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A convenience sample of community health care providers (N = 19) was asked to preview and rate the acceptability of the Ask Suicide-Screening Questions (ASQ) tool and the ASQ Brief Suicide Safety Assessment (BSSA) guide. Providers were also asked about potential barriers to implementation. The majority of participants stated they would be comfortable screening for suicide with the ASQ tool (78.9%; N = 15), that they would recommend the ASQ tool and the BSSA to colleagues (84.2%; N = 16), and that they were “satisfied” or “highly satisfied” with the ASQ and BSSA (88.2%; N = 13). Barriers to implementation reported included a lack of knowledge regarding suicide risk screening and lack of access to behavioral health resources. Education regarding the ASQ, the BSSA, and suicide risk screening are highlighted as crucial elements for future implementation.

Clinical practice guidelines for opioid substitution treatment (OST) for opioid dependence recommend that patients receive at least 60 mg daily methadone and have access to a broad array of psychosocial services. However, there is still wide variation in clinical practice in OST clinics. In real-world settings, patients could receive lower methadone doses and less psychosocial care because they require less intensive care for recovery; alternatively, barriers to delivery of guideline concordant care could limit treatment received and impair recovery. The Multisite Opioid Substitution Treatment (MOST) study examines the impact of more consistent adherence to guideline recommendations in eight Veterans Affairs OST clinics. While patients at all clinics demonstrated improvements in substance use over the first year in treatment, patients at clinics that more consistently adhered to guidelines had greater reductions in heroin and cocaine use and greater improvement in mental health. These results suggest that efforts to increase guideline adherence in OST will improve patient outcomes.

An emerging trend within managed care, “disease management” (DM), will affect consumers and providers of mental health services, clinicians, and mental health administrators. Central to DM programs is the idea that particular diseases, especially chronic illnesses (including depression), can be “carved out” and managed. Pharmaceutical benefit management (PBM) firms may specialize in managing prescription benefits for employers and other managed care organizations by using DM programs. However, given what is known from the theoretical and empirical literature on adherence to medication for chronic illnesses such as depression, it is questionable whether the techniques that are used by PBMs will be effective in managing illnesses that require a multifaceted approach to care. Because the management of antidepressants may have an impact on members of vulnerable populations (e.g., the elderly), more research is required on the approaches used by PBMs and on the cost and quality of the services provided.

Real-world medication adherence and healthcare costs of patients with schizophrenia initiating long-acting injectable (LAI) vs. oral antipsychotics were compared. Patients with schizophrenia initiating LAI or oral antipsychotics (index event) were identified from MarketScan Commercial and Medicare claims databases and their medication possession ratios (MPR), pre- and post-index costs for inpatient/outpatient care were compared. Of 3,004 patients, 394 initiated LAI antipsychotics and 2,610 oral antipsychotics. Post-index, the mean MPR was greater for the LAI cohort (0.67 ± 0.34 vs. 0.56 ± 0.35; p < 0.001). Schizophrenia-related hospital costs for LAI users were reduced during the follow-up period in comparison to the pre-index period, but were increased for patients using oral antipsychotics (-$5,981 ± $16,554 vs. 758 ± 14,328, p < 0.001). The change in costs of outpatient care also favored LAI medications ($134 ± 8,280 vs. 658 ± 3,260, p = 0.023). Drug costs of LAI antipsychotics were higher ($4,132 ± 4,533 vs. 2,562 ± 2,714, p < 0.001). Schizophrenia patients initiating LAI antipsychotics incur less healthcare costs in comparison to patients initiating oral antipsychotics.

This study examined the association between acute aggressive behavior patterns of 145 adolescents in residential treatment facilities with use of and changes in antipsychotic medication for the chronic management of aggression. Seclusion/restraint (S/R) frequency over 12 months was used to categorize youth into none, low, moderate, and high S/R groups. Data were analyzed using longitudinal mixed effects logistic regression models that allowed for intra-subject variability over time. The high and moderate S/R groups were significantly more likely to receive antipsychotics, get higher doses, and have changes in medication compared with the none S/R group. Increases in antipsychotic dose were associated with a lower likelihood of changes in antipsychotic medication over time. Despite persistent antipsychotic use at higher doses, youth in the high and moderate S/R groups continued to be secluded/restrained frequently. The findings question the adequacy of these medications in managing aggressive behavior.

This paper presents the findings of an exploratory research study of foster care youth residing in group homes in a mid-Atlantic state in the USA. The aims of the present study were to (1) describe youth characteristics, (2) explore whether baseline functioning differed by gender or ethnicity, (3) explore predictors of cross-time differences in psychosocial functioning, and (4) explore predictors of later functioning, specifically age, gender, and length of stay. Psychosocial functioning at two time points (i.e., T1 = admission into group home; T2 = current or discharge) in 180 charts from 29 randomly selected group homes were reviewed. Youth were on average 14.86 years of age, predominantly male (71 %; n = 128), and predominantly African American (79 %). Findings suggest that group home placement may benefit some youth but not others, particularly girls and younger children with lower initial level of need. Findings underscore the potential complexity of intervention impact in the context of unique youth, family, and environment factors.

This study explored whether youth involved in joint service systems differed from single-agency users in terms of types of crimes committed and clinical functioning. Data from 4,924 youth involved in one county's public mental health and juvenile justice service systems were examined. Twenty percent of those youth receiving mental health services had recent arrest records, and 30% of youth arrested received mental health services. Of all youth arrested in the county, mental health service users had more arrests than non-mental health service users. A subsample of 94 mental health service users with arrests was matched on demographics with 94 mental health service users without arrests. Youth with arrests had a higher frequency of conduct disorder, higher Child Behavior Checklist Externalizing and Total Problem Scale scores, and more functional impairment on the Child and Adolescent Functional Assessment Scale as compared to youth without arrests. Implications for behavioral health service delivery were discussed.