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Social health is important to measure when assessing outcomes in community mental health. Our objective was to validate social health scales using items from two broader commonly used measures that assess mental health outcomes. Participants were 609 adults receiving psychological treatment services. Items were identified from the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program (MHSIP) outcome measures by their conceptual correspondence with social health and compared to the Social Functioning Questionnaire (SFQ) using correlational analyses. Pearson correlations for the identified CA-QOL and MSHIP items with the SFQ ranged from .42 to .62, and the identified scale scores produced Pearson correlation coefficients of .56, .70, and, .70 with the SFQ. Concurrent validity with social health was supported for the identified scales. The current inclusion of these assessment tools allows community mental health programs to include social health in their assessments.

Peer Specialists (PS) often work in outpatient mental health programs serving transition age youth (TAY). This study examines program managers' perspectives on efforts to strengthen PS' professional development. In 2019, we interviewed program managers (n = 11) from two Southern California Counties employed by public outpatient mental health programs (n = 8) serving TAY and conducted thematic analyses. We present themes and illustrative quotes. PS' roles are highly flexible; thus, PM support PS to strengthen skills to address organization-facing and client-facing responsibilities. PM addressed time management, documentation, PS integration into the organization, and workplace relationships. Trainings to better support clients included addressing cultural competency to serve LGBTQ TAY and racial/ethnic subgroups. Diverse supervision modalities address PS' diverse needs. Supporting PS' technical and administrative skills (e.g., planning, interpersonal communication skills) may aid their implementation of a complex role. Longitudinal research can examine the impact of organizational supports on PS' job satisfaction, career trajectories, and TAY clients' engagement with services. [ABSTRACT FROM AUTHOR]

Peer providers are increasingly used by mental health programs to engage transition age youth (TAY, age 16-24) living with serious mental illness. This study elicited TAY clients' perspectives on peer providers' roles, responsibilities, and contribution to TAYs' use of mental health services. In 2019, six focus groups were conducted with TAY clients (n=24) receiving publicly funded mental health services in Southern California. Results from this analysis included four themes that illustrated the role of peers as perceived by TAY clients, including: 1) building client–peer provider relationships, 2) engaging with mental health services, 3) role-modelling recovery and supporting skill acquisition to instill hope and empowerment, and 4) peer roles and experiences specific to racial/ethnic concordance. These findings provide needed perspectives on the evolving role of peer providers in mental health services programming for TAY clients. [ABSTRACT FROM AUTHOR]

Aim: To examine whether roles of peer specialists affect service use among Black, Latinx and White youth ages 16‐24 with serious mental illness (SMI) in Los Angeles and San Diego Counties. Methods: Administrative data from 2015 to 2018 was used to summarize service use among 6329 transition age youth age 16‐24 with SMI who received services from 76 outpatient public mental health programs with peer specialists on staff. Roles of peer specialists were assessed via a program survey. Generalized linear models were used to assess the relationship between peer specialist characteristics and service use outcomes (ie, outpatient and inpatient). Results: Having a transition age youth peer specialist on staff (vs older peer specialists) and having peer specialists that provide four or more services (vs fewer services) was associated with an increase in annual outpatient visits in both counties (P = <.001 each). In Los Angeles County, having three or more peer specialist trainings (vs fewer trainings) was associated with lower use of inpatient services (P <.001). In San Diego County, having a transition age youth peer specialist and peer specialists that provide four or more services was associated with lower use of inpatient services (P <.001 each). Conclusions: Types of peer support and number of types of peer services were associated with mental health service utilization. Detailed examination of the roles of peer specialists is merited to identify the specific pathways that improve outcomes. [ABSTRACT FROM AUTHOR]

We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16–24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015–2018 was used to summarize service use among 13,363 transition age youth age 16–24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤.05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P <.001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P <.05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: The Medicaid health home option of the Affordable Care Act provides a new opportunity to address the fragmented system of care for persons with serious mental illness. This study examined the implementation of integrated health homes in Los Angeles County.Methods: Longitudinal data on client-reported physical health status, clinician-reported mental health recovery, and screening for common chronic conditions among 1,941 persons enrolled in integrated care programs for serious mental illness and chronic general medical illness were combined with site visit data measuring the level of integration of general medical and mental health care among ten integrated care programs. Various analyses were used to compare outcomes by level of program integration (generalized estimating equations for physical health status and mental health recovery and logistic regression and chi-square tests for screening for common chronic conditions and clinical risk factors).Results: Clients in more highly integrated programs had greater improvements in physical health status and mental health recovery and higher rates of screening for common chronic conditions compared with clients in less integrated programs. They also had greater reductions in hypertension but a worrisome increase in prediabetes and diabetes.Conclusions: Highly integrated mental health and general medical programs were associated with greater improvements in health outcomes compared with less integrated programs. Additional research is necessary to identify predictors of integration, to determine which aspects of integration drive improvements in health outcomes, and to identify strategies to increase integration within less integrated programs. Efforts are needed to coordinate pharmacotherapy, including increased consideration of the metabolic effects of antipsychotic medication. [ABSTRACT FROM AUTHOR]

Objective: Permanent supportive housing (PSH) programs are being implemented nationally and on a large scale. However, little is known about PSH for transition-age youths (ages 18 to 24). This study estimated health services costs associated with participation in PSH among youths and examined the relationship between fidelity to the Housing First model and health service outcomes.Methods: Administrative data were used in a quasi-experimental, difference-in-differences design with a propensity score-matched contemporaneous control group to compare health service costs among 2,609 youths in PSH and 2,609 youths with serious mental illness receiving public mental health services in California from January 1, 2004, through June 30, 2010. Data from a survey of PSH program practices were merged with the administrative data to examine changes in service use among 1,299 youths in 63 PSH programs by level of fidelity to the Housing First model.Results: Total service costs increased by $13,337 among youths in PSH compared with youths in the matched control group. Youths in higher-fidelity programs had larger declines in use of inpatient services and larger increases in outpatient visits compared with youths in lower-fidelity programs.Conclusions: PSH for youths was associated with substantial increases in costs. Higher-fidelity PSH programs may be more effective than lower-fidelity programs in reducing use of inpatient services and increasing use of outpatient services. As substantial investments are made in PSH for youths, it is imperative that these programs are designed and implemented to maximize their effectiveness and their impact on youth outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study examined whether receipt of outpatient psychiatric services after hospital discharge was associated with reduced risk of readmission. Methods: Treatment records from patients admitted to San Diego County psychiatric hospitals over a one-year period were obtained from the San Diego County Behavioral Health Services electronic health record system. A discrete-time proportional hazards model was used to examine the association of receipt of outpatient psychiatric services with readmission within 30 days of discharge from the index hospitalization. Results: Of the 4,663 patients, 16% were readmitted within 30 days. In an adjusted model, receipt of outpatient therapy after discharge was associated with a greater likelihood of being readmitted (hazard ratio=1.36, 95% confidence interval=1.14-1.67), whereas receipt of case management or medication management was not associated with readmission. Conclusions: The differential risk of readmission by service type suggests a need for studies that explore reasons for an increased risk of readmission with certain types of services. [ABSTRACT FROM AUTHOR]

Objective: Few studies have examined the effect of limited English proficiency on use of mental health services by persons with mental illness from ethnic minority groups who are uninsured or publicly insured. This study examined how indigent or publicly insured Latino and Asian adults with limited English proficiency initially accessed the public mental health system and how their use of services changed over time compared with English-proficient peers. Methods: Data from San Diego County for fiscal years 2000-2005 were used to examine point of first contact and use of inpatient, emergency, and outpatient services in the 18 subsequent months among 9,243 clients with a psychiatric diagnosis of schizophrenia, bipolar disorder, or major depression. Multivariate regression models were used to compute standardized estimates of utilization. Results: Latino and Asian clients with limited English proficiency were significantly less likely to first access the system through emergency services and more likely to access the system through out-patient services (p<.001 for each comparison). In two outpatient programs that were focused on delivering services to clients with limited English proficiency, clients had a higher intensity of outpatient service use than clients in clinics that did not have such a focus (p<.05 for each). Conclusions: The initial pattern of service use was favorable for both groups. However, over time this pattern persisted for Asian clients with limited English proficiency but not for Latino clients with limited English proficiency. Findings suggest that ethnically focused programs may be an effective approach to engaging populations that are underrepresented in the mental health system. [ABSTRACT FROM AUTHOR]

• Transition Age Youth (TAY) peer supporters held a range of social network positions in their trauma-informed community-based partnership communication networks. • In networks where TAY peer supporters were located both at the network's core and the network's periphery, TAY peer supporters reported positive experiences with team communication. • TAY peer supporters who were located only at the network's periphery reported challenges communicating with their teams. Transition age youth (TAY) experiencing mental illness, homelessness, and trauma face challenges in navigating the transition to adulthood. Age appropriate, trauma-informed support from peer specialists (PS) can assist TAY who have experienced trauma in navigating their transition to adulthood. Whether and how TAY PS are involved in trauma-informed community-based partnerships is unclear. This study explores TAY PS experiences with and social network positions in trauma-informed 'TAY-support networks.' Social network data were collected from four TAY-support networks. Structural analyses (network size and density) and core periphery analyses were conducted to elucidate TAY PS network positions, while focus groups were conducted with TAY PS to understand their experiences delivering services. Focus group data were analyzed using thematic analysis. Data were triangulated to understand whether and how focus group results expanded on our social network analysis. TAY support networks included 194 persons (range: 32–55) and 26 TAY PS. In two networks, TAY PS were located at the network's core and periphery, and reported ongoing contributions to initiative activities. In two other networks, TAY PS were located at the network periphery and reported challenges with team communication. To maximize TAY PS contributions to multidisciplinary partnerships, organizations should 1) include TAY PS throughout program planning and implementation and 2) provide age-appropriate professional supports to TAY PS. [ABSTRACT FROM AUTHOR]