Intensive Outpatient Treatment (IOP) of Behavioral Health (BH) Problems: Engagement Factors Predicting Subsequent Service Utilization.

The purpose of the study is to 1) better understand patterns of utilization of Intensive Outpatient Treatment (IOP) Programs and Services in the State of Connecticut by adult Medicaid recipients experiencing a serious mental illness, substance use disorder, or co-occurring disorders; and 2) to determine the relationship between the duration of an IOP episode and connection to care rates for higher (i.e., rehospitalization) or lower levels of care following discharge. We hypothesized that the duration of an IOP episode would impact positively in reducing the use of higher levels of care while increasing the use of lower levels of care. In order to examine the frequency and duration of use of Intensive Outpatient (IOP) services by the CT Medicaid population, a two-year timeframe was selected: July 1, 2012 to June 30, 2014. A survival analysis was conducted to assess the risk of readmission to an IOP within 180 days based on demographic and utilization factors including, Age (in years on date of discharge), Race and Ethnicity, Gender, Homeless Status (at least one day in CY 2013), and Engagement Group (Intent to Treat, Early Termination, Minimally Adequate Dosage, & Target or More). To better understand the patterns of utilization associated with Adult IOP services, the average length of stay, number of treatment days, and average number of treatment days per week were explored. The number of unique individuals who were part of this analysis is 11,473, of which 2050 were mental health IOP utilizers (18%), 4598 were co-occurring IOP utilizers (40%), and 4825 (42%) were substance use IOP utilizers. For the total population, the average length of stay (ALOS) in days was 42 and the average number of treatment days attended per week was 2.5, for an average of 15 treatment days per episode of care. Among the IOP Cohorts, the Mental Health Cohort had the longest ALOS at 44.15 days, an average of 2.34 days of service per week, for an average of 14.76 days of IOP service per episode of care. The Substance Use Cohort had the shortest ALOS at 41.33 days, but had the highest intensity of services per week at 2.71 for an average of 16 days of service per episode of care. The Co-Occurring Cohort presented an ALOS of 41.74 days, an average of 2.32 services per week and an average of 13.83 sessions per episode. Overall there is evidence supporting an association between the number of days of care and protection from hospitalization, up to a certain number of days of care or number of days in IOP. Above the Minimally Adequate Dosage, the IOP protection factor seems to reach a plateau. This means that after 16 days of care, the chances of hospitalization remain the same regardless of the additional days provided.

Association of maternal smoking status with breastfeeding practices: Missouri, 2005.

OBJECTIVE: We sought to determine the association of smoking status as a risk factor for reduced initiation and duration of breastfeeding. METHODS: The Missouri Pregnancy Related Assessment and Monitoring System collected a stratified sample of new mothers in 2005. Surveys were mailed, with telephone follow-up, and completed within 2 to 12 months after delivery. Respondents were classified as nonsmokers, smokers who quit during pregnancy, light smokers (10 cigarettes per day). Multivariable binomial regression and Cox proportional hazards models were used to assess breastfeeding initiation and duration according to smoking status. RESULTS: Overall, 1789 women participated (weighted response rate: 61%). Approximately 74% of the women ever breastfed; 31% of the women ever smoked while pregnant. Compared with nonsmokers, the moderate/heavy smokers and light smokers were less likely to initiate breastfeeding, after controlling for sociodemographic characteristics, the presence of other smokers in the household, alcohol use, mode of delivery, and infant hospitalization. Compared with nonsmokers, the moderate/heavy smokers, light smokers, and smokers who quit during pregnancy were more likely to wean over time, controlling for the same covariates. There were no significant differences between nonsmokers and smokers regarding reasons for not initiating or ceasing breastfeeding. CONCLUSIONS: Mothers who smoked initiated breastfeeding less often and weaned earlier than nonsmoking mothers. Incorporating knowledge of the association between smoking and breastfeeding into existing smoking-cessation and breastfeeding programs could provide opportunities to reduce perinatal exposure to tobacco smoke, improve interest in breastfeeding, and address other barriers to breastfeeding that smoking mothers may face.

Folic acid consumption among Missouri women in the periconceptional period.

Periconceptional folic acid consumption significantly reduces the risk for neural tube defects. The purpose of this study was to identify the risk factors for poor periconceptional folic acid supplementation among Missouri women. Sixty-five percent of Missouri women reported not taking periconceptional multivitamins regularly. Unintended pregnancy (aOR = 0.49), maternal adolescent age (aOR = 0.44) and smoking before pregnancy (aOR = 0.53) were significantly associated with poor periconceptional multivitamin use. Folic acid interventions targeting specific sub-groups of women are needed in Missouri.

Maternal depression after delivery in Oklahoma.

BACKGROUND: The reduction of depression after delivery is one of the Healthy People 2010 targets. Postpartum depression (PPD) can inhibit care-giving practices and mother-child bonding and can lead some women to harm themselves. This study will examine correlates of maternal depression after delivery and associated stressors and will provide recommendations to address this issue in Oklahoma. METHODS: Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to estimate prevalence among demographic groups and related behaviors. Logistic regression modeling was used to produce adjusted odds ratios (p < 0.05) for factors and predictors associated with depression after delivery. RESULTS: One in four new mothers reported symptoms of maternal depression within two to six months postpartum. Women 20-24 were twice as likely to indicate symptoms of depression when compared to women 35 or older; adolescents were 2.5 times as likely. Stressors found to increase the risk of depression symptoms were having an unintended pregnancy, arguing with a partner more than usual during pregnancy and having bills they could not pay. Receiving a postpartum health checkup was protective against postpartum depression symptoms. CONCLUSION: Every postpartum woman in Oklahoma should be screened for PPD using a valid and reliable scale. Providers should discuss the risks of PPD with pregnant women as a routine part of their prenatal care and encourage women to receive their postpartum health checkup within six weeks of delivery.