Literature Collection

This column describes Project ECHO (Extension for Community Healthcare Outcomes), a teleconsultation, tele-education, telementoring model for enhancing primary care treatment of underserved patients with complex medical conditions. Numerous centers have adapted ECHO to support primary care treatment of behavioral health disorders. Preliminary evidence for behavioral health ECHO programs suggests positive impacts on providers, treatment planning, and emergency department costs. ECHO has the potential to improve access to effective and cost-effective behavioral health care by virtually integrating behavioral health knowledge and support in sites where specialty providers are not available. Patient-level outcomes research is critical.

Individuals with serious mental illness (SMI) have poorer oral health than the general population for various reasons, including poor oral hygiene, adverse effects of psychotropic medicines, stigma, fear, cognitive impairment, lack of insur¬ance coverage, and a shortage of professionals qualified to manage the oral health needs of this population. Oral health deteriorates further when care is postponed, resulting in greater treatment needs when the patient visits the dental office. This retrospective study aimed to determine differ¬ences in service return rate and frequency of visits for each of 12 American Dental Association (ADA) oral procedures in patients with and without SMI who were treated in a predoctoral dental clinic at a northeastern US dental school. This retrospective study used the dental electronic health records of 12,138 adult patients aged 18 years and over (total of 19,096 unique patient encounters) who received at least 1 comprehensive oral evaluation between January 1, 2017, and August 31, 2021. Three data processing methods were implemented to retrieve periodontal diagnoses in accordance with American Academy of Periodontology guidelines and to extract medical histories and behavioral factors from free text. Chi-square tests determined that there were statistically significant differences between the 2 groups for 4 of 12 ADA procedures, while t tests deter¬mined that the SMI group had a higher frequency of visits for 6 procedure categories. Logistic regression analysis showed that patients with an SMI had a significantly higher odds ratio of receiving 2 procedure categories (remov¬able prosthodontics and adjunctive general services). A negative binomial regression analysis was then conducted to predict the frequency of visits; patients with an SMI had a higher incidence rate ratio of receiving 4 ADA procedure categories (preventive, removable prosthodontics, oral and maxillofacial surgery, and adjunctive general services). This study identified the existence of oral healthcare disparities in a population with SMI in relation to specific ADA dental procedure categories. Improving integrated care models, interprofessional collaboration, and education of predoc¬toral dental students and licensed professionals may help alleviate some of the existing disparities.

INTRODUCTION: Integrated youth services (IYS) presents a unique opportunity to adopt social prescribing (SP) strategies within the IYS service model by developing and leveraging a highly connected multidisciplinary network of clinical and community-based service providers to tackle health inequities and enhance service access and outcomes for youth. This paper outlines a case study of Youth Wellness Hubs Ontario (YWHO), Canada, a collective of youth-serving organizations integrated and networked, and operating as a learning health system implementing SP services. The main study objective was to document how YWHO hubs engage in social prescribing through service provision. METHODS: We adopted an embedded case study approach. Data were collected from youth (n = 6361) aged between 12 and 25 years who were seeking services at a YWHO hub. Descriptive analyses, including frequencies across categories, were generated from service data, including reason for visit, needs addressed and service provided. RESULTS: A comparative analysis of services requested and provided found that youth across visits to YWHO hubs were engaging with multiple services and service providers, with a wide range of health, mental health and social support needs being addressed. CONCLUSION: YWHO implements SP services that aim to improve mental health resilience by supporting the vocational, educational and socialization needs of young people accessing IYS through YWHO hubs.; IYS exemplifies an innovative approach to SP through the development of a closely connected network of interdisciplinary service providers. Youth engaged in IYS are likely to connect with multiple services concurrently as biopsychosocial needs are identified and addressed. The most common services provided by YWHO address mental health, educational and relationships needs, and are provided by mental health workers, care navigators and education or training support workers.; eng

: Health care teams are constructive and efficient ways to approach, assess, coordinate, plan, and facilitate the client-centric and population-based care. Some iteration of team is in place across most practice settings, comprising different professionals and specialists, from multidisciplinary, interdisciplinary, and transdisciplinary to the most recent interprofessional model. This 2-part article series sets the tone for how interprofessional team-based care (IPTBC) empowers the care process. Part 1 focused on the history and fundamental concepts of interprofessional models, with outcomes to promote the value proposition for IPTBC implementation.This Part 2 article focuses on the identification of seminal group development and team processes. An original model, the Interprofessional Team Activation Cycle (ITAC), is presented, as well as defined tactics for professional case managers to promote successful implementation of IPTBC in their organizations. PURPOSE/OBJECTIVES: This article: PRIMARY PRACTICE SETTING(S):: Applicable to all health and behavioral health settings where case management is practiced. FINDINGS/CONCLUSIONS: Shifts in reimbursement models, organizational cultures, and client populations have yielded emphasis on the swift IPTBC implementation. In addition, the recognition of team development as a fluid process endemic to achieve client-centric outcomes and organizational return on investment mandates a keen eye to the phases of a team implementation, especially those that are interprofessional in scope. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: With case management so closely linked to the fiscal imperatives of organizations, engagement in IPTBC is a necessity for every practice setting yet not always implemented properly or successfully. Poor team collaboration contributes to unsuccessful outcomes for clients, increased costs, and concerning quality and risk management issues for the organization. Models focused on group development serve to support how health and behavioral health organizations consider and implement interprofessional teams.

Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.