Literature Collection

INTRODUCTION: Borderline personality disorder (BPD) is a burdensome and diagnostically challenging condition. There is a need to identify its risk factors, yet prior studies are scarce and small-scale. We aimed to describe the prevalence of psychiatric comorbidities and the level of mental health resource utilization during adolescence in patients with BPD. METHODS: We conducted a retrospective descriptive study of 938 participants (aged 18-26 years) with BPD at a large, multi-site, integrated health maintenance organization (HMO) system in Southern California. Data were collected from January 2010 to September 2020. Comorbidities of interest were other psychiatric conditions diagnosed before age 18. Healthcare utilization data included age of first psychiatry encounter, age at first psychiatric hospitalization, number of psychiatric hospitalizations per year, number of sessions of intensive outpatient group therapy and partial hospitalization, number of visits with a psychiatrist, number of crisis calls, and number of psychotherapy sessions. RESULTS: The analytic cohort included 816 (87.0%) female patients with a mean age of 22 years. BPD prevalence in the overall population was 0.1% (n=2,287). Comorbidities with the highest prevalence included depressive and anxiety disorders at 83.5% (n=783) and 69.6% (n=653), respectively. Suicidal ideation and suicide attempts were prevalent at 38.6% (n=362) and 0.5% (n=5). Before the age of 18 years, 70.7% (n=663) had a psychiatric visit, 86.7% (n=813) had psychotherapy, and 34.8% (n=326) had a psychiatric hospitalization. CONCLUSION: The findings of this study suggest high psychiatric comorbidity and healthcare utilization in patients with BPD. Given lower rates of adolescent suicidality, early intervention may decrease BPD-associated mortality. Psychiatric comorbidities may predict the risk of developing BPD. Future comparative analyses should validate the statistical significance of these predictors and whether screening improves BPD outcomes.

BACKGROUND: Children with medical complexity (CMC) are children who have a range of chronic physical, developmental, and behavioral conditions. CMC is a vulnerable population that requires special care and receives support from multidisciplinary teams. The COVID-19 pandemic reshaped healthcare practices, with long-term consequences. CMC was particularly impacted, encountering medical, behavioral, and social challenges due to disruptions in care and pandemic-related restrictions. This qualitative study aims to understand the impact of the COVID-19 pandemic on the CMC care journey from a healthcare provider's perspective. Understanding COVID-19 challenges will help refine healthcare strategies, improve patient safety, and ensure CMC care meets their unique needs. METHODS: In this qualitative study, we captured views from various providers who cared for CMC during the pandemic. We conducted semi-structured interviews between May 2023 and December 2023. In total, we had 24 healthcare providers participate in the study, including 4 Hospitalists, 13 Specialists, 2 Outpatient Pediatricians, and 5 Home Nurses. Interviews were audio recorded to ensure accuracy in transcription and analysis. We used an inductive thematic analysis with a codebook approach for our coding process. RESULTS: As a result of inductive thematic analysis, ten primary themes emerged from the data related to CMC care challenges during the COVID-19 pandemic from the healthcare providers' perspective. Each theme consists of a set of subthemes. Themes are clustered into three main categories: (1) Access and Continuity of Care, (2) Families, Staff, and Collaborative Care, and (3) Infection Risk and Prevention Strategies. CONCLUSIONS: This study highlights the challenges of caring for CMC during the COVID-19 pandemic, focusing on system vulnerabilities and the resilience of healthcare providers and families. It shows the need for family-centered care, better telehealth integration, and comprehensive support for providers.

Wyoming was awarded a Center for Medicare and Medicaid Services (CMS) Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Demonstration Grant! Maryland, Georgia and Wyoming submitted a joint application to implement and/or expand a Care Management Entity (CME) provider model using High Fidelity Wraparound and Intensive Care Coordination. Wyoming seeks to improve clinical, functional, and cost outcomes, access to home and community-based services, and youth and family resiliency of Medicaid children and youth with serious behavioral health challenges and historically high costs or at risk of high cost through implementation of a CME pilot in the Southeastern Region of Wyoming.