Literature Collection

BACKGROUND: Lesbian, bisexual+ and queer (LBQ+) cisgender women have considerable unmet mental health needs. The aims of this study were to examine LBQ+ cisgender women's prior engagement with general practitioners (GPs), and how this relationship shaped their mental health service use. METHOD: Data from 2707 cisgender LBQ+ women were drawn from a national survey of adults who are lesbian, gay, bisexual, trans, intersex, queer or questioning, asexual and other diverse sexuality and gender identities (LGBTIQA+) in Australia. Multivariable logistic regression analyses examined demographic predictors of continuity of care with GPs and GPs' awareness of LBQ+ women's sexual orientation. The relationship between these variables and recent mental health service use was then analysed, comparing LBQ+ women's engagement with services known to be LGBTIQA+ inclusive and those without an inclusive reputation. RESULTS: LBQ+ cisgender women with a regular GP had greater odds of having accessed mental health services in the last 12months. Two-thirds had a regular GP, with the lowest odds among women aged 18-35years and highest odds among women with a disability. LBQ+ women who did not believe their regular GP knew of their sexuality had lower odds of having accessed LGBTIQA+ inclusive mental health services. These individuals were typically aged below 25years, bisexual+ or queer identified, had below undergraduate-level education, earned <$2000 AUD per week, or lived in an outer-suburban or regional area. CONCLUSION: GPs may be missing opportunities to promote continuity of care through developing trusting relationships with specific sub-populations of LBQ+ women, which in turn appears to sustain inequitable access to mental health care. To offer appropriate care and referrals for this population, GPs should provide safe and inclusive environments to enable comfortable and supportive discussions about sexual orientation when this is relevant to a person's health care.

Children with complex health and behavioral health conditions face challenges accessing coordinated health and community-based services. Adverse childhood experiences (ACEs), social determinants of health, and care delivery silos can lead to negative long-term outcomes. This paper provides an update on the Integrated Care for Kids (InCK) model from the Centers for Medicare &Medicaid Services' Innovation Center and discusses barriers and facilitators to program implementation in the seven communities. The three core InCK activities-supported by flexible alternative payment models-are early identification, risk stratification, and service integration. Challenges include obtaining the appropriate Medicaid and Children's Health Insurance Program (CHIP) authorities, sharing data across non-traditional partners, assessing impact in non-clinical domains, and evaluating the program's impact on child health. InCK enables innovation in value-based purchasing by creating a guiding framework that allows states to design and implement a service delivery and payment model that accounts for the heterogeneity of Medicaid programs.