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OBJECTIVES: This study was designed to investigate demonstrable impacts of the Mental Health Services Program for Youth (MHSPY), a highly coordinated, intentionally integrated 'system of care,' on patterns of health service utilization for youth with multiple needs. METHODS: The MHSPY intervention is available to a target population of urban youth who face barriers to health care and are at risk for out-of-home placement. These youth are enrolled in a non-profit managed care organization (MCO). Patterns of medical, pharmacy, and mental health and substance abuse service use were compared for children aged 3 to 19 across insurance categories. RESULTS: Despite risks for access and engagement barriers to care, and for greater medical expense due to greater morbidity, MHSPY enrollees received significantly more ambulatory care per person-year than either the privately insured population or the Medicaid Standard population, and medical expense for MHSPY members was significantly lower than expected. During the four years studied, individuals in the privately insured and Medicaid Standard populations were less likely than MHSPY enrollees to have had an ambulatory pediatric visit (odds ratio [OR] 0.833, 95% confidence interval [CI] 0.765, 0.908 and OR 0.823, 95% CI 0.775, 0.897, respectively). Medical expenses per member per month for MHSPY enrollees were significantly less than that for the similarly impaired Medicaid Disabled population with any medical claim (p < 0.001) or with any outpatient mental health claim (p < 0.01). CONCLUSIONS: Patterns of health care for subpopulations with known risk are important to identify to evaluate system-of-care effectiveness. The service utilization patterns for youth enrolled in the MHSYP system of care vs. those for similar MCO youth suggest health care access for individuals can be affected by delivery system design variables. [ABSTRACT FROM AUTHOR]

Individuals with a laryngectomy face a host of challenges ranging from restricted vocal communication to significant lifestyle modifications associated with breathing through a stoma. Although there are significant mental and physical health benefits achieved by returning to recreational pursuits that were enjoyed pre-surgery, there can be significant obstacles in doing so. One particular challenge arises during participation in water activities (e.g, fishing, boating, etc.) where accidental submersion poses a significant risk of drowning. This manuscript describes a proof-of-concept device that protects the airway from accidental incursion of water into the airway during unanticipated submersion in water, thereby allowing laryngectomees to return to participation in water activities. The device is designed to be worn comfortably for long periods of time, while not interfering with the common methods of replacement speech that are utilized post-laryngectomy., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Physiotherapeutic Scoliosis-Specific Exercise (PSSE) is a conservative approach for management of adolescent idiopathic scoliosis (AIS). Although there is Level I evidence for the efficacy of PSSE, compliance in the teenage population remains in question. The purpose of this study is to investigate the association between completion of formal PSSE training and compliance to prescribed home exercise programs (HEP)., Methods: Patients with AIS evaluated at our institution between 2013 and 2015 with a minimum of one PSSE session were enrolled. A chart review and questionnaire completed by caregivers was utilized to assess HEP compliance following the final PSSE session at 1 week, 3 months, 1 year, and 2 years. Patients were divided into two groups, those completing formal training (10 or more PSSE sessions), and those who did not complete formal training (fewer than 10 sessions)., Results: 81 patients were identified (mean age of 13.1 years; major curve of 31.3°). Patients who completed training demonstrated 50% compliance at 1 week (vs. 25.6% for non-completers, Odds Ratio (OR): 2.9, p = 0.027), 41.2% at 3 months (vs. 18.9% for non-completers, OR: 3.0, p = 0.044), 23.5% at 1 year (vs. 13.5% for non-completers, OR: 2.0, p = 0.281), and 25.7% at 2 years (vs. 13.5% for non-completers, OR: 2.2, p = 0.197). The mean HEP duration (minutes) in patients who completed training was higher at 1 week (80.8 vs. 48, p = 0.010), 3 months (64.6 vs. 23.7, p ≤ 0.001), 1 year (35.3 vs. 22.7, p = 0.270), and 2 years (34.3 vs. 18.9, p = 0.140)., Conclusion: Patients who completed PSSE training maintained higher HEP compliance.

It is now well understood that exposure to Adverse Childhood Experiences (ACEs) is negatively linked to health and well-being across the lifespan. In an effort to disrupt ACEs exposure and its effects, there is a nationwide movement to screen for ACEs in primary care, despite a lack of well-established guidelines for assessing and responding to risk within routine care. Additionally, developing culturally responsive models of ACEs assessment is imperative, particularly because racial and ethnic minority populations face disproportionate risk of exposure to ACEs and disparities in quality of health care. Using mixed methods, we explored the feasibility, acceptability, and utility of conducting ACEs routine inquiry with an ethnically and economically diverse pediatric population through a unique collaborative practice model (CPM) consisting of an integrated, multidisciplinary team within primary care. In the CPM study, 163 children from a safety-net health system were enrolled; of those, an ACEs questionnaire was collected from 158 (97%) study participants as part of their mental health evaluation. The sample was highly ACEs exposed, with 40% of children and 56% of teens having scores of four or more. There were significant associations between level of ACEs exposure and degree of mental health impairment in both children and teens. Providers viewed the ACEs assessment process as feasible, acceptable, and to have utility for the care of the study's diverse pediatric population. Findings highlight benefits, challenges, cultural considerations and recommendations for promoting health equity through a primary-care integrated ACEs assessment model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evidence suggests that Repetitive Head Impacts (RHI) directly influence the brain over the course of a single contact collision season yet do not significantly impact a player's performance on the standard clinical concussion assessment battery. The purpose of this study was to investigate changes in static postural control after a season of RHI in Division I football athletes using more sensitive measures of postural control as compared to a non-head contact sports. Fourteen Division I football players (CON) (age=20.4±1.12years) and fourteen non-contact athletes (NON) (2 male, 11 female; age=19.85±1.21years) completed a single trial of two minutes of eyes open quiet upright stance on a force platform (1000Hz) prior to athletic participation (PRE) and at the end of the athletic season (POST). All CON athletes wore helmets outfitted with Head Impact Telemetry (HIT) sensors and total number of RHI and linear accelerations forces of each RHI were recorded. Center of pressure root mean square (RMS), peak excursion velocity (PEV), and sample entropy (SampEn) in the anteroposterior (AP) and mediolateral (ML) directions were calculated. CON group experienced 649.5±496.8 mean number of impacts, 27.1±3.0 mean linear accelerations, with ≈1% of total player impacts exceeded 98g over the course of the season. There were no significant interactions for group x time RMS in the AP (p=0.434) and ML (p=0.114) directions, PEV in the AP (p=0.262) and ML (p=0.977) directions, and SampEn in the AP (p=0.499) and ML (p=0.984) directions. In addition, no significant interactions for group were observed for RMS in the AP (p=0.105) and ML (p=0.272) directions, PEV in the AP (p=0.081) and ML (p=0.143) directions, and SampEn in the AP (p=0.583) and ML (p=0.129) directions. These results suggest that over the course of a single competitive season, RHI do not negatively impact postural control even when measured with sensitive non-linear metrics., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: This study examined mental health service use outcomes for children receiving integrated care via a collaborative-practice model (CPM). The study hypothesis was that the delivery of intensively integrated clinical care within pediatrics, combined with community-based parent support from family support specialists (FSSs), would facilitate mental health or substance use disorder treatment access and engagement for youths at risk of experiencing disparities., Methods: The study sample consisted of 228 children referred by pediatricians for outpatient child psychiatry evaluation within an urban safety-net hospital system in 2013. In the pilot clinic, 32 youths were referred to the CPM intervention. Among the remaining seven clinics, 196 youths were referred to usual care (control group). Differences in treatment access and engagement between the intervention and control groups were assessed using propensity-score weighted logistic regression models., Results: Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01)., Conclusions: Access and engagement were significantly higher for children receiving CPM than for usual care participants. This suggests that integrated CPM warrants further investigation as an approach for improving the odds that children and families will receive needed mental health or substance use disorder treatment.

Background: Approximately 90% of athletes with concussion experience a certain degree of visual system dysfunction immediately post-concussion. Of these abnormalities, gaze stability deficits are denoted as among the most common. Little research quantitatively explores these variables post-concussion. As such, the purpose of this study was to investigate and compare gaze stability between a control group of healthy non-injured athletes and a group of athletes with concussions 24-48hours post-injury., Methods: Ten collegiate NCAA Division I athletes with concussions and ten healthy control collegiate athletes completed two trials of a sport-like antisaccade postural control task, the Wii Fit Soccer Heading Game. During play all participants were instructed to minimize gaze deviations away from a central fixed area. Athletes with concussions were assessed within 24-48 post-concussion while healthy control data were collected during pre-season athletic screening. Raw ocular point of gaze coordinates were tracked with a monocular eye tracking device (240Hz) and motion capture during the postural task to determine the instantaneous gaze coordinates. This data was exported and analyzed using a custom algorithm. Independent t-tests analyzed gaze resultant distance, prosaccade errors, mean vertical velocity, and mean horizontal velocity., Findings: Athletes with concussions had significantly greater gaze resultant distance (p=0.006), prosaccade errors (p<0.001), and horizontal velocity (p=0.029) when compared to healthy controls., Interpretation: These data suggest that athletes with concussions had less control of gaze during play of the Wii Fit Soccer Heading Game. This could indicate a gaze stability deficit via potentially reduced cortical inhibition that is present within 24-48hours post-concussion., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Mental health advocates seek to expand children's services, noting widespread failure to meet the needs of public sector youth suffering from serious emotional disturbance (SED). However, state and national budgets face deepening cuts, with rising health care costs taking the blame. As the gap between needs and finances widens, identification of cost-effective treatments that will benefit children with SED and their families is of increasing importance. Community-based interventions for this population, such as the wraparound approach and systems-of-care, are being disseminated but literature is scant regarding effects on expense. The Mental Health Services Program for Youth (MHSPY) model is aligned philosophically with wraparound and systems-of-care but unique in blending public agency dollars to deliver integrated medical, mental health and social services. MHSPY's linked clinical and expense data is useful to study community-based treatment cost-effectiveness., Aims of Study: To examine the cost-effectiveness of an intensively integrated, family and community-based clinical intervention for youth with mental health needs in comparison to "usual care.'', Methods: Study and reference populations were matched on age, gender, community, psychiatric diagnosis, morbidity and insurance type. Claims analyses included patterns of service utilization and medical expense for both groups. Using propensity score matching, results for study youth are compared with results for the population receiving "usual care.'' Clinical functioning was measured for the intervention group at baseline and 12 months., Results: The intervention group used lower intensity services and had substantially lower claims expense (e.g. 32% lower for emergency room, 74% lower for inpatient psychiatry) than their matched counterparts in the "usual care'' group. Intervention youth were consistently maintained in least restrictive settings, with over 88% of days spent at home and showed improved clinical functioning on standard measures., Discussion: The intensive MHSPY model of service delivery offers potential as a cost-effective intervention for complex youth. Its integrated approach, recognizing needs across multiple life domains, appears to enhance engagement and the effectiveness of mental health treatment, resulting in statistically significant clinical improvements. Functional measures are not collected in "usual care,'' limiting comparisons. However, claims expense for intervention youth was substantially lower than claims expense for Medicaid comparison youth, suggesting clinical needs for intervention youth post-enrollment were lower than for those receiving "usual care.'', Implications for Health Care Provision and Use: The MHSPY model, which intentionally engages families in "clustered'' traditional and non-traditional services, represents a replicable strategy for enhancing the impact of clinical interventions, thereby reducing medical expense., Implications for Health Policies: Blending categorical state agency dollars and insurance funds creates flexibility to support community-based care, including individualized services for high-risk youth. Resulting expenses total no more, and are often less, than "treatment as usual'' but yield greater clinical benefits., Implications for Further Research: Further research is needed regarding which intervention elements contribute the most towards improved clinical functioning, as well as which patients are most likely to benefit. A randomized trial of MHSPY vs. "usual care,'' including examination of the sustainability of effects post-disenrollment, would provide a chance to further test this innovative model.

The Massachusetts Mental Health Services Program for Youth (MHSPY) is a home-based clinical intervention that seeks to maintain youth with severe functional impairment in the community via delivery of integrated primary care, mental health, substance abuse, and social services. Using blended public agency funding, traditional and nontraditional services are provided within a private, not-for-profit, managed care organization. Individualized, comprehensive care plans are developed by an MHSPY care manager, who works intensively with the family and the Care Planning Team to identify needs and resources. Data on clinical functioning are collected at baseline and every six months during the program. Service utilization and cost are measured on a quarterly basis. Family, youth, and agency satisfaction ratings are collected at disenrollment. Aggregate analyses based on four years of data show that MHSPY participants have improved clinical functioning, including significant reduction in risk to self and others. They also experience reduced service utilization and cost and high rates of family satisfaction.

This article reviews the tension between "gatekeeping," routinely practiced by managed care to limit utilization of care and, presumably, cost, and the increased demands of purchasers (such as Medicaid), consumer groups, and the National Council for Quality Assurance for mental health screening, outreach, and access to specialty care, particularly for vulnerable populations. Using examples from Harvard Pilgrim Health Care in Boston, the second oldest health maintenance organization in the country, the argument is advanced that early detection, coordination with primary care, and readily available expert consultation actually diminish cost while reducing morbidity and improving satisfaction.

Objective: This study sought to determine whether affective abnormalities could be detected in home movies of children who later developed schizophrenia., Method: Trained observers coded facial expressions of emotion of 32 schizophrenic patients and 31 of their healthy siblings from home movies made when they were children. All of the patients met the DSM-III criteria for schizophrenia with onset in late adolescence or early adulthood. The sibling comparison subjects had no history of psychiatric illness. Nine emotions and a neutral category were rated., Results: Analyses revealed significantly lower proportions of joy expressions among the total expressions of the preschizophrenic female subjects than among the same-sex healthy siblings. This difference extended from infancy through adolescence. Among the male subjects, there were inconsistent differences between diagnostic groups in expressions of joy across age levels. However, both the preschizophrenic male subjects and the preschizophrenic female subjects showed greater negative affect than their same-sex comparison groups., Conclusions: These findings lend support to the assumption that vulnerability to schizophrenia may be subtly manifested in emotional behavior long before the onset of clinical symptoms.