Literature Collection

BACKGROUND: Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups. METHODS: MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders. RESULTS: Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001). CONCLUSION: Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients.

BACKGROUND: The Sparkbrook Children's Zone (SCZ) is an integrated health and social care offer for children and young people (CYP) in an economically marginalised area of Birmingham, UK. This study sought to measure: clinic reach to CYP living in deprivation; proportion of CYP receiving preventive health offers; referral rate to secondary care; proportion of CYP referred to a family support worker. METHODS: Observational study using routinely collected data to evaluate activity and impact of the SCZ. SCZ weekly clinics, embedded in a partner primary care network, are located in Sparkbrook and Balsall Heath East, Birmingham's second most populous ward with a young population, high diversity and high infant mortality. The clinics provide preventive health, clinical care, mental health support and social support to CYP <16 years. UK Health Research Authority approval reference: 25/PR/0168. RESULTS: From March 2022 to December 2024, 2265 CYP were booked into clinics (93.5% slots taken up); 89% of families were from the bottom Index of Multiple Deprivation quintile.Preventive healthcare: immunisation advice increased from 10.7% in 2023 to 40.2% in 2024; oral health promotion from 29.2% to 46.8%; smoking cessation advice from 1.8% to 12.5%; 97% eligible children received Healthy Start vitamins; 83% had body mass index measured.Clinical care: 73.8% of CYP discharged after seeing General Practitioner/paediatrician, 3.8% referred to secondary care, 14.7% patients were not brought to appointments.Social support: 28.2% of CYP referred to a family support worker. Five top reasons for referral: feeding, behaviour, activities, special educational needs and disabilities, parenting skills. CONCLUSION: Initial data suggest preventive health and social support can be successfully integrated in a neighbourhood health offer for CYP living in deprivation, with low referral rates to secondary care.