Workforce Planning for Embedded Mental Health Care in the U.S. Navy.

INTRODUCTION: Embedding mental health providers directly into operational units provides opportunities for holistic individual and population focused mental health support. To effectively provide clinical mental health care to a large number of Sailors and Marines while supporting the larger command, it is crucial to arrive at an optimal number of mental health (MH) care staff. In response to an increasing demand for MH care by operational units distributed globally, the U.S. Navy (USN) critically analyzed the current MH staffing levels, estimated future demand for MH care providers, and evaluated several staffing options. The following article illustrates a case study of workforce planning for the USN's embedded MH delivery model. MATERIALS AND METHODS: Several existing data sources were used to calculate current number of MH care staff across all USN platforms and to estimate demand for MH care. An open source Linear Programming application was used to estimate staffing solutions that meet business requirements in the most efficient manner possible. RESULTS: Results suggested different conclusions for embedded mental health staffing across USN communities. Depending on existing staffing levels and the number of Sailors or Marines anticipated to require care, the Linear Programming algorithm estimated needed staffing levels to address demand. CONCLUSION: The current project represents the first systematic workforce planning initiative designed to help staff the USN's global demand for community focused MH care. The results of this project have identified areas where additional embedded mental health resources should be made available. By systematically documenting all services and capabilities and carefully examining the operational demands of each community, the current solution was able to identify precisely what type of MH resources should be allocated to a given community.

Predisposing, enabling and need-for-care predictors of adolescents' intention to use sexual health services.

BACKGROUND: The study aimed to understand the influence of predisposing, enabling and need-for-care factors on adolescents' intention to use sexual health services, using Andersen's Behavioural Model of Health Service Utilisation to organise and test these factors. METHODS: A sample of predominantly Hispanic teens (n=600) in Los Angeles, California completed a self-report survey about their sexual health knowledge, beliefs, intentions, and behaviours. Hierarchical regression modelling was used to examine the incremental influences on adolescents' intention to use sexual health services of: 1) predisposing sociodemographic factors; 2) predisposing knowledge and beliefs about sexual health; 3) enabling factors regarding perceived access to sexual health services; and 4) a need-for-care factor (sexual experience). RESULTS: Adolescents reported high intentions to use sexual health services (3.25 on a 4-point scale), yet only 42% reported knowing where to access services. Sexual health knowledge and beliefs significantly predicted adolescents' intention to use services beyond the effect of sociodemographics (P<0.001). Enabling factors indicating awareness of and importance attributed to accessibility significantly predicted intention to use services incremental to predisposing factors (P<0.001). However, need for care - that is, sexual experience - was not statistically associated with intention to use services (P=0.402). CONCLUSIONS: Sexual health interventions are needed to provide sexual health information, promote positive beliefs about health care, and ensure adolescents' awareness of and access to sexual health services.