Literature Collection

BACKGROUND: Mental health concerns among youth living with HIV are well documented. Given the interconnection between physical and mental health, behavioral health screening in medical settings is recommended to ensure patients are linked to mental health services. Unfortunately, COVID-19 disrupted medical and mental health services for people living with HIV, including youth. However, the extent of this disruption and its impact are not entirely known. OBJECTIVE: We aimed to explore the impact of COVID-19 on psychosocial screening practices and outcomes among youth living with HIV aged 12-25 in an integrated care setting in the southeastern United States. METHODS: Using existing program evaluation and continuous quality improvement data, we examined psychosocial screenings before and after the onset of COVID-19 (2019-2022). RESULTS: Findings revealed decreased psychosocial screening of eligible youth living with HIV between 2019 and 2021, but an increase in 2022. The percentage of positive depression and anxiety screeners decreased between 2019 and 2020, increased in 2021, and decreased again in 2022. However, positive post-traumatic stress screeners increased between 2019 and 2020, decreased in 2021, and increased again in 2022. Substance use screening indicated a steady increase in alcohol and tobacco use between 2019 and 2021. In 2022, alcohol continued to increase, but tobacco use decreased. CONCLUSIONS: Findings underscore the critical need for robust, adaptable psychosocial screening practices in integrated care settings to address the evolving mental health and substance use needs of youth living with HIV, especially during and after major public health disruptions.

One in six youth has a neurodevelopmental disability (NDD), and autism diagnostic rates continue to rise. Before and after a diagnosis, families need trusted sources of guidance to navigate co-occurring medical and psychological conditions, and to manage unique stressors including transition to adulthood. However, medical professionals from all specialty areas struggle to identify resources to support the complex psychosocial and healthcare needs of these patients and their families. This primer on psychosocial supports for youth with autism will explore the major mental and physical health stressors faced by affected youth and families, and discuss opportunities for primary care and other providers to provide resources and empower their patients. Through awareness of key challenges and resources, non-specialist providers can integrate autism-specific supports into their regular practice. These same approaches will also allow providers to offer more holistic care for the broader NDD patient community as well.

INTRODUCTION: The aim of this review is to identify common mood concerns in ICD patients and suggest brief psychological screeners essential for early detection and monitoring in patient care. AREAS COVERED: Reliable and valid psychological assessment tools are reviewed, including those specifically designed for ICD patient populations. EXPERT OPINION: Psychological assessment, in combination with cardiologic standard of care, can help overcome many barriers associated with poor implantable cardioverter-defibrillator (ICD) management and related cardiovascular outcomes. Earlier identification and treatment of mood concerns in ICD patients has been shown to improve quality of life (QOL) and patient outcomes. At this time, however, logistical challenges and time restraints, in addition to knowledge of appropriate treatment plans or referral options, remain central barriers to providing integrated, patient-centered care. Ultimately, all cardiology clinics would benefit from a collaborative care team that includes a mental health consultant or in-house psychologists who can provide consultations or referral services. Additionally, all patients that come to the clinics should complete proactive screening measures as routine component of care to assess the presence of mood concerns to improve patient outcomes and aid in treatment planning.

BACKGROUND: The Veterans Health Administration (VHA) greatly expanded the proportion of health care services it purchases from community providers over the last decade, which could impact the quality of care and create care fragmentation. Continuity of care between inpatient and outpatient care delivery systems is critical for high-quality mental health care. OBJECTIVE: To compare rates of outpatient follow-up visits between VHA-purchased and VHA-delivered psychiatric hospitalizations, overall and by VHA facility. METHODS: Using VHA electronic medical records and community care claims data, we compared 7-day and 30-day outpatient follow-up rates across VHA-purchased and VHA-delivered settings. We estimated follow-up rates and comparisons overall as well as separately for 4 diagnosis groups and separately across VHA facilities. RESULTS: Our sample included 64,784 hospitalizations; more than 30% were VHA-purchased as opposed to VHA-delivered. Compared with VHA-delivered hospitalizations, follow-up rates were 30.1 (95% CI: 27.8-32.5) percentage points lower at 7 days and 22.5 (95% CI: 20.8-24.1) percentage points lower at 30 days for VHA-purchased hospitalizations. Lower follow-up rates occurred for neurocognitive disorder discharges for both VHA-purchased and delivered care. Follow-up rates at 30 days were significantly lower for VHA-purchased hospitalizations at 121 out of 128 facilities and significantly higher at no facility. CONCLUSIONS: VHA enrollees seeking mental health care and VHA program managers could benefit from data on psychiatric care quality differences between community providers and VHA providers. From a system perspective, VHA-purchased care quality reports and value-based purchasing contracts could include outpatient follow-up quality measures to incentivize higher quality care.