Literature Collection

OBJECTIVE: The authors sought to assess workplace characteristics associated with perceived reasonable workload among behavioral health care providers in the Veterans Health Administration. METHODS: The authors evaluated perceived reasonable workload and workplace characteristics from the 2019 All Employee Survey (AES; N=14,824) and 2019 Mental Health Provider Survey (MHPS; N=10,490) and facility-level staffing ratios from Mental Health Onboard Clinical Dashboard data. Nine AES and 15 MHPS workplace predictors of perceived reasonable workload, 11 AES and six MHPS demographic predictors, and facility-level staffing ratios were included in mixed-effects logistic regression models. RESULTS: In total, 8,874 (59.9%) AES respondents and 5,915 (56.4%) MHPS respondents reported having a reasonable workload. The characteristics most strongly associated with perceived reasonable workload were having attainable performance goals (average marginal effect [AME]=0.10) in the AES and ability to schedule patients as frequently as indicated (AME=0.09) in the MHPS. Other AES characteristics significantly associated with reasonable workload included having appropriate resources, support for personal life, skill building, performance recognition, concerns being addressed, and no supervisor favoritism. MHPS characteristics included not having collateral duties that reduce care time, staffing levels not affecting care, support staff taking over some responsibilities, having spirit of teamwork, primary care-mental health integration, participation in performance discussions, well-coordinated mental health care, effective veteran programs, working at the top of licensure, and feeling involved in improving access. Facility-level staffing ratios were not significantly associated with perceived reasonable workload. CONCLUSIONS: Leadership may consider focusing resources on initiatives that support behavioral health providers' autonomy to schedule patients as clinically indicated and develop attainable performance goals.

PURPOSE: The shortage of competent behavioral healthcare professionals across the U.S. limits the availability of services, leaving primary care providers as the first point of access for many diverse populations, yet many lack training to provide high-quality care. This study discusses findings from four cohorts of a federally funded workforce development program that trained graduate social work (MSW) students in behavioral health skills and competencies, with a particular emphasis on interprofessional collaboration and care for diverse populations, including transition-aged youth and LGBTQ populations. METHODS: Student competencies were assessed through self-reported surveys across domains of interprofessional collaborative practice, utilizing a pre- and post-program test design. RESULTS: All cohorts demonstrated increased positive attitudes toward integrated healthcare teams, enhanced competencies in team skills, and improved interprofessional collaboration. DISCUSSION: Results yield important implications for ongoing interprofessional training among MSW students and indicate the significance of workforce development programs in preparing students for future work on integrated healthcare teams. CONCLUSIONS: Interprofessional practice models offer practical solutions to current healthcare gaps. Workforce development programs advance interprofessional practice and provide the interprofessional education and training necessary to work effectively on integrated healthcare teams.

OBJECTIVE: This study aimed to evaluate the implementation outcomes and lessons learned from the first 5 years of the Indiana Behavioral Health Access Program for Youth (Be Happy), a statewide child psychiatry access program (CPAP) designed to support primary care providers (PCPs) in addressing pediatric mental health needs. METHODS: Program utilization data were analyzed, including PCP characteristics, consultation characteristics, psychiatrist impressions, and PCP feedback. RESULTS: From 2019 to 2024, Be Happy received 3,031 consultation requests guiding behavioral health care for children and adolescents residing in 87 of Indiana's 92 counties. Calls often addressed medication management and therapy recommendations for patients with conditions such as anxiety, attention-deficit hyperactivity disorder, and depression. Consultations were completed on the same day, with one-half of cases managed entirely within the primary care setting. PCPs reported high satisfaction with Be Happy, citing increased confidence in addressing pediatric mental health needs, managing medications, and providing information about therapy resources. CONCLUSIONS: The Be Happy program demonstrates the utility of CPAPs in addressing workforce shortages, empowering PCPs, and improving access to mental health care for children and adolescents. Key lessons included the need for targeted outreach to rural areas and the importance of embedding CPAP awareness into health care training programs. Future research should explore patient-level outcomes and strategies to sustain and expand the impact of CPAPs.

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.