Market Factors Associated with Comprehensive Behavioral Health Crisis Care Availability: A Resource Dependence Theory Study

Burns, Ashlyn; Vest, Joshua R.; Menachemi, Nir; Mazurenko, Olena; Salyers, Michelle P.; Yeager, Valerie A.

doi:10.1177/00469580241256822

Cited by 3 publications

References 30 publications

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Availability of behavioral health crisis care and associated changes in emergency department utilization

Burns,

Vest,

Menachemi

et al. 2024

Health Services Research

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ObjectiveTo determine whether availability of behavioral health crisis care services is associated with changes in emergency department (ED) utilization.Data Sources and Study SettingWe used longitudinal panel data (2016–2021) on ED utilization from the Healthcare Cost and Utilization Project's State ED Databases and a novel dataset on crisis care services compiled using information from the Substance Abuse and Mental Health Services Administration's National Directories of Mental Health Treatment Facilities. A total of 1002 unique zip codes from Arizona, Florida, Kentucky, Maryland, and Wisconsin were included in our analyses.Study DesignTo estimate the effect of crisis care availability on ED utilization, we used a linear regression model with zip code and year fixed effects and standard errors accounting for clustering at the zip code‐level. ED utilization related to mental, behavioral, and neurodevelopmental (MBD) disorders served as our primary outcome. We also examined pregnancy‐related ED utilization as a nonequivalent dependent variable to assess residual bias in effect estimates.Data Collection/Extraction MethodsWe extracted data on crisis care services offered by mental health treatment facilities (n = 14,726 facility‐years) from the National Directories. MBD‐related ED utilization was assessed by applying the Clinical Classification Software Refined from the Healthcare Cost and Utilization Project to the primary ICD‐10‐CM diagnosis code on each ED encounter (n = 101,360,483). All data were aggregated to the zip code‐level (n = 6012 zip‐years).Principal FindingsThe overall rate of MBD‐related ED visits between 2016 and 2021 was 1610 annual visits per 100,000 population. Walk‐in crisis stabilization services were associated with reduced MBD‐related ED utilization (coefficient = −0.028, p = 0.009), but were not significantly associated with changes in pregnancy‐related ED utilization.ConclusionsWalk‐in crisis stabilization services were associated with reductions in MBD‐related ED utilization. Decision‐makers looking to reduce MBD‐related ED utilization should consider increasing access to this promising alternative model.

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Availability of behavioral health crisis care and associated changes in emergency department utilization

Burns,

Vest,

Menachemi

et al. 2024

Health Services Research

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Implementation and sustainability of systems change for mental health promotion and substance misuse prevention: a qualitative study

Burns,

Kampman,

Magee

et al. 2024

BMC Health Serv Res

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Background Social determinants of health have been shown to influence individual mental health and overall well-being. Additionally, populations that experience stigma and/or discrimination because of race, class, gender, or another identity group experience disproportionately higher rates of mental health disorders than populations that do not experience such marginalization. One way to address upstream social determinants that influence mental health is through systems change initiatives. In 2019, Indiana implemented a statewide Regional Prevention System (RPS) focused on systems change to promote mental health and prevent substance misuse. Methods We developed a semi-structured interview guide to collect insights about the RPS implementation and sustainability. Potential participants were identified based on their role as an active regional coordinator ( n = 9). We conducted qualitative interviews with all 9 regional coordinators in Indiana. Interview recordings were transcribed and coded using an a priori coding framework based on constructs from the Theory of Innovation Implementation and the Consolidated Framework for Implementation Research. Results Insights about the RPS implementation process are presented across four domains: innovation, system-level, organization-level, and sustainability. In terms of implementation barriers, coordinators encountered hesitancy and distrust from community members, which they had to overcome to gain buy-in. They also described stigma, including community and individual social norms towards mental health and substance misuse, as barriers that challenged efforts to engage community members in the RPS. Facilitators of implementation included having established community infrastructure and external partnerships. In communities without existing infrastructure to support prevention efforts, particularly rural communities, the implementation process took longer but community members welcomed the additional support and valued the new communication platforms created by the RPS. On sustainability, coordinators provided examples of communities that were able to obtain grant funding in support of prevention initiatives launched through the RPS. Conclusion The process of implementing and sustaining prevention efforts through the RPS varied across communities. Prioritizing the delivery of systems-change efforts in underserved communities that are ready for change, rather than statewide efforts, may offer a better strategy for addressing disparities in the social determinants of health that influence mental health and substance misuse. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-024-11962-5.

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Implementation and sustainability of systems change for mental health promotion and substance misuse prevention: A qualitative study

Burns,

Kampman,

Magee

et al. 2024

Preprint

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Background Social determinants of health have been shown to influence individual mental health and overall well-being. Additionally, populations that experience stigma and/or discrimination because of race, class, gender, or another identity group experience disproportionately higher rates of mental health disorders than populations that do not experience such marginalization. One way to address upstream social determinants that influence mental health is through systems change initiatives. In 2019, Indiana implemented a statewide Regional Prevention System (RPS) focused on systems change to promote mental health and prevent substance misuse. Methods We developed a semi-structured interview guide to collect insights about the RPS implementation and sustainability. Potential participants were identified based on their role as an active regional coordinator (n = 9). We conducted qualitative interviews with all 9 regional coordinators in Indiana. Interview recordings were transcribed and coded using an a priori coding framework based on constructs from the Theory of Innovation Implementation and the Consolidated Framework for Implementation Research. Results Insights about the RPS implementation process are presented across four domains: innovation, system-level, organization-level, and sustainability. In terms of implementation barriers, coordinators encountered hesitancy and distrust from community members, which they had to overcome to gain buy-in. They also described stigma, including community and individual social norms towards mental health and substance misuse, as barriers that challenged efforts to engage community members in the RPS. Facilitators of implementation included having established community infrastructure and external partnerships. In communities without existing infrastructure to support prevention efforts, particularly rural communities, the implementation process took longer but community members welcomed the additional support and valued the new communication platforms created by the RPS. On sustainability, coordinators provided examples of communities that were able to obtain grant funding in support of prevention initiatives launched through the RPS. Conclusion The process of implementing and sustaining prevention efforts through the RPS varied across communities. Prioritizing the delivery of systems-change efforts in underserved communities that are ready for change, rather than statewide efforts, may offer a better strategy for addressing disparities in the social determinants of health that influence mental health and substance misuse.

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Market Factors Associated with Comprehensive Behavioral Health Crisis Care Availability: A Resource Dependence Theory Study

Cited by 3 publications

References 30 publications

Availability of behavioral health crisis care and associated changes in emergency department utilization

Availability of behavioral health crisis care and associated changes in emergency department utilization

Implementation and sustainability of systems change for mental health promotion and substance misuse prevention: a qualitative study

Implementation and sustainability of systems change for mental health promotion and substance misuse prevention: A qualitative study

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