Healthcare Utilization Patterns Among Children With a History of Child Protective Services Investigations.

PURPOSE: Examine whether children with a prior child protective services (CPS) investigation had different healthcare utilization compared to children without a history of CPS investigations. METHODS: The Children's Health Assessment and Planning Survey assessed 6,492 primary caregivers of children ages 0-17 years residing in North Texas in 2015. Caregivers reported prior CPS investigations and child healthcare utilization (emergency department [ED] use, unmet medication needs, and unmet medical care needs). PRINCIPLE FINDINGS: A total of 408 (5%) caregivers reported their child had a CPS investigation. Children with CPS investigations had greater odds of visiting the ED (OR = 1.9; 95% CI: 1.4, 2.5) and not receiving necessary medical care (OR = 1.9; 95% CI: 1.4, 2.8) compared to children without a CPS investigation. CONCLUSIONS: Prior CPS investigation was associated with disparities in receipt of necessary medical care and ED utilization for children.

Prevalence of Mental Illness and Mental Health Care Use Among Police Officers.

Importance: Limited literature has characterized patterns of mental illnesses and barriers in seeking mental health care among police officers. Objectives: To assess the prevalence of mental illness (diagnosis) and symptoms of mental illness, evaluate the characteristics of officers interested in seeking mental health care, and characterize perceptions of mental health care use. Design, Setting, and Participants: This survey study was conducted among officers at a large police department in Dallas-Fort Worth, Texas. Focus group sessions were conducted from April 1, 2019, to November 30, 2019, and the survey was conducted from January 1 to February 27, 2020. A total of 446 sworn, employed patrol officers who were present during the recruitment briefing were eligible to participate in surveys and focus groups. Main Outcomes and Measures: Officers reported lifetime or current diagnosis of depression, anxiety, and posttraumatic stress disorder, as well as current mental health symptoms (using validated screeners of depression, anxiety, posttraumatic stress disorder, and suicidal ideation or self-harm) and mental health care use in the past 12 months. Focus group data were collected to contextualize mental health care use. Logistic regression analyses were used for quantitative data, and focus groups were iteratively coded by 4 coders using inductive and deductive thematic identification. Results: Of the 446 officers invited to participate, 434 (97%) completed the survey (mean [SD] age, 37 [10] years; 354 [82%] male; 217 White [50%]). Of these officers, 19 (17%) had sought mental health care services in the past 12 months. A total of 54 officers (12%) reported a lifetime mental health diagnosis, and 114 (26%) had positive screening results for current mental illness symptoms. Among officers with positive screening results, the odds of interest in using mental health services was significantly higher for officers with suicidal ideation or self-harm than for those who did not (adjusted odds ratio, 7.66; 95% CI, 1.70-34.48). Five focus groups were conducted with 18 officers and found 4 primary barriers in accessing mental health services: (1) inability to identify when they are experiencing a mental illness, (2) concerns about confidentiality, (3) belief that psychologists cannot relate to their occupation, and (4) stigma that officers who seek mental health services are not fit for duty. Conclusions and Relevance: The study found that although few officers were seeking treatment, they were interested in seeking help, particularly those with suicidal ideation or self-harm. Additional interventions appear to be needed to systematically identify and refer officers to health care services while mitigating their concerns, such as fear of confidentiality breach.

Do neighborhood demographics, crime rates, and alcohol outlet density predict incidence, severity, and outcome of hospitalization for traumatic injury? A cross-sectional study of Dallas County, Texas, 2010.

BACKGROUND: Unintentional injury leads all other causes of death for those 1 to 45 years old. The expense of medical care for injured people is estimated to exceed $406 billion annually. Given this burden on the population, the Centers for Disease Control and Prevention consistently refers to injury prevention as a national priority. We postulated that exposure to crime and the density of alcohol outlets in one's neighborhood will be positively associated with the incidence of hospitalization for and mortality from traumatic injuries, independent of other neighborhood characteristics. METHODS: We conducted a cross-sectional study with ecological and individual analyses. Patient-level data for traumatic injury, injury severity, and hospital mortality due to traumatic injury in 2010 were gathered from the Dallas-Fort Worth Hospital Council Foundation. Each case of traumatic injury or death was geospatially linked with neighborhood of origin information from the 2010 U.S. Census within Dallas County, Texas. This information was subsequently linked with crime data gathered from 20 local police departments and the Texas Alcoholic Beverage Commission alcohol outlet dataset. The crime data are the Part One crimes reported to the Federal Bureau of Investigation. RESULTS: The proportion of persons 65 years old or older was the strongest predictor of the incidence of hospitalization for traumatic injury (b = 12.64, 95% confidence interval (CI) 8.73 to 16.55). In turn, the incidence of traumatic injury most strongly predicted the severity of traumatic injury (b = 0.008, 95% CI 0.0003 - 0.0012). The tract-level unemployment rate was associated with a 5% increase in the odds of hospital mortality among hospitalized trauma patients. CONCLUSIONS: Several neighborhood characteristics were associated with the incidence, severity, and hospital mortality from traumatic injury. However, crime rates and alcohol outlet density carried no such association. Prevention efforts should focus on neighborhood characteristics such as population density, mean age of the residents, and unemployment rate, regardless of crime rates and alcohol outlet density.