Julia Zur

Unmet Need Among Homeless and Non-Homeless Patients Served at Health Care for the Homeless Programs

This study compared the level of unmet need for medical, dental, mental health (MH), and substance use disorder (SUD) treatment between homeless and non-homeless patients served at Health Care for the Homeless programs. Using the 2009 Health Center Patient Survey, logistic regression models were used to assess the relationship between homelessness and unmet need for care. Descriptive statistics were then used to examine reasons for unmet need. Homeless patients were just as likely as non-homeless patients to have medical and dental treatment needs met. However, they were significantly more likely to report an unmet need for MH counseling and less likely to report an unmet need for SUD treatment. The primary reasons underlying unmet need were an inability to afford care and a lack of knowledge about where to obtain it. Results highlight the benefits of allotting additional funding to HCH programs so that they have the capacity to expand their overall scope of services.

Medical Respite and Linkages to Outpatient Health Care Providers among Individuals Experiencing Homelessness

ABSTRACT Medical respite programs provide nursing care and case management to individuals experiencing homelessness following hospitalization for an acute medical problem. One goal of these programs is to link clients to outpatient providers to decrease their reliance on hospital services. Through qualitative interviews with staff members (n = 8) and clients (n = 14) at a medical respite program, we explored processes of, and challenges associated with, linking clients to outpatient care. Six themes were identified, which offer insight about important considerations when linking clients to outpatient providers and highlight the value of medical respite programs for this population.

Opting Out of Medicaid Expansion: Impact on Encounters With Behavioral Health Specialty Staff in Community Health Centers

OBJECTIVE This study examined how state decisions not to expand Medicaid have affected behavioral health services utilization in health centers. Because health center revenues are adversely affected, the ability to provide on-site nonrequired services, such as specialty mental health and substance abuse treatment services, is compromised. METHODS Using 2012 Uniform Data System data and the projected health center insurance case mix in 2020, the authors estimated the amount of additional revenue that could accrue to health centers if all states were to expand Medicaid by 2020. Using the estimated percentage of total revenues supporting the provision of specialty behavioral treatment services, the authors also estimated the number of encounters with behavioral health specialists that might be possible in 2020 if all states expand Medicaid by then. State-specific estimates are provided. RESULTS If all states expand Medicaid by 2020, it is estimated that nearly

Homeless Caseload is Associated with Behavioral Health and Case Management Staffing in Health Centers

230 million in additional revenue could accrue to health centers in states that opted out of expanding Medicaid in 2014. An estimated

An investigation of school-related variables as risk and protective factors associated with problematic substance use among vulnerable urban adolescents

11.3 million would likely be used for mental health services and

Laying the Foundation: Factors Associated With Medical Home Recognition Among Health Centers.

1.6 million might be used to provide substance use disorder services. This translates to over 70,500 additional encounters that could occur with behavioral health specialists if all states expand Medicaid by 2020. CONCLUSIONS On-site behavioral health services are needed in health centers. However, financial constraints might limit the ability of health centers to provide on-site behavioral health services, particularly in states opting out of Medicaid expansion.

Off to the Right Start: Well-Child Visit Attendance Among Health Center Users.

Community health centers provide co-located medical, behavioral, and case management services to meet the unique and complex needs of the underserved, including homeless individuals. Multivariate analysis of staffing patterns in health centers serving high homeless caseloads highlights above-average behavioral and case management staffing, regardless of Health Care for the Homeless funding status. Rural health centers and those in the South had lower behavioral health and enabling services staffing. Implications include the need to monitor disparities, link health centers with available technical assistance, and emphasize integrating co-located behavioral health, enabling, and medical services through grant oversight mechanisms.

Factors Associated with Geographic Variation in Psychiatric Prescription Drug Expenditures Among Medicaid Beneficiaries

Research has shown that early initiation of substance abuse has negative impacts on school performance and is predictive of substance abuse in adulthood. The aim of the present study was to evaluate the association between school-related variables and problematic substance use among adolescents in an urban setting. Adolescent participants (M age = 16.26, SD = 2.10; 65.3% male; 70.2% African-American) completed face-to-face interviews consisting of the Personal Experience Inventory (PEI) and a school-related questionnaire. Participants reported using alcohol to get drunk (44.9%), using marijuana (63.9 %) and other drugs to get high (19.8%). School-related risk and protective factors included: failed a class (61.8%), held back a grade (42.7%), sent to the principal (46.0%), family called for a conference (44.7%), suspended (39.0%), expelled (18.7%), and feeling good about school (61.3%) and teachers (66.1%). Having failed a class (AOR = 2.83), having been held back a grade (AOR = 4.68), and having been sent to the principal (AOR = 2.98) predicted problematic substance use. Feeling good about school (AOR = 0.39) and teachers (AOR = 0.27) was protective against problematic substance use. Findings demonstrate the importance of developing school-based targeted interventions for vulnerable youth.

Racial and Ethnic Disparities among Pediatric Patients at Community Health Centers.

INTRODUCTION The characteristics associated with medical home recognition among federally qualified health centers were explored. The results will help guide the transformation of health centers and other providers to the medical home model of practice. METHODS This study included the universe of 1,198 federally qualified health centers in calendar year 2012; the data were collected in 2013 and analyzed in 2014-2015. Using the 2012 Uniform Data System, descriptive statistics were calculated and differences in means of health center characteristics by third-party medical home recognition status were tested. Multivariable logistic regression models examined correlates of recognition. RESULTS In 2012, 17.3% of health centers had third-party medical home recognition. Health centers in the Northeast had more than three times the odds of being recognized as medical homes, compared with health centers located in the South (OR=3.3, p<0.001). Health centers with medical home recognition were larger and had higher odds of having electronic health records in all sites (OR=3.08, p<0.001). Recognized health centers had a higher percentage of total staffing composed of behavioral health specialists, compared with health centers that had not attained medical home recognition in 2012 (OR=1.06, p<0.001). CONCLUSIONS These findings highlight the importance of monitoring which types of health centers are falling behind, encouraging the adoption of health information technology, and enabling the recruitment of onsite behavioral health staffing.

Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts

INTRODUCTION This study examines correlates of past-year well-child visit attendance, reasons for choosing to receive care at a health center, and patient experience among pediatric federally qualified health center users. METHOD This observational study used cross-sectional 2009 Health Center Patient Survey data. Descriptive statistics, bivariate analysis, and multivariable models were utilized. RESULTS This study found that 83.0% of children who visited a health center in the past year had a well-child visit in the past year and 88.5% had a usual source of care, with no disparities based on race/ethnicity or insurance status. A usual source of care, especially a health center, enhanced well-child visit attendance. The top reasons for seeking care at a health center include convenience (31.6%), quality (24.5%), accessibility (17.7%), and co-located nonmedical services (11.5%). DISCUSSION Well-child visit attendance is high but there is room for improvement, particularly among patients who lack a usual source of care.