Literature Collection

PURPOSE OF REVIEW: We review recent literature on the adaptive assessment of complex mental health disorders and provide a detailed comparison of classical test theory and adaptive testing based on multidimensional item response theory. RECENT FINDINGS: Adaptive tests for a wide variety of mental health traits (e.g., depression, anxiety, mania, substance misuse, suicidality) are now available in a cloud-based environment. These tests have been validated in a variety of settings against lengthy structured clinical interviews with excellent results and even higher reliability than fixed-length tests. Applications include screening and assessments in emergency departments, psychiatric and primary care clinics, student health clinics, perinatal medicine clinics, child welfare settings, and the judicial system. The future of mental health measurement will be based on automated screening and assessments. Adaptive tests will provide increased precision of measurement and decreased burden of measurement. Integration into the electronic health record is important and now easily accomplished.

Background: Opioid dependence during pregnancy is associated with increased risk of low birthweight, neonatal mortality, and maternal complications. Methadone or buprenorphine maintenance therapy can prevent the effects of repeated withdrawals on the fetus and improve outcomes for infants and mothers. Method: This report uses the combined 2007 to 2012 National Surveys on Drug Use and Health (NSDUHs), the 2012 Treatment Episode Data Set (TEDS), and the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) to examine opioid misuse and treatment among women of childbearing age (aged 15 to 44). Results: An annual average of 21,000 pregnant women aged 15 to 44 misused opioids in the past month. Among pregnant women aged 15 to 44, those who were younger and those living below the federal poverty level were more likely than other pregnant women to be past month opioid misusers. Of the pregnant female treatment admissions, 22.9 percent reported heroin use and 28.1 percent reported nonheroin opioid misuse. About half of pregnant female admissions with heroin use had methadone or buprenorphine as a part of their treatment plan compared with less than one-quarter of nonpregnant female admissions with heroin use. For female admissions aged 15 to 44 reporting nonheroin opioid misuse, rates for having methadone or buprenorphine as a part of their treatment plan were comparatively lower. About 13 percent of outpatient-only substance use treatment facilities and residential treatment facilities offered a special program or group for pregnant/postpartum women. Between 61 and 79 percent of facilities that offered specialized programs or groups to pregnant or postpartum women accepted Medicaid as a form of payment. Conclusion: The findings suggest that outreach and educational resources targeting younger pregnant women and women living below the federal poverty level about the dangers of misusing prescription pain relievers may be especially beneficial. The health insurance gap among pregnant treatment admissions suggests that these women may need assistance in navigating the health insurance and health service opportunities provided by the Affordable Care Act to ensure critical access to the health care system.