Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth.

OBJECTIVE: There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth. METHOD: Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years. RESULTS: In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes. CONCLUSION: Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services.

After the Crisis: Racial/Ethnic Disparities and Predictors of Care Use Following Youth Psychiatric Emergencies.

OBJECTIVE: Youth psychiatric emergencies have increased at alarming rates, and disproportionately so for youth of color. Outpatient follow-up care is critical for positive youth outcomes, but rates of follow-up remain low, especially for racial/ethnic minoritized youth. Mobile crisis response can initiate care connection. The current study (1) describes the population who received mobile crisis response (MCR) within the nation's largest county public mental health system, (2) assesses rates of follow-up outpatient services after MCR, and (3) examines racial/ethnic disparities in outpatient services and correlates of receipt of therapy dose (≥8 sessions). METHOD: Administrative claims for MCR and outpatient services for youth ages 0 to 18 were abstracted from the Los Angeles County Department of Mental Health. RESULTS: From October 2016-2019, 20,782 youth received a MCR, 52.5% of youth were female, and youth mean age was 13.41 years. The majority of youth (91.8%) received some outpatient services after their first MCR. However, only 56.7% of youth received ≥1 therapy session. In a logistic regression, youth age, gender, race/ethnicity, primary language, primary diagnosis, insurance status, MCR call location, and MCR disposition significantly predicted receipt of ≥8 therapy sessions. CONCLUSIONS: Findings highlight disparities in therapy receipt for Asian American Pacific Islander, Black, and White youth (relative to Latinx youth), older youth, youth whose MCR was initiated from a police station call, and youth whose MCR did not result in hospitalization. We discuss priorities for quality improvement for MCR processes and strategies to promote linkage to care to achieve mental health equity.

Reducing Internalized Homonegativity: Refinement and Replication of an Online Intervention for Gay Men.

We refined and replicated an efficacious brief intervention to reduce internalized homonegativity (IH) with a sample of gay and exclusively same-sex attracted men recruited from outside of LGBT community networks using Amazon Mechanical Turk. We sought to 1) determine if levels of IH differed between the original study's community-based sample and our non-community-based sample, 2) examine the efficacy of the replicated intervention, and 3) assess for longitudinal effects of the intervention at a 30-day follow-up. Four hundred eighty-four participants completed either the intervention or a stress management control condition. Mean levels of IH were higher in the current sample compared with the earlier study's community sample. The intervention was efficacious at reducing global IH, reducing personal homonegativity, and increasing gay affirmation. Ninety-six participants completed the follow-up; follow-up results were not significant and may have been affected by high rates of attrition. Implications for research and practice are discussed.

L or G or B or T: Matching Sexual and Gender Minorities with Subpopulation-Specific Interventions.

Sexual and gender minorities (SGM) may benefit from psychological interventions tailored to specific subpopulations (e.g., lesbians, gay men, bisexual people, transgender people) given differing experiences with stigma. However, determining the inclusion/exclusion process for subpopulation-specific interventions is challenging and recommendations for this process are scarce. We developed and evaluated a matching procedure to place 1183 SGM participants into four targeted online interventions designed to reduce internalized stigma for lesbian, gay, bisexual, and transgender people. We evaluated participant attrition, efficacy, satisfaction with placement, and qualitative feedback across the four interventions. Results indicated that our matching procedure was time-efficient and largely successful in terms of low attrition, high satisfaction, and reaching segments of the SGM population not usually captured with the LGBT acronym. Based on these findings, we offer six practical guidelines for devising the inclusion/exclusion process or matching procedure for future subpopulation-specific SGM interventions studies.

A computer-based intervention to reduce internalized heterosexism in men.

Internalized heterosexism (IH) is a strong predictor of the psychological well-being of lesbian, gay, bisexual (LGB), or other same-sex attracted individuals. To respond to the call for interventions to address IH, the current study developed and tested an online intervention to reduce IH among gay, bisexual, and other same-sex attracted men. A total of 367 self-identified same-sex attracted adult males were recruited through various nationwide LGB-related sources and were assigned by birth month to either the experimental condition (focusing on IH reduction) or the control condition (a similarly structured invention focusing on stress management); 290 of these participants completed the intervention and all post-intervention measures. Mean levels of IH were compared by condition, indicating significant differences on the IH global score and 2 of the 3 IH subscale scores between the participants in the 2 conditions. The study findings support the promise of using the Internet to deliver IH interventions. Implications for research and practice are discussed.