Alicia Boccellari

Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial.

OBJECTIVE The objective of the study was to test the hypothesis that clinical case management is more cost-effective than usual care for frequent users of the emergency department (ED). METHODS The study is a 24-month randomized trial obtaining data on psychosocial problems through interviews and service usage and cost data from administrative records. RESULTS Two-hundred fifty-two frequent users were randomized (167 to case management, 85 to usual care). Case management was associated with statistically significant reductions in psychosocial problems common among ED frequent users, including homelessness, alcohol use, lack of health insurance and social security income, and financial need. Case management was associated with statistically significant reductions in ED use and cost. Case management and usual care patients did not differ in use or cost of other hospital services. CONCLUSIONS Case management appears cost-effective for ED frequent users because it yields statistically and clinically significant reductions in psychosocial problems at a cost similar to that of usual care.

Postbereavement depressive mood and its prebereavement predictors in HIV+ and HIV- gay men.

Prebereavement predictors of the course of postbereavement depressive mood were examined in 110 gay men who were their partners caregiver until the partners death of AIDS. In all, 37 HIV+ and 73 HIV- bereaved caregiving partners were assessed bimonthly throughout a 10-month period beginning 3 months before and ending 7 months after the partners death. Throughout the 10 months, mean Centers for Epidemiology Scale-Depression (CES-D) scores on depressive mood were above the cutoff for being at risk for major depression. CES-D scores decreased for 63% bereaved caregivers over the 7 postbereavement months, and 37% showed little change from high CES-D scores or increasing CES-D scores. High prebereavement CES-D scores and finding positive meaning in caregiving predicted diminishing depressive mood; HIV+ serostatus, longer relationships, hassles, and use of distancing and self-blame to cope predicted unrelieved depressive mood.

Psychoeducation to Address Stigma in Black Adults Referred for Mental Health Treatment: A Randomized Pilot Study

Forty-two Black clients referred for outpatient treatment were randomly assigned to receive existing brochures about services or a psychoeducational booklet about stigma based on experiences of Black mental health consumers. At 3-month follow-up, clients reported that both types of information were helpful; there were no significant differences between the types of information on treatment attendance. However, individuals who reported higher perceived treatment need or greater uncertainty about treatment showed greater stigma reduction from the psychoeducation. Findings indicate the need to move beyond “customer satisfaction” to evaluate educational interventions, as well as for greater understanding of differential impact of stigma reduction interventions.

Outreach, Engagement, and Practical Assistance: Essential Aspects of PTSD Care for Urban Victims of Violent Crime:

The purpose of this article is to examine the literature on the increased risk factors of disadvantaged inner-city residents for becoming victims of violence and for developing posttraumatic stress disorder (PTSD) and barriers to accessing comprehensive mental health services. Second, the article discusses the limitations of evidence-based treatments for early intervention with urban victims of violence and provides a new model of care emphasizing outreach, engagement, and practical assistance. Finally, the article concludes with recommendations for comprehensive hospital-based urban programs in terms of practice, policy, and research.

Ethnic Disparities in Mental Health Treatment Engagement among Female Sexual Assault Victims

Few female sexual assault victims receive mental health treatment following victimization. This is particularly true for ethnic minority women. This descriptive study examined ethnic differences in treatment need and treatment engagement in a diverse sample of 104 women (White, Black, Latina, and other) offered no-cost mental health services following a sexual assault. Despite equivalent or higher need for services, Black women were less likely (odds ratio = 0.17) than White women to engage in treatment in the year following assault. Results suggest that Black–White differences in help-seeking after sexual assault are not explained solely by differences in access. Further exploration of additional barriers to mental health care for Black women after sexual assault is needed.

Central Nervous System Involvement in the Acquired Immunodeficiency Syndrome (AIDS)

Excerpt To the Editor:Grant and associates (1) have described a trend of progressive neuropsychologic impairment in a small number of patients (n= 55) spread across four groups: those with the acqu...

Reduction of State Victim Compensation Disparities in Disadvantaged Crime Victims Through Active Outreach and Assistance: A Randomized Trial

OBJECTIVES We examined whether providing active outreach and assistance to crime victims as part of comprehensive psychosocial services reduced disparities in access to state compensation funds. METHODS We analyzed data from a randomized trial of injured crime victims (N = 541) and compared outcomes from comprehensive psychosocial services with usual community care. We examined the impact of outreach and assistance on disparities in applying for victim compensation by testing for interactions between victim characteristics and treatment condition in logistic regression analyses. RESULTS Victims receiving comprehensive services were much more likely to apply for victim compensation than were victims receiving usual care. Comprehensive services decreased disparities associated with younger age, lower levels of education, and homelessness. CONCLUSIONS State-level victim compensation funds are available to help individuals recover physically, psychologically, and financially from crime victimization. However, few crime victims apply for victim compensation, and there are particularly low application rates among young, male, ethnic minority, and physical assault victims. Active outreach and assistance can address disparities in access to victim compensation funds for disadvantaged populations and should be offered more widely to victims of violent crime.

Characterizing Drug-Facilitated Sexual Assault Subtypes and Treatment Engagement of Victims at a Hospital-Based Rape Treatment Center

Variation among existing studies in labeling, defining, identifying, and subtyping cases of suspected drug-facilitated sexual assault (DFSA) poses challenges to integrating research findings for public health purposes. This descriptive study addressed methodological issues of nomenclature and DFSA operational definitions to improve case identification and was designed to distinguish assault subtypes. We studied a 2-year ethnically diverse cohort of 390 patients who presented acutely to an urban rape treatment center (RTC). We abstracted data from RTC medical and mental health records via chart review. Assault incidence rates; engagement into medical, forensic, and mental health services; injury sustained; and weapon use were calculated separately for assault subtypes and compared. DFSA accounted for over half of the total sexual assault (SA) cases. Involuntary DFSA (in which an incapacitating substance was administered to victims without their knowledge or against their will) increased from 25% to 33% of cases over the 2-year period. DFSA victims presented sooner, and more often attended medical follow-up and psychotherapy than non-DFSA victims. Incidence rates indicated increasing risk for young males. These findings indicate that DFSA continues to be a growing and complex phenomenon and suggest that DFSA victims have greater service needs. The field would benefit from innovations to address symptomatology arising from this novel type of trauma and the unique risks and needs of male victims, as well as underscoring the ongoing need for DFSA-specific prevention efforts for both victims and perpetrators.