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Mark TL, Dolan M, Allaire B, Parish W, Strack C, Poehler D, Madden E, Butler V. Untreated Psychiatric and Substance Use Disorders Among Caregivers With Children Reported to Child Protective Services. JAMA Health Forum 2024; 5:e240637. [PMID: 38639981 PMCID: PMC11065155 DOI: 10.1001/jamahealthforum.2024.0637] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/27/2024] [Indexed: 04/20/2024] Open
Abstract
Importance Mental and substance use disorders can interfere with parents' ability to care for their children and are associated with a greater likelihood of child protective services involvement to address child maltreatment. Parent engagement in psychiatric and substance use disorder treatment can prevent child maltreatment and family separations. Objective To determine whether caregivers with psychiatric or substance use disorders whose children were referred to child protective services received Medicaid-funded psychiatric or substance use disorder treatment. Design, Setting, and Participants Caregivers listed on child welfare records were linked with their Medicaid records using 2017 to 2020 Medicaid and child welfare data from Florida and Kentucky. Medicaid claims were analyzed to determine if caregivers had a psychiatric or substance use disorder diagnosis and whether those caregivers received counseling or medications. The analysis was conducted in 2023. Exposure Diagnosis of a psychiatric or substance use disorder in 2020. Main Outcome and Measure Receipt of psychiatric or substance use disorder counseling or medications. Results Of the 58 551 caregivers, 65% were aged between 26 and 40 years; 69% were female and 31% were male. Overall, 78% identified as White, 20% identified as Black/African American, and less than 1% identified as American Indian/Alaska Native, Asian, or Native Hawaiian/Other Pacific Islander. In 2020, 59% of caregivers with Medicaid and children referred to child protective services had a mental health or substance use disorder diagnosis, compared with 33% of age- and sex-matched Medicaid beneficiaries without children referred to child protective services (P < .001). Among caregivers with a psychiatric disorder, 38% received counseling and 67% received psychiatric medication. Among those with a substance use disorder, 40% received counseling and 38% received a substance use disorder medication. Conclusions and Relevance In this case-control study, despite Medicaid coverage of an array of effective behavioral health treatments, large portions of caregivers with Medicaid coverage, who need treatment and whose children were referred to child protective services, were not receiving treatment. Medicaid and child welfare agencies should make a greater effort to connect caregivers to behavioral health services.
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Affiliation(s)
| | | | | | | | | | | | - Emily Madden
- Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC
| | - Valeria Butler
- Office of Planning, Research and Evaluation, Administration for Children and Families, Department of Health and Human Services, Washington, DC
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Mark TL, Dolan M, Allaire B, Parish W, Poehler D, Strack C, Madden E, Butler V. Linked Child Welfare and Medicaid Data in Kentucky and Florida Highlights Racial Disparities in Access to Care. Child Maltreat 2024:10775595241234569. [PMID: 38378439 DOI: 10.1177/10775595241234569] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Parents with serious mental health (MH) and substance use disorders (SUD) can face profound challenges caring for their children. MH/SUD treatment can improve outcomes for both parents and their children. This study evaluated whether parents with Medicaid with MH/SUD conditions whose children had child protective services (CPS) involvement were receiving MH/SUD treatment and whether receipt differed by race. We analyzed the 2020 Child and Caregiver Outcomes Using Linked Data (CCOULD) which contains Medicaid and child welfare records from Kentucky and Florida on 58,551 CPS-involved caregivers. Among caregivers with an MH diagnosis, White individuals were more likely than Black individuals to have received counseling (42% vs. 20%) or an MH medication (69% vs. 52%). Among caregivers with an SUD, White individuals were more likely than Black individuals to have received counseling (43% vs. 20%) or an SUD medication (43% vs. 11%). More effort is needed to connect parents with CPS involvement to MH/SUD treatment, particularly Black parents.
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Affiliation(s)
- Tami L Mark
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | | | | | - Emily Madden
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC, USA
| | - Valeria Butler
- US Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research and Evaluation, Washington, DC, USA
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Parish W, Beil H, He F, D'Arcangelo N, Romaire M, Rojas-Smith L, Haber SG. Health Care Impacts Of Resource Navigation For Health-Related Social Needs In The Accountable Health Communities Model. Health Aff (Millwood) 2023:101377hlthaff202201502. [PMID: 37196210 DOI: 10.1377/hlthaff.2022.01502] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Social determinants of health can adversely affect health and therefore lead to poor health care outcomes. When it launched in 2017, the Accountable Health Communities (AHC) Model was at the forefront of US health policy initiatives seeking to address social determinants of health. The AHC Model, sponsored by the Centers for Medicare and Medicaid Services, screened Medicare and Medicaid beneficiaries for health-related social needs and offered eligible beneficiaries assistance in connecting with community services. This study used data from the period 2015-21 to test whether the model had impacts on health care spending and use. Findings show statistically significant reductions in emergency department visits for both Medicaid and fee-for-service Medicare beneficiaries. Impacts on other outcomes were not statistically significant, but low statistical power may have limited our ability to detect model effects. Interviews with AHC Model participants who were offered navigation services to help them find community-based resources suggested that navigation services could have directly affected the way in which beneficiaries engage with the health care system, leading them to be more proactive in seeking appropriate care. Collectively, findings provide mixed evidence that engaging with beneficiaries who have health-related social needs can affect health care outcomes.
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Affiliation(s)
- William Parish
- William Parish , RTI International, Research Triangle Park, North Carolina
| | - Heather Beil
- Heather Beil, RTI International, Research Triangle Park, North Carolina
| | - Fang He
- Fang He, RTI International, Research Triangle Park, North Carolina
| | - Noah D'Arcangelo
- Noah D'Arcangelo, RTI International, Research Triangle Park, North Carolina
| | - Melissa Romaire
- Melissa Romaire, RTI International, Research Triangle Park, North Carolina
| | | | - Susan G Haber
- Susan G. Haber, RTI International, Waltham, Massachusetts
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Abstract
OBJECTIVE This study aimed to investigate whether state Medicaid programs systematically reimburse psychiatrists less than they reimburse primary care physicians. METHODS This study used outpatient Medicaid claims data from 2014 for 11 U.S. states. Claims with a primary behavioral health diagnosis (i.e., mental or substance use disorder) and an evaluation and management procedure code of 99213 or 99214 were identified. These are the most frequently used procedure codes by both psychiatrists and primary care physicians when treating patients with mental and substance use disorders. Average reimbursements were compared for nonfacility claims submitted by psychiatrists and primary care physicians. RESULTS In 9 states, psychiatrists were reimbursed less on average than primary care physicians. In one state, reimbursements were nearly equivalent. CONCLUSIONS Disparities in reimbursements across specialties may reduce access to psychiatric specialty care through Medicaid and are inconsistent with the Mental Health Parity and Addiction Equity Act.
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Affiliation(s)
- Tami L Mark
- RTI International, Research Triangle Park, North Carolina (Mark, Parish, Zarkin); Legal Action Center, New York (Weber)
| | - William Parish
- RTI International, Research Triangle Park, North Carolina (Mark, Parish, Zarkin); Legal Action Center, New York (Weber)
| | - Gary A Zarkin
- RTI International, Research Triangle Park, North Carolina (Mark, Parish, Zarkin); Legal Action Center, New York (Weber)
| | - Ellen Weber
- RTI International, Research Triangle Park, North Carolina (Mark, Parish, Zarkin); Legal Action Center, New York (Weber)
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Mark TL, Parish W. Opioid medication discontinuation and risk of adverse opioid-related health care events. J Subst Abuse Treat 2019; 103:58-63. [DOI: 10.1016/j.jsat.2019.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 01/19/2023]
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Abstract
This study describes changes in the proportion of Medicare Part D plans requiring prior authorization for buprenorphine products before and after a 2017 FDA rquirement that the drug’s label emphasize the importance of drug treatment of opioid use disorder.
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Affiliation(s)
| | - William Parish
- RTI International, Research Triangle Park, North Carolina
| | - Gary A. Zarkin
- RTI International, Research Triangle Park, North Carolina
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Zhao Y, Parish W, Yang LG, Emch M, Ho KM, Fong FY, Miu HYH, Tucker JD, Wong WCW. 1271. Prevalence and Factors Associated With HIV Testing Among Sexually Experienced 18–49-Year-Old Hong Kong Residents. Open Forum Infect Dis 2018. [PMCID: PMC6252696 DOI: 10.1093/ofid/ofy210.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The main HIV transmission route in Hong Kong is sex, accounting for 78.0% of the total reported cases. The majority of HIV cases were identified among those 20 to 49 years of age. In this study, we explored the prevalence and factors associated with HIV testing among 18 to 49 years old residents in Hong Kong.
Methods
A population-based survey on sexual practice and health behavior was conducted in Hong Kong with a sample of 881 participants drawn from geospatial modeling, proportional to the district population sizes. Invitation letters were sent to selected households and interviewers were sent to recruit one subject per household. Once recruited, face-to-face interviews were carried out with a computer-assisted self-interview. The final data were weighted according to the 2011 Hong Kong census and factors identified through logistic regression.
Results
Among 881 participants, 81.6% reported having sex before, among whom, 19.5% (137) had ever taken HIV tests. The main reasons for the 75.5% of participants not taking HIV testing are they do not think they are at risk of HIV infection (59.1%) or think they are very healthy (29.4%). The main places for HIV testing among those tested were public hospital/clinic (39.7%), private clinic/hospital (34.7%), and another 22.0% was tested in antenatal check-up or Hong Kong Red Cross. Among the sexually experienced residents, factors associated with HIV testing include marital status and number of sexual partners. Compared with single participants, those cohabiting, married, or with marital history were about seven times more likely to be tested (aOR = 6.73, 95% CI 2.23–20.31). Those who had >1 sexual partners were about twice as likely to be tested (aOR = 1.84, 95% CI 1.05–3.25). Other factors such as condom use, sexual orientation, anal sex behaviors or sexually transmitted infections history were not associated with HIV testing.
Conclusion
HIV testing among Hong Kong residents is comparatively low. Though those with more than one sexual partner are more likely to be tested, those single, nonconsistent condom users, or with risky behavior such as anal sex behaviors do not associate with higher HIV testing. More HIV testing campaign and awareness raising shall be targeted toward people with at-risk behaviors.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Yanping Zhao
- The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Li-Gang Yang
- Division of STD Control, Guangdong Provincial Dermatology Hospital, Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Guangzhou, Guangdong Province., Guangzhou, China
| | - Michael Emch
- 206 Carolina Hall CB #3220 Chapel Hill, North Carolina 27599 USA, Chapel Hill, North Carolina, North Carolina
| | - King Man Ho
- Social Hygiene Service, Department of Health, Hong Kong Government, Hong Kong S.A.R., China., Hong Kong, Hong Kong
| | - Francois Yeung Fong
- Hong Kong Sexual Health Centre, Hong Kong S.A.R., China., Hong Kong, Hong Kong
| | - Heidi Yin Hai Miu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph D Tucker
- Division of Infectious Diseases, University of North Carolina Project-China and University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - William Chi Wai Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Abstract
Background Thirty-four countries worldwide have abnormally high sex ratios (>102 men per 100 women), resulting in over 100 million missing women. Widespread sex selective abortion, neglect of young girls leading to premature mortality, and gendered migration have contributed to these persistent and increasing distortions. Abnormally high adult sex ratios in communities may drive sexually transmitted disease (STD) spread where women are missing and men cannot find stable partners. We systematically reviewed evidence on the association between high community sex ratios and individual sexual behaviors. Methods and Findings Seven databases (PubMed, Web of Science, Embase, Scopus, The Cochrane Database of Systematic Reviews, Sociological Abstracts, and PopLINE) were searched without restrictions on time or location. We followed PRISMA guidelines and evaluated quality according to STROBE criteria. 1093 citations were identified and six studies describing 57,054 individuals were included for review. All six studies showed an association between high community sex ratios and individual sexual risk behaviors. In high sex ratio communities, women were more likely to have multiple sex partners and men were more likely to delay first sexual intercourse and purchase sex. Only two studies included STD outcomes. Conclusions High community sex ratios were associated with increased individual sexual risk behavior among both men and women. However, none of the studies examined unprotected sex or appropriately adjusted for gendered migration. Further studies are needed to understand the effect of community sex ratios on sexual health and to inform comprehensive STD control interventions.
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Affiliation(s)
- Cedric H. Bien
- University of North Carolina Project-China, Guangzhou, China
| | - Yong Cai
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Michael E. Emch
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - William Parish
- University of Chicago, Chicago, Illinois, United States of America
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Sawicka M, Pawlikowski J, Wilson S, Ferdinando D, Wu H, Adams PD, Gunn DA, Parish W. The specificity and patterns of staining in human cells and tissues of p16INK4a antibodies demonstrate variant antigen binding. PLoS One 2013; 8:e53313. [PMID: 23308192 PMCID: PMC3540092 DOI: 10.1371/journal.pone.0053313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 11/30/2012] [Indexed: 01/26/2023] Open
Abstract
The validity of the identification and classification of human cancer using antibodies to detect biomarker proteins depends upon antibody specificity. Antibodies that bind to the tumour-suppressor protein p16INK4a are widely used for cancer diagnosis and research. In this study we examined the specificity of four commercially available anti-p16INK4a antibodies in four immunological applications. The antibodies H-156 and JC8 detected the same 16 kDa protein in western blot and immunoprecipitation tests, whereas the antibody F-12 did not detect any protein in western blot analysis or capture a protein that could be recognised by the H-156 antibody. In immunocytochemistry tests, the antibodies JC8 and H-156 detected a predominately cytoplasmic localised antigen, whose signal was depleted in p16INK4a siRNA experiments. F-12, in contrast, detected a predominately nuclear located antigen and there was no noticeable reduction in this signal after siRNA knockdown. Furthermore in immunohistochemistry tests, F-12 generated a different pattern of staining compared to the JC8 and E6H4 antibodies. These results demonstrate that three out of four commercially available p16INK4a antibodies are specific to, and indicate a mainly cytoplasmic localisation for, the p16INK4a protein. The F-12 antibody, which has been widely used in previous studies, gave different results to the other antibodies and did not demonstrate specificity to human p16INK4a. This work emphasizes the importance of the validation of commercial antibodies, aside to the previously reported use, for the full verification of immunoreaction specificity.
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Affiliation(s)
- Magdalena Sawicka
- Unilever Discover, Colworth Science Park, Sharnbrook, Bedford, United Kingdom
| | - Jeffrey Pawlikowski
- Institute of Cancer Sciences, CR-UK Beatson Labs, University of Glasgow, Glasgow United Kingdom
| | - Stephen Wilson
- Unilever Discover, Colworth Science Park, Sharnbrook, Bedford, United Kingdom
| | - Dudley Ferdinando
- Unilever Discover, Colworth Science Park, Sharnbrook, Bedford, United Kingdom
| | - Hong Wu
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Peter David Adams
- Institute of Cancer Sciences, CR-UK Beatson Labs, University of Glasgow, Glasgow United Kingdom
| | - David Andrew Gunn
- Unilever Discover, Colworth Science Park, Sharnbrook, Bedford, United Kingdom
| | - William Parish
- Unilever Discover, Colworth Science Park, Sharnbrook, Bedford, United Kingdom
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Abstract
While 70% of HIV positive individuals live in sub-Saharan Africa, it is widely believed that the future of the epidemic depends on the magnitude of HIV spread in India and China, the world's most populous countries. China's 1.3 billion people are in the midst of significant social transformation, which will impact future sexual disease transmission. Soon approximately 8.5 million 'surplus men', unmarried and disproportionately poor and migrant, will come of age in China's cities and rural areas. Meanwhile, many millions of Chinese sex workers appear to represent a broad range of prices, places, and related HIV risk behaviors. Using demographic and behavioral data, this paper describes the combined effect of sexual practices, sex work, and a true male surplus on HIV transmission. Alongside a rapid increase in sexually transmitted disease incidence across developed parts of urban China, surplus men could become a significant new HIV risk group. The anticipated high sexual risk among many surplus men and injecting drug use use among a subgroup of surplus men may create bridging populations from high to low risk individuals. Prevention strategies that emphasize traditional measures--condom promotion, sex education, medical training--must be reinforced by strategies which acknowledge surplus men and sex workers. Reform within female sex worker mandatory re-education centers and site specific interventions at construction sites, military areas, or unemployment centers may hold promise in curbing HIV/sexually transmitted infections. From a sociological perspective, we believe that surplus men and sex workers will have a profound effect on the future of HIV spread in China and on the success or failure of future interventions.
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