Literature Collection

Young adulthood is a major transition period, particularly challenging for those with mental disorders. Though the prevalence of depressive and anxiety disorders is especially high, young adults are less likely to receive mental health treatment than younger and older individuals. Reasons for this mental health treatment gap are multifold and range from individual- to system-level factors that must be taken into consideration when addressing young adult mental health needs. Studies in adults and adolescents have shown that integrated care in primary care settings is an effective model of treatment of mental disorders. After providing an overview of the mental health treatment gap in this developmental period, the argument is made for research focused on integrated care models specifically tailored for young adults that takes into consideration the various needs and challenges that they face and addresses the mental health treatment gap in young adulthood.

Young adulthood is a major transition period, particularly challenging for those with mental disorders. Though the prevalence of depressive and anxiety disorders is especially high, young adults are less likely to receive mental health treatment than younger and older individuals. Reasons for this mental health treatment gap are multifold and range from individual- to system-level factors that must be taken into consideration when addressing young adult mental health needs. Studies in adults and adolescents have shown that integrated care in primary care settings is an effective model of treatment of mental disorders. After providing an overview of the mental health treatment gap in this developmental period, the argument is made for research focused on integrated care models specifically tailored for young adults that takes into consideration the various needs and challenges that they face and addresses the mental health treatment gap in young adulthood.

The COVID-19 pandemic created significant mental stressors among patients, which had the potential to impede access to primary care behavioral health (PCBH) services through rapid unplanned shifts to telehealth. The authors utilized retrospective administrative data and patient surveys to assess the feasibility, acceptability, and clinical outcomes of Jefferson Health PCBH pre- and post-COVID pandemic onset (Cohort 1 in person-only visits and Cohort 2 telemedicine-only visits). Using a retrospective cohort comparison study, outcomes included number of patients receiving PCBH in both cohorts, frequency of visits, no-show and cancellation rates, change in mean PHQ-9 and GAD-7 scores for patients, changes in the levels of depression and anxiety severity using established severity levels, and patient satisfaction with telehealth (Cohort 2 only). Patients in Cohort 2 were significantly more likely to have an anxiety diagnosis, had a smaller average number of visits, and were more likely to have a cancelled appointment. Both cohorts had statistically significant improvements in PHQ-9 and GAD-7 scores. In regression analyses, treatment cohort was not a significant predictor of final PHQ-9 or GAD-7 score. More members of Cohort 2 reported severe anxiety at both initial and final measurements. Nearly all Cohort 2 patients agreed or strongly agreed that telehealth made it easier for them to obtain care, that the platform was easy to use, and the visit was effective. Overall, PCBH telehealth services post-COVID-19 onset were feasible, acceptable to patients, and yielded similar clinical improvements to in-person behavioral health visits conducted before the pandemic.

OBJECTIVE: This study aimed to describe the goals of service users with first-episode psychosis who enrolled in coordinated specialty care (CSC), along with the goals their family members have for them, and to understand service users' and family members' perceived needs for recovery after discharge from the program. METHODS: The authors conducted 32 in-depth interviews in English or Spanish with service users and their family members recruited between September 2021 and December 2022. Transcripts were analyzed to determine the common concerns and expectations of service users and family members. RESULTS: Most service users described wanting financial and social independence from their families of origin, including an education that would allow them to obtain well-paid, stable employment; transportation; and an independent residence. Service users described hoping to replace some of the support they received from CSC with friends they would make in the future; some family members hoped their loved one would be able to develop and sustain romantic relationships. Most family members described not feeling ready to leave CSC at the 2-year mark, whereas service users expressed mixed opinions about their readiness to exit the program. CONCLUSIONS: Although service users were excited about the prospect of discharge, they, along with their family members, agreed that ongoing support was needed after CSC. On the basis of the findings, the authors delineate supports that service users and family members believe are necessary for a successful step-down.

PURPOSE: Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice. METHOD: To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework. RESULTS: An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills. CONCLUSION: The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

BACKGROUND: Eating disorders (EDs) are severe mental illnesses with high rates of mortality, morbidity, and reduced quality of life. Their onset occurs during adolescence and early adulthood, coinciding with the critical transition from pediatric to adult care. To address the lack of guidelines to support ED transitions in Canada, this study developed evidence-based guideline recommendations. METHODS: Scoping review methodology was employed using comprehensive searches across seven databases, supplemented by forward and backward citation chaining to identify records on youth and young adults (YYAs) (16-25 years) with EDs and/or mental health conditions transitioning from pediatric to adult care. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the quality of the evidence for applicable studies. Using a modified Delphi method, the evidence was reviewed by a guideline development panel and consensus was achieved in a single round of voting. RESULTS: After de-duplication, 14,350 records from all sources were screened, with 1817 studies undergoing full-text review. A total of 419 studies were included. Of these, 199 were primary research studies which fell under one or more of the following categories: descriptive (n = 86), qualitative (n = 75), predictors (n = 48), transition interventions (n = 21), measurement tools (n = 8), and key outcomes (n = 3). The certainty of the evidence for specific interventions and tools was generally low. RECOMMENDATIONS: The panel issued strong recommendations for integrated, collaborative transition approaches involving YYAs, families, and providers, and for the use of the Transition Readiness Assessment Questionnaire (TRAQ) to support transition planning. Additional recommendations are included, with an emphasis on future research focused on long-term outcomes such as care continuity and treatment retention. CONCLUSION: This research addressed the absence of a cohesive approach to transitions for YYAs experiencing EDs and/or mental health conditions, highlighting evidence variability and the need for a unified approach. These guidelines propose actionable steps for improving care transitions for YYAs with EDs and/or mental health conditions by promoting collaborative care models, prioritizing outcome-focused research, and using measurement tools.; Young people with eating disorders (EDs) and/or other mental health conditions often face challenges when moving from pediatric to adult care, both in mental health and physical health realms. This transition typically occurs during adolescence or early adulthood which is a critical developmental period when continuation of care and support is essential. In Canada, there are no clear guidelines to help navigate this process. To address this gap, our team developed six recommendations based on a comprehensive scoping review of existing research. In these recommendations, we emphasize the importance of a collaborative approach that involves young people, families, and healthcare providers to ensure continuity and coordination of their care during the transition. In addition, research should prioritize the study of long-term outcomes, such as whether young people stay in treatment, leave early, or achieve successful transitions. Tools like the Transition Readiness Assessment Questionnaire (TRAQ) can help assess how prepared someone is for this change, but these tools need more testing to ensure they work well for people with EDs. These guidelines aim to improve care during this transition and to ensure that young people with EDs and/or other mental health conditions are prepared and supported as they move into adult healthcare services.; eng