Ethical Imperatives for Participation in Integrated/Collaborative Care Models for Pediatric Mental Health Care

The significant and ongoing shortage of child and adolescent psychiatrists has limited access to mental health care in the pediatric population. In response to this problem, integrated/collaborative care models have been established. These models, as all imperfect things in medicine, have their own set of challenges. A careful ethical analysis of integrated/collaborative care models is essential to protect the social and emotional health and safety of children with mental illness. To this end, ethical assessment supports the use of integrated/collaborative care models, and recent studies have demonstrated the benefits of their implementation. Keywords: Behavioral health; Collaborative care; Ethics; Integrated care; Mental health; Pediatric

A Graphical Description of Partial Exchangeability

Partial exchangeability is sufficient for the identification of some causal effects of interest. Here we review the use of common graphical tools and the sufficient component cause model in the context of partial exchangeability. We illustrate the utility of single world intervention graphs (SWIGs) in depicting partial exchangeability and provide an illustrative example of when partial exchangeability might hold in the absence of complete exchangeability

Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms

OBJECTIVE: Perinatal depression is common and associated with poor birth, infant and child outcomes. Screening for perinatal depression alone does not improve treatment rates or patient outcomes. This paper describes the development, implementation and outcomes of a new and low-cost population-based program to help providers address perinatal depression, the Massachusetts Child Psychiatry Access Project (MCPAP) for Moms. METHOD: MCPAP for Moms builds providers\u27 capacity to address perinatal depression through (1) trainings and toolkits on depression screening, assessment and treatment; (2) telephonic access to perinatal psychiatric consultation for providers serving pregnant and postpartum women; and (3) care coordination to link women with individual psychotherapy and support groups. RESULTS: In the first 18 months, MCPAP for Moms enrolled 87 Ob/Gyn practices, conducted 100 trainings and served 1123 women. Of telephone consultations provided, 64% were with obstetric providers/midwives and 16% were with psychiatrists. MCPAP for Moms costs $8.38 per perinatal woman per year ($0.70 per month) or $600,000 for 71,618 deliveries annually in Massachusetts. CONCLUSION: The volume of encounters, number of women served and low cost suggest that MCPAP for Moms is a feasible, acceptable and sustainable approach that can help frontline providers effectively identify and manage perinatal depression

Causal inference with limited resources: proportionally-representative interventions

Investigators often evaluate treatment effects by considering settings in which all individuals are assigned a treatment of interest, assuming that an unlimited number of treatment units are available. However, many real-life treatments are of limited supply and cannot be provided to all individuals in the population. For example, patients on the liver transplant waiting list cannot be assigned a liver transplant immediately at the time they reach highest priority because a suitable organ is not likely to be immediately available. In these cases, investigators may still be interested in the effects of treatment strategies in which a finite number of organs are available at a given time, that is, treatment regimes that satisfy resource constraints. Here, we describe an estimand that can be used to define causal effects of treatment strategies that satisfy resource constraints: proportionally-representative interventions for limited resources. We derive a simple class of inverse probability weighted estimators, and apply one such estimator to evaluate the effect of restricting or expanding utilization of "increased risk" liver organs to treat patients with end-stage liver disease. Our method is designed to evaluate policy-relevant interventions in the setting of finite treatment resources

Sexual assault incidents among college undergraduates: Prevalence and factors associated with risk.

Sexual assault on college campuses is a public health issue. However varying research methodologies (e.g., different sexual assault definitions, measures, assessment timeframes) and low response rates hamper efforts to define the scope of the problem. To illuminate the complexity of campus sexual assault, we collected survey data from a large population-based random sample of undergraduate students from Columbia University and Barnard College in New York City, using evidence based methods to maximize response rates and sample representativeness, and behaviorally specific measures of sexual assault to accurately capture victimization rates. This paper focuses on student experiences of different types of sexual assault victimization, as well as sociodemographic, social, and risk environment correlates. Descriptive statistics, chi-square tests, and logistic regression were used to estimate prevalences and test associations. Since college entry, 22% of students reported experiencing at least one incident of sexual assault (defined as sexualized touching, attempted penetration [oral, anal, vaginal, other], or completed penetration). Women and gender nonconforming students reported the highest rates (28% and 38%, respectively), although men also reported sexual assault (12.5%). Across types of assault and gender groups, incapacitation due to alcohol and drug use and/or other factors was the perpetration method reported most frequently (> 50%); physical force (particularly for completed penetration in women) and verbal coercion were also commonly reported. Factors associated with increased risk for sexual assault included non-heterosexual identity, difficulty paying for basic necessities, fraternity/sorority membership, participation in more casual sexual encounters ("hook ups") vs. exclusive/monogamous or no sexual relationships, binge drinking, and experiencing sexual assault before college. High rates of re-victimization during college were reported across gender groups. Our study is consistent with prevalence findings previously reported. Variation in types of assault and methods of perpetration experienced across gender groups highlight the need to develop prevention strategies tailored to specific risk groups

Associations between demographic and behavioral characteristics and experience of any sexual assault since enrolling at CU/BC, by gender.

<p>Associations between demographic and behavioral characteristics and experience of any sexual assault since enrolling at CU/BC, by gender.</p

Associations between demographic and behavioral characteristics and each type of sexual assault since enrolling at CU/BC, by gender.

<p>Associations between demographic and behavioral characteristics and each type of sexual assault since enrolling at CU/BC, by gender.</p