Telebehavioral health at a federally qualified health center pre- and peri-COVID-19.

Federally Qualified Health Centers (FQHCs) are a safety net for low-income individuals needing mental and/or physical health care. The COVID-19 pandemic required FQHCs (and other health organizations) to pivot rapidly to telehealth. In theory, telehealth services can expand access to needed care. The COVID-19 pandemic provides a natural opportunity to "test" this assumption. We compared sociodemographic differences in patients accessing behavioral health services pre- and peri-COVID-19 at an FQHC. We also investigated potential patient sociodemographic disparities in telebehavioral health service use during the first year of the COVID-19 pandemic. Data were collected from a single FQHC (13 sites, 4 integrated primary care medical clinics) in the southern United States. Participants included 5,190 patients (69.2% female, 59.7% persons of color) attending a total of 16,474 behavioral health sessions across 2 years (one pre- and one peri-COVID-19). Before the COVID-19 pandemic, 100% of behavioral health visits were conducted in person. During the pandemic, nearly half of behavioral health visits were conducted via telehealth. Telehealth visits were most frequently attended by adults, non-Latinx Whites, women, and people making ≤ 200% of the federal poverty level. A combination of in-person and telehealth service delivery models should be used by FQHCs to maximize access to care for different demographic groups. FQHCs should consider key factors (e.g., access, ableism, technology facility, and language) to increase patients' ability to take advantage of telehealth services where available. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social Vulnerability and Emotional Distress in Older Adults: A Study in Primary Care Centers in Mexico City.

OBJECTIVES: To analyze the association between social vulnerability and emotional distress in older adults (OAs) visiting health centers in Mexico City, to describe the strategies and services used by OAs when they experience emotional distress, and to determine whether emotional distress is addressed in these primary care settings. METHODS: A sequential exploratory mixed method. In the first phase, qualitative information was collected through semi-structured interviews with 17 OAs. The information obtained was used to construct the instrument used in the second phase, which obtained quantitative data from 61 OAs. RESULTS: The main causes of emotional distress were feelings of loneliness, unemployment, and problems with children. The main actions used to address this distress were seeking support from family and friends, "hanging on," and engaging in religious practices. A total of 29.5% indicated that their doctor asked about emotional distress; 23% said they were referred to a psychologist, but few took this advice. CONCLUSIONS: The presence of emotional distress in OAs is not an individual health problem but rather the result of their living conditions and environment.

A Retrospective Examination of Symptom Improvements in Primary Care Patients Receiving Behavior Therapy With and Without Concurrent Pharmacotherapy.

Primary care providers are the biggest prescribers of psychopharmacological medications. In this non-randomized retrospective examination, we asked whether primary care patients receiving behavioral health interventions with and without concurrent pharmacological treatments showed differential symptom improvement. Participants (79.4% women, 61.5% Hispanic, M age = 41.68, SD = 13.50) were 431 primary care patients referred to behavioral health with a primary concern of depression at one of three federally qualified health centers. Thirty-three percent of patients initiated or had an increase in pharmacotherapy concurrently with behavioral therapy; 26.9% had no change in medication during the episode of care, and 39.7% had no concurrent psychotropic medication prescribed during the episode of care. One-way analyses of variance revealed patients in the no medication group had higher global functioning, as measured by Global Assessment of Functioning (GAF) scores, than patients who were taking medication, or who initated or had an increase in medication. There was a significant main effect of time, where patients had significantly higher GAF scores during their last session in comparison to the first session. All three patient groups experienced comparable improvements in GAF scores, but patients in the initiated/increased medication group were significantly more likely to terminate behavioral health treatment prematurely. Results suggest primary care patients experience improvements in functioning across an episode of behavioral health care, even without concurrent psychotropic medication use.