Publications by authors named "Cynthia A Fontanella"
Background: Despite recognition that early intervention for first-episode psychosis (FEP) improves outcomes, Black youth with FEP continue to experience critical disparities in care. A historical lack of scientific focus on racial and ethnic factors in the study of psychosis and scant investigations among publicly insured (ie, Medicaid-enrolled) youth hinder our ability to understand and address factors that contribute to disparities in early FEP care. Strategies for improving FEP services for Black youth are reliant on more precise identification of faces disparities and during the early course of illness disparities are experienced.
View Article and Find Full Text PDFLittle is known about the impact of child welfare system-level factors on child mortality as an outcome within foster care. Using data from the Adoption and Foster Care Analysis and Reporting System, 2009-2018, we examined the associations between county-level sociodemographic, foster care performance, and judicial reform characteristics with all-cause mortality rates. Results of random effects negative binomial regression analyses showed that higher proportions of younger children (<1 year: IRR = 1.
View Article and Find Full Text PDFObjective: The authors sought to examine the association between adverse social determinants of health (SDoHs) and risk for self-harm among youths.
Methods: The authors performed a retrospective longitudinal analysis of Ohio Medicaid claims data (April 1, 2016-December 31, 2018) of 244,958 youths (ages 10-17 years) with a primary psychiatric diagnosis. SDoHs were identified from codes and classified into 14 categories, encompassing abuse and neglect, child welfare placement, educational problems, financial problems, exposure to violence, housing instability, legal issues, disappearance or death of a family member, family disruption by separation or divorce, family alcohol or drug use, parent-child conflict, other family problems, social and environmental problems, and nonspecific psychosocial needs.
Adolescents with substance use disorders (SUD) should receive timely access to treatment to improve lifelong outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment (IET) performance measure was intended to promote quality improvement for patients with SUD. Yet, few studies have assessed predictors of measure performance among adolescents or other engagement in mental health services, which is critical to understanding disparities in treatment quality or opportunities for targeted improvement strategies.
View Article and Find Full Text PDFObjective: The authors investigated levels of perceived need for help, patterns of mental health service utilization, and barriers to care among US medical students with a focus on students who perceived a need for help but did not report service use in the past 12 months.
Methods: The authors administered an online survey to 2,868 medical students at three schools in Ohio between January and February 2020 including validated scales for psychological distress, self-stigma, and an exploration of mental health treatment. The authors used multivariable logistic regression to identify factors associated with treatment and qualitative analysis to identify common barriers to care.
Importance: More than 50 000 youths are incarcerated in the United States on any given day, and youth incarceration has been linked to lasting adverse outcomes, including early mortality. Improving our understanding of the factors associated with early mortality among incarcerated youths can inform appropriate prevention strategies.
Objective: To examine mortality rates and causes of death among youths previously incarcerated in the juvenile legal system.