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Tomovic M, Balfour ME, Cho T, Prathap N, Harootunian G, Mehreen R, Ostrovsky A, Goldman ML. Patient Flow and Reutilization of Crisis Services Within 30 Days in a Comprehensive Crisis System. Psychiatr Serv 2024:appips20230232. [PMID: 38410037 DOI: 10.1176/appi.ps.20230232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Crisis services are undergoing an unprecedented expansion in the United States, but research is lacking on crisis system design. This study describes how individuals flow through a well-established crisis system and examines factors associated with reutilization of such services. METHODS This cross-sectional study used Medicaid claims to construct episodes describing the flow of individuals through mobile crisis, specialized crisis facility, emergency department, and inpatient services. Claims data were merged with electronic health record (EHR) data for the subset of individuals receiving care at a crisis response center. A generalized estimating equation was used to calculate adjusted odds ratios for demographic, clinical, and operational factors associated with reutilization of services within 30 days of an episode's end point. RESULTS Of 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset (N=9,202 episodes) with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status. CONCLUSIONS Crisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.
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Affiliation(s)
- Milos Tomovic
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Margaret E Balfour
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Ted Cho
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Nishanth Prathap
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Gevork Harootunian
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Raihana Mehreen
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Andrey Ostrovsky
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Matthew L Goldman
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
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Goldman ML, McDaniel M, Manjanatha D, Rose ML, Santos GM, Shade SB, Lazar AA, Myers JJ, Handley MA, Coffin PO. Impact of San Francisco's New Street crisis response Team on Service use among people experiencing homelessness with mental and substance use disorders: A mixed methods study protocol. PLoS One 2023; 18:e0295178. [PMID: 38051726 PMCID: PMC10697604 DOI: 10.1371/journal.pone.0295178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
Mobile crisis services for people experiencing distress related to mental health or substance use are expanding rapidly across the US, yet there is little evidence to support these specific models of care. These new programs present a unique opportunity to expand the literature by utilizing implementation science methods to inform the future design of crisis systems. This mixed methods study will examine the effectiveness and acceptability of the Street Crisis Response Team (SCRT), a new 911-dispatched multidisciplinary mobile crisis intervention piloted in San Francisco, California. First, using quantitative data from electronic health records, we will conduct an interrupted time series analysis to quantitatively examine the impacts of the SCRT on people experiencing homelessness who utilized public behavioral health crisis services in San Francisco between November 2019 and August 2022, across four main outcomes within 30 days of the crisis episode: routine care utilization, crisis care reutilization, assessment for housing services, and jail entry. Second, to understand its impact on health equity, we will analyze racial and ethnic disparities in these outcomes prior to and after implementation of the SCRT. For the qualitative component, we will conduct semi-structured interviews with recipients of the SCRT's services to understand their experiences of the intervention and to identify how the SCRT influenced their health-related trajectories after the crisis encounter. Once complete, the quantitative and qualitative findings will be further analyzed in tandem to assist with more nuanced understanding of the effectiveness of the SCRT program. This evaluation of a novel mobile crisis response program will advance the field, while also providing a model for how real-world program implementation can be achieved in crisis service settings.
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Affiliation(s)
- Matthew L. Goldman
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Megan McDaniel
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
| | - Deepa Manjanatha
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States of America
| | - Monica L. Rose
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States of America
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ann A. Lazar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Division of Oral Epidemiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Janet J. Myers
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
- UCSF Partnerships for Research in Implementation Science for Equity (PRISE Center), San Francisco, San Francisco, CA, United States of America
| | - Margaret A. Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
- UCSF Partnerships for Research in Implementation Science for Equity (PRISE Center), San Francisco, San Francisco, CA, United States of America
| | - Phillip O. Coffin
- San Francisco Department of Public Health, San Francisco, San Francisco, CA, United States of America
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
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Pope LG, Patel A, Fu E, Zingman M, Warnock A, Ellis S, Ashekun O, Watson A, Wood J, Compton MT. Crisis Response Model Preferences of Mental Health Care Clients With Prior Misdemeanor Arrests and of Their Family and Friends. Psychiatr Serv 2023; 74:1163-1170. [PMID: 37070262 DOI: 10.1176/appi.ps.20220363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The overrepresentation of people with serious mental illnesses in the criminal legal system has spurred the development of crisis response models to improve or reduce police response to a mental health crisis. However, limited research has explored preferences for crisis response, and no research in the United States has examined the responses desired by mental health care clients or their family members. This study aimed to understand the experiences of people with serious mental illnesses interacting with police and to learn about their preferences for crisis response models. The authors interviewed 50 clients with serious mental illnesses and a history of arrest who were enrolled in a randomized controlled trial of a police-mental health linkage system, as well as 18 of their family members and friends. Data were coded with deductive and inductive approaches and were grouped into larger themes. Clients and family or friends described needing a calm environment and empathy during a crisis. They selected a nonpolice response as their first choice and response from a crisis intervention team as their last choice among four options, highlighting the importance of trained responders and past negative interactions with police. However, they also noted concerns about safety and the shortcomings of a nonpolice response. These findings build understanding about clients' and family members' preferences for crisis response and highlight concerns that are relevant for policy makers.
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Affiliation(s)
- Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Ashnee Patel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - En Fu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Michael Zingman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Amanda Warnock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Samantha Ellis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Oluwaytoyin Ashekun
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Amy Watson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Jennifer Wood
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
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