experienced significant and lasting changes to the hippocampus despite improvements in survival and severe disability. Future studies should target diminishing injury to the hippocampus to improve overall outcomes.