Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values \u3e .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos

Need, Access, and the Reach of Integrated Care: A Typology of Patients

Introduction: In this paper, we report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also describe the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). Method: A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Results: Hierarchical and k-means cluster analyses revealed three groups: (1) Well-served patients, characterized by high perceived need for services, high service utilization, and low barriers to service use (40%); (2) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (3) Subclinical patients, characterized by low perceived need, low service utilization, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. Discussion: We found primary care patients could be grouped into three categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health settings. IBHC may be a promising approach for extending the reach of mental health care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service delivery model

Must we measure what we mean?

This paper excavates a debate concerning the claims of ordinary language philosophers that took place during the middle of the last century. The debate centers on the status of statements about “what we say”. On one side of the debate, critics of ordinary language philosophy argued that statements about “what we say” should be evaluated as empirical observations about how people do in fact speak, on a par with claims made in the language sciences. By that standard, ordinary language philosophers were not entitled to the claims that they made about what we would say about various topics. On the other side of the debate, defenders of the methods of ordinary language philosophy sought to explain how philosophers can be entitled to statements about what we would say without engaging in extensive observations of how people do in fact use language. In this paper I defend the idea that entitlement to claims about what we say can be had in a way that doesn’t require empirical observation, and I argue that ordinary language philosophers are (at least sometimes) engaged in a different project than linguists or empirically minded philosophers of language, which is subject to different conditions of success

Diagnoses, Intervention Strategies, and Rates of Functional Improvement in Integrated Behavioral Health Care Patients

Objective—Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. Method—Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. Results—The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. Conclusion—Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components

Ethics and ‘fracking’: A review of (the limited) moral thought on shale gas development

Whilst claims about the ethicality of shale gas development via hydraulic fracturing (‘fracking’) are commonplace in everyday discourse, little scholarly attention has been afforded explicitly to this aspect of unconventional fossil fuel extraction. The limited research that speaks to ethical considerations largely describes ethical concerns associated with development – extremely few claims in research literature make an ethical case for development. The most common ethical concerns cited in research stem from issues of distributive justice, with procedural justice, the precautionary principle, exposure to involuntary risks, rights-based arguments, and changes in community character and way of life as next most common. Additional research hints implicitly at ethical dilemmas associated with shale gas development, but does not openly identify these issues as having moral implications. Many ethical considerations relate closely to concerns about water quality and the volume/supply of water available for other purposes. The limited scholarship in this area reveals the import of understanding the ways in which ethics permeate thoughts about shale gas development for designing policy that responds to constituent needs and concerns. Even more limited than research on ethical claims in association with shale gas development is well-reasoned scholarship that analyses the extent to which ethical claims about development are well justified and philosophically justifiable. A comprehensive and systematic analysis of the range of ethical claims potentially relevant to shale gas development and their usefulness for informing policy on this topic would contribute greatly to informed decision-making on this controversial issue – something that science alone cannot achieve

Epidemiological Features of Infantile Hypertrophic Pyloric Stenosis in Taiwanese Children: A Nation-Wide Analysis of Cases during 1997–2007

OBJECTIVE: To describe the epidemiological characteristics of infantile hypertrophic pyloric stenosis (IHPS) in ethnic Chinese children. MATERIALS AND METHODS: We reviewed the National Health Insurance claims database and analyzed data from children less than one year of age who had been diagnosed with IHPS (ICD-9-CM 750.5) and had undergone pyloromyotomy (ICD-9-CM 43.3). We analyzed the incidence, gender, age at diagnosis, length of hospital stay, seasonal variation and cost of IHPS from data collected between January 1997 and December 2007. RESULTS: A total of 1,077 infants met inclusion criteria, including 889 boys and 188 girls. The annual incidence of IHPS ranged from 0.30 to 0.47 per 1,000 live births with a mean incidence of 0.39 per 1,000 live births. Between 2002 and 2007, the incidence showed a declining trend (P = 0.025) with coincidentally increasing trends for both exclusive breastfeeding (P = 0.014) and breastfeeding plus bottle feeding (P = 0.004). The male-to-female rate ratio was dynamic and increased from 3.03 during the first two weeks of life to 8.94 during the 8(th) through 10th weeks of life. The overall male-to-female rate ratio was 4.30. The mean age at diagnosis was 43.1 ± 2.4 days. After analyzing the months of birth and hospital admission, no seasonal variation associated with IHPS was detected. The mean length of hospital stay was 8.28 ± 7.10 days. CONCLUSIONS: The incidence of IHPS in Taiwan, a country with a majority ethnic Chinese population, was lower than observed incidences in Caucasian populations living in Western countries. Breastfeeding campaigns and low maternal smoking rates may contribute to the lower incidence of IHPS in Taiwan. However, additional studies with longer follow-up periods are needed

Framing the Real: Lefèbvre and NeoRealist Cinematic Space as Practice

In 1945 Roberto Rossellini's Neo-realist Rome, Open City set in motion an approach to cinema and its representation of real life – and by extension real spaces – that was to have international significance in film theory and practice. However, the re-use of the real spaces of the city, and elsewhere, as film sets in Neo-realist film offered (and offers) more than an influential aesthetic and set of cinematic theories. Through Neo-realism, it can be argued that we gain access to a cinematic relational and multidimensional space that is not made from built sets, but by filming the built environment. On the one hand, this space allows us to "notice" the contradictions around us in our cities and, by extension, the societies that have produced those cities, while on the other, allows us to see the spatial practices operative in the production and maintenance of those contradictions. In setting out a template for understanding the spatial practices of Neo-realism through the work of Henri Lefèbvre, this paper opens its films, and those produced today in its wake, to a spatio-political reading of contemporary relevance. We will suggest that the rupturing of divisions between real spaces and the spaces of film locations, as well the blurring of the difference between real life and performed actions for the camera that underlies much of the central importance of Neo-realism, echoes the arguments of Lefèbvre with regard the social production of space. In doing so, we will suggest that film potentially had, and still has, a vital role to play in a critique of contemporary capitalist spatial practices

Schuldig landschap. Over de toeristische aantrekkingskracht van Baantjer, Wallander en Inspector Morse

De opnamelokaties van tv-detectives genieten een toenemende populariteit onder toeristen. In dit artikel wordt, op basis van een tekstuele analyse van ‘Baantjer’, ‘Inspector Morse’ en ‘Wallander’, onderzocht welke inhoudelijke kenmerken van deze tv-detectives mogelijk als ‘trigger’ fungeren. Uit de analyse blijkt dat plaats en beweging een centrale rol vervullen binnen de narratieve structuur van dit genre. Door zelf de lokaties te bezoeken, kunnen toeristen het spoor nalopen van hun geliefde detective om aldaar, vanuit een veilige positie, tijdelijk op te gaan in het schemergebied tussen fictie en werkelijkheid