Literature Collection

Cerebral palsy (CP) is a lifelong condition that affects 1.5-3.4 per 1000 children worldwide. As they grow older, these children must transition from pediatric to adult healthcare services. This transition comes with stress and uncertainty for a population that is already at a higher risk of poor mental health. This paper discusses what is known about mental health in youth with CP and its impact on their transition within the medical system. It also uses a biopsycho-ecological framework to understand how transition impacts several domains of their life including family structure and social participation. Actionable guidance for medical providers and caregivers is given to promote a healthier transition process.

AIM: To explore factors that foster positive mental health among adults with type 1 and type 2 diabetes and identify opportunities for more accessible, person-centred mental health support within diabetes care. METHODS: Participants were purposively sampled from the Mental health IN Diabetes Monitoring And Pathways (MIND-MAP) cohort study. Semi-structured online interviews were conducted with 32 adults in Victoria, Australia. Interviews explored factors associated with emotional well-being and experiences and preferences for mental health support. Data were analysed using reflexive thematic analysis, informed by phenomenology and constructivist grounded theory. The study was co-designed with guidance from a multidisciplinary Steering Committee and lived experience input through a Community Advisory Group comprising 12 adults with type 1 or type 2 diabetes. RESULTS: Participants described internal strengths (e.g. acceptance, perspective-taking) and external supports (e.g. peer connections, empathetic health professionals, timely access to mental health care) that supported their mental health. Several barriers to accessing mental health support were reported, including limited-service access, geographic and financial constraints, discomfort discussing emotions, and a lack of diabetes-specific mental health expertise. Emotional support was often absent at diagnosis and other key transition points. Participants called for support that is empathetic, non-judgemental, tailored and embedded within diabetes services. CONCLUSION: Adults with type 1 and type 2 diabetes show resilience in managing mental health, yet systemic, practical and attitudinal barriers remain. Care models should build on personal strengths, normalise emotional support and integrate psychological care from diagnosis, as well as harness the value of peer support.

Primary care providers often screen for autism during well child visits in the first few years of life and refer children for diagnostic evaluations when needed. However, most children do not receive a diagnosis until years later which delays access to services. Racism, socioeconomic status, and other systemic inequalities that limit access to health care further delay diagnostic evaluations. Mental health clinicians who work in primary care clinics can help address barriers to accessing diagnostic evaluation services once they are recommended by their primary care provider. However, mental health clinicians who work in primary care typically do not have training in diagnosing autism. The goal of this study was to evaluate a program training mental health professionals working in an urban primary care setting, primarily serving Black and Latinx families insured by Medicaid, to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through the Autism in Primary Care (APC) program. The wait time to access an evaluation through APC was significantly shorter than through standard avenues of care (e.g. referring to a separate autism clinic). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Conducting autism evaluations in primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.

High-need, high-cost (HNHC) adults require comprehensive strategies that address both clinical and social determinants of health (SDOH). This retrospective, propensity score-matched study (n = 526) evaluated a care model integrating monthly SDOH screenings, medication oversight, and real-time admission-discharge-transfer alerts in four urban primary care clinics. Compared to usual care, the intervention significantly reduced acute utilization within 60 days: emergency department (ED) visits decreased by 0.17 (P < 0.001) and hospital admissions declined by 0.12 (P < 0.001). Gross per-participant costs fell from $6,019 to $2,422 (a $3,597 reduction); after accounting for intervention expenses, net savings reached $3,222 (P < 0.001), yielding an estimated 6.9:1 return on investment. Patient-reported outcomes also demonstrated significant gains: EQ-5D-5L scores increased by 0.082 (P < 0.001) in the intervention cohort, exceeding the threshold for clinically meaningful change, while Net Promoter Scores rose by 8.8 points (P < 0.001). Subgroup analyses revealed slightly smaller quality-of-life gains among non-White cohorts, highlighting the need for culturally tailored approaches to advance equity. These findings align with prior Population Health Management research showing that integrated care models can reduce costs and enhance patient satisfaction. Overall, this multifaceted model effectively curbs avoidable ED visits and admissions, generates short-term cost savings, and boosts patient satisfaction-key outcomes under value-based care contracts. Future research should investigate longer-term outcomes and refine equity-focused strategies to ensure sustained and inclusive benefits.