Associations Between Cumulative Social Adversities and Substance Use Comorbidity in a Statewide Sample of Individuals in Treatment for Mental Illnesses.

We sought to investigate associations of cumulative social adversities in four areas (low education, unemployment, homelessness, and criminal/legal involvement) with presence of comorbid alcohol and drug use disorders among individuals in treatment for mental illnesses. Using data from 103,416 adults in mental health treatment, generalized estimating equation modified Poisson models were used to estimate increased risk of having comorbid substance use disorders based on individual and/or cumulative number of social adversities present. Controlling for effects of sex, race/ethnicity, and region (New York City vs .

Associations between Social Adversities and Chronic Medical Conditions in a Statewide Sample of Individuals in Treatment for Mental Illnesses.

Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.

Racial and Ethnic Disparities in Health Care Access and Utilization among Medicaid Managed Care Beneficiaries.

This quasi-experimental study examined the impact of a statewide integrated special needs program Health and Recovery Plan (HARP) for individuals with serious mental illness and identified racial and ethnic disparities in access to Medicaid services. Generalized estimating equation negative binomial models were used to estimate changes in service use, difference-in-differences, and difference-in-difference-in-differences in the pre- to post-HARP periods. Implementation of the special needs plan contributed to reductions in racial/ethnic disparities in access and utilization.

Health Disparities Between Older Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the Public Mental Health System.

Objective: In this study, the authors examined disparities in general health, substance use, mental health conditions, and acute service use between lesbian, gay, and bisexual (LGB) adults (ages ≥50 years) and a matched sample of heterosexual adults.

Methods: Individuals whose electronic health record indicated their sexual orientation as gay, lesbian, or bisexual from the 2015 New York State Office of Mental Health Patient Characteristics Survey were matched with heterosexual individuals, resulting in N=1,659 individuals in each of the two groups. Differences in health status indicators and acute service use were compared in generalized estimating equation models.

Impact of the 1115 behavioral health Medicaid waiver on adult Medicaid beneficiaries in New York State.

Objective: To evaluate the impact of the Health and Recovery Plan (HARP), a capitated special needs Medicaid managed care product that fully integrates physical and behavioral health delivery systems in New York State.

Data Sources: 2013-2019 claims and encounters data on continuously enrolled individuals from the New York State Medicaid data system.

Study Design: We used a difference-in-difference approach with inverse probability of exposure weights to compare service use outcomes in individuals enrolled in the HARP versus HARP eligible comparison group in two regions, New York City (NYC) pre- (2013-2015) versus post- (2016-2018) intervention periods, and rest of the state (ROS) pre- (2014-2016) versus post- (2017-2019) intervention periods.

Health Disparities, Inpatient Stays, and Emergency Room Visits Among Lesbian, Gay, and Bisexual People: Evidence From a Mental Health System.

Objective: This study examined differences in health outcomes and acute service use between lesbian, gay, and bisexual (LGB) individuals and a matched heterosexual control group.

Methods: Individuals ages 18 to 85 whose electronic health records indicated a sexual orientation as LGB and who were included in the 2015 New York State Office of Mental Health Patient Characteristics Survey (N=5,775) were matched with heterosexuals (N=5,775) by sex assigned at birth, age, race, Hispanic ethnicity, and county of residence and compared on health status indicators, conditions and behaviors, and acute service use. Generalized estimating equation models were used to estimate the odds and rates of acute service use.

The role of physical and psychological health problems in the drug use treatment process.

The role of physical and psychological health is examined as a predictor of client engagement in prison-based drug treatment. A treatment process model was expanded to include physical and mental health issues. The sample included 6009 offenders in prison-based drug treatment, comprised of 67% male, 26% African American, 51% white, and 22% Hispanic; average age was 34.

Evaluating the Impact of a Targeted Brief HIV Intervention on Multiple Inter-Related HIV Risk Factors of Knowledge and Attitudes among Incarcerated Drug Users.

Increases in HIV prevalence indicate ongoing need for HIV interventions. A brief manualized intervention called TCU which addresses multiple HIV risks, was further evaluated to determine how it addressed individual's knowledge deficiencies in the assessed risks. The sample of 1256 offenders in 8 correctional substance abuse treatment programs participated either in treatment as usual (TAU) or TCU .

: A self-administered android tablet application for helping individuals on probation make better decisions pertaining to health risk behaviors.

This paper describes the development and protocol for feasibility and efficacy testing of a risk reduction intervention designed to improve behavioral health outcomes among drug offenders on probation under community supervision or in residential substance abuse treatment centers. is a self-administered tablet-based intervention for teaching better decision-making skills regarding health risk behaviors, especially those involving HIV risks. We are using pre/post, experimental/control group randomized clinical trial (RCT) in both community and residential probation settings with goals to 1) assess the feasibility and acceptance of by examining participation rates and satisfaction measures, and 2) examine the impact of on decision-making skills, confidence and motivation to avoid sex and drug risks, willingness to discuss health risks and concerns with helpful others, and engagement in health risk behaviors.

A Brief Assessment for HIV Risk: The TCU HVHP Form.

Targeted HIV screens may help identify some risk-related concerns of drug-using offenders. The present study describes the Texas Christian University HIV/Hepatitis Risk Assessment (TCU HVHP) form, a 19-item self-report instrument measuring HIV and hepatitis risks based on a sample (N = 1,056) of offenders in eight prisons. Principal components analysis indicated four scales (Injection Risk, Condom Attitudes, Sex Risk, and AIDS Concern) with reliable psychometric properties with coefficient α reliabilities ranging from .

Evaluation of WaySafe: A Disease-Risk Reduction Curriculum for Substance-Abusing Offenders.

With a focus on reducing disease risk behavior in the community, a six-session curriculum, WaySafe, was developed to increase positive decision-making skills among soon-to-be-released inmates participating in a therapeutic community substance abuse treatment program. The intervention used TCU Mapping-Enhanced Counseling as an approach to focus on cognitive aspects of risky sexual and drug use behaviors in an effort to improve problem recognition, commitment to change, and strategies for avoiding behavioral risks of infections. A total of 1393 inmates from eight different institutions in two states were randomly assigned to receive WaySafe or treatment as usual (TAU).

Gender as a moderator in predicting re-arrest among treated drug-involved offenders.

The primary aim of the current study is to explore gender differences on the relationships of pre-treatment risk factors and psychosocial functioning with time to re-arrest following termination from prison. The sample consisted of 384 males and 313 females who were admitted to four prison-based substance abuse treatment programs. Results showed that female inmates experienced a longer time to re-arrest than male inmates.

Effectiveness of a theoretically-based judgment and decision making intervention for adolescents.

Although adolescents demonstrate capacity for rational decision making, their tendency to be impulsive, place emphasis on peers, and ignore potential consequences of their actions often translates into higher risk-taking including drug use, illegal activity, and physical harm. Problems with judgment and decision making contribute to risky behavior and are core issues for youth in treatment. Based on theoretical and empirical advances in cognitive science, the Treatment Readiness and Induction Program (TRIP) represents a curriculum-based decision making intervention that can be easily inserted into a variety of content-oriented modalities as well as administered as a separate therapeutic course.