Innovations in Practice: Intensive crisis intervention for adolescent suicidal ideation and behavior - an open trial.

BACKGROUND: Adolescent suicide is a major public health concern worldwide. However, evidence regarding the effectiveness of interventions targeting youth suicide risk is limited. The purpose of this study was to assess the feasibility, acceptability, and clinical outcomes of Intensive Crisis Intervention (ICI), a cognitive-behavioral, family-centered treatment that provides an alternative to longer inpatient care. METHOD: Intensive Crisis Intervention was piloted over a two-year period with 50 adolescents (Mage  = 15.1 years; 86% Female; 78% Caucasian) admitted to an intensive crisis stabilization unit presenting with suicidal ideation and/or attempts. Data were collected at admission, 30 days, and 3 months post-admission to evaluate changes in suicidal ideation and functioning over time. RESULTS: Follow-up data were provided by 88% of study participants. At 3 months, the mean Suicidal Ideation Questionnaire-Junior score improved 34.2 points relative to baseline (effect size of 2.2, p < .0001). Significant improvements in functioning, high rates of consumer satisfaction and readiness for care transition upon discharge were also reported. CONCLUSION: Study findings set the stage for a larger, randomized controlled trial to examine the efficacy of ICI in targeting suicidal ideation and behavior in adolescents.

Recent Tobacco Smoking is Associated with Poor HIV Medical Outcomes Among HIV-Infected Individuals in New York.

Tobacco smoking is associated with adverse health effects among people living with HIV (PLWH), including a higher risk of cancer and cardiovascular problems. Further, there is evidence that PLWH are two to three times more likely to smoke than the general population. The aim of this study was to examine the association between tobacco smoking and biomarkers of HIV disease progression, including unsuppressed viral load (viral load >200 copies/mL) and low CD4 cell count (<200 cells/mm(3)). Recent tobacco smoking was reported by 40 % (n = 5942) of 14,713 PLWH enrolled in Ryan White Part A programs in the New York City metropolitan area. In multivariate analyses controlling for sociodemographic and clinical characteristics, recent tobacco smoking was independently associated with unsuppressed viral load (AOR = 1.38, CI 1.26-1.50) and low CD4 cell count (AOR = 1.12, CI 1.01-1.24). Findings suggest the importance of routine assessments of tobacco use in clinical care settings for PLWH.

Old-for-Grade Status and Suicide Risk in U.S. High School Students.

Health-risk behaviors associated with increased risk of suicide are more prevalent in old-for-grade students compared to age-appropriate-for-grade peers; however, the association between old-for-grade status and suicidal behavior is largely unknown. This study investigated sex-specific differences in suicidal ideation, planning, attempts, and other risk behaviors by old-for-grade status. Secondary analyses utilizing bivariate and logistic regression methods for complex samples were conducted using data from the 2011, 2013, and 2015 National Youth Risk Behavior Survey for 16,579 female and 17,282 male high school students in grades 9 through 11. Among both males and females, students considered old-for-grade reported increased drug use, feeling sad/hopeless, violence, sexual activity, and limited/no seatbelt use compared with their peers. Old-for-grade students were also more likely to report a suicide attempt with increased suicidal ideation and planning observed only in old-for-grade males. Associations between old-for-grade status and suicide risk-related outcomes were attenuated in both sexes after adjusting for demographic characteristics and other health-risk behaviors. Findings suggest that common risk factors (e.g., sadness, substance use) may explain increased rates of suicidal behaviors in old-for-grade students.

How does being part of a pediatric accountable care organization impact health service use for children with disabilities?

OBJECTIVE: To examine the impact of a Medicaid-serving pediatric accountable care organization (ACO) on health service use by children who qualify for Medicaid by virtue of a disability under the "aged, blind, and disabled" (ABD) eligibility criteria. DATA SOURCES/STUDY SETTING: We evaluated a 2013 Ohio policy change that effectively moved ABD Medicaid children into an ACO model of care using Ohio Medicaid administrative claims data for years 2011-2016. STUDY DESIGN: We used a difference-in-difference design to examine changes in patterns of health care service use by ABD-enrolled children before and after enrolling in an ACO compared with ABD-enrolled children enrolled in non-ACO managed care plans. DATA COLLECTION/EXTRACTION METHODS: We identified 17 356 children who resided in 34 of 88 counties as the ACO "intervention" group and 47 026 ABD-enrolled children who resided outside of the ACO region as non-ACO controls. PRINCIPAL FINDINGS: Being part of the ACO increased adolescent preventative service and decreased use of ADHD medications as compared to similar children in non-ACO capitated managed care plans. Relative home health service use decreased for children in the ACO. CONCLUSIONS: Our overall results indicate that being part of an ACO may improve quality in certain areas, such as adolescent well-child visits, though there may be room for improvement in other areas considered important by patients and their families such as home health service.

Satisfaction With Care Coordination for Families of Children With Disabilities.

INTRODUCTION: Children with disabilities have significant health care needs, and receipt of care coordinator services may reduce caregiver burdens. The present study assessed caregivers' experience and satisfaction with care coordination. METHOD: Caregivers of Medicaid-enrolled children with disabilities (n = 2,061) completed a survey (online or by telephone) collecting information on the caregivers' experiences and satisfaction with care coordination using the Family Experiences with Coordination of Care questionnaire. RESULTS: Eighty percent of caregivers with a care coordinator reported receiving help making specialist appointments, and 71% reported help obtaining community services. Caregivers who reported that the care coordinator helped with specialist appointments or was knowledgeable, supportive, and advocating for children had increased odds of satisfaction (odds ratio = 3.46, 95% confidence interval = [1.01, 11.77] and odds ratio = 1.07, 95% confidence interval = [1.03, 1.11], respectively). DISCUSSION: Findings show opportunities for improving care coordination in Medicaid-enrolled children with disabilities and that some specific elements of care coordination may enhance caregiver satisfaction with care.

The Association Between Food Insufficiency and HIV Treatment Outcomes in a Longitudinal Analysis of HIV-Infected Individuals in New York City.

BACKGROUND: To date, there have been few longitudinal studies of food insecurity among people living with HIV (PLWH). Food insufficiency (FI) is one dimension of the food insecurity construct that refers to periods of time during which individuals have an inadequate amount of food intake because of limited resources. The aim of this analysis was to examine the relationship between FI and HIV treatment outcomes among HIV-infected individuals in New York City (NYC). METHODS: Associations between FI ("consistent"--food insufficient on both of the last 2 assessments, "inconsistent"--food insufficient on 1 of the last 2 assessments, or neither) and clinical indicators of HIV disease progression (viral load > 200 copies per milliliter, CD4 count < 200 cells per cubic millimeter) were analyzed for NYC Ryan White Part A food and nutrition program clients who were matched to the NYC HIV Surveillance Registry and completed 2 FI assessments between November 2011 and June 2013. RESULTS: Among 2,118 PLWH in food and nutrition programs, 61% experienced consistent FI and 25% experienced inconsistent FI. In multivariate analyses controlling for sociodemographic characteristics, consistent FI was independently associated with unsuppressed viral load (adjusted odds ratio = 1.6, confidence interval: 1.1 to 2.5). Consistent FI was only associated with low CD4 counts at the bivariate level. CONCLUSIONS: Future studies should examine biological, structural, and psychosocial factors that may explain the relationship between FI and HIV treatment outcomes to inform intervention development. Persistent FI among food and nutrition program clients suggests that services are needed to address underlying needs for financial stability (eg, vocational counseling) for PLWH.

Crystal methamphetamine use and HIV medical outcomes among HIV-infected men who have sex with men accessing support services in New York.

BACKGROUND: Drug use poses multiple challenges to maintaining physical health among HIV-infected individuals, particularly with regard to disease progression. Few studies, however, have examined the association between the use of crystal methamphetamine ("crystal meth") and HIV disease progression specifically among HIV-infected men who have sex with men (MSM). Understanding this relationship among HIV-infected MSM is particularly critical because of the high rates of crystal meth use reported in the population. METHODS: Associations between recent crystal meth use and poor HIV medical outcomes (viral load>200 copies/mL, CD4 count <350 cells/mm(3)) were analyzed for 2896 HIV-infected MSM enrolled in Ryan White Part A programs in the greater New York metropolitan area between November 2010 and June 2012. RESULTS: Crystal meth use (reported by 4%) was independently associated with unsuppressed viral load (AOR=1.8, CI=1.1-2.9) in multivariate analyses controlling for sociodemographic characteristics. There was no significant relationship between crystal meth use and low CD4 counts. CONCLUSIONS: To date, little research has examined how crystal meth use influences HIV medical outcomes among HIV-infected MSM. This analysis showed a significant independent association between crystal meth use and unsuppressed viral load among MSM in an HIV service population. Future studies should examine biological and psychosocial mediators, moderators and confounders of this relationship to inform intervention development for MSM crystal meth users in HIV care settings.