Expedited Medicaid, Mental Health Service Use, and Criminal Recidivism among Released Prisoners with Severe Mental Illness

To investigate whether Washington State’s 2006 policy of expediting Medicaid enrollment for offenders with severe mental illness released from state prisons increased Medicaid access and use of community mental health services while decreasing criminal recidivism

Enrollment and Service Use Patterns Among Persons With Severe Mental Illness Receiving Expedited Medicaid on Release From State Prisons, County Jails, and Psychiatric Hospitals

OBJECTIVE: This study examined postrelease patterns of Medicaid coverage and use of services among persons with severe mental illness who were referred for expedited Medicaid enrollment before their release from state prisons, county jails, and psychiatric hospitals in Washington State during 2006, the first year of a new policy authorizing this practice. METHODS: A retrospective cohort design was used with linked administrative data to identify persons with severe mental illness (schizophrenia, bipolar disorder, or major depression) who were referred for expedited Medicaid enrollment from state prisons (N=252), county jails (N=489), and psychiatric hospitals (N=507). For each cohort, logistic regression was used to compare those who were approved for expedited Medicaid with those who were not approved; for the 30-, 60-, and 90-day periods after release, Medicaid enrollment status and use of outpatient mental health services were also compared. RESULTS: Approval rates were higher for persons released from psychiatric hospitals (91%) and state prisons (83%) than for those released from jails (66%) (p<.001). Across settings, approval was more likely for those with a diagnosis of schizophrenia and for women (p<.001), as well as for whites and older offenders (p<.01). At the 90-day follow-up, those who were approved were more likely than those who were denied to be enrolled in Medicaid (p<.001) and to have used outpatient mental health services (p<.001). CONCLUSIONS: Expediting Medicaid benefits for persons with severe mental illness was associated with increased enrollment and outpatient mental health service use in the 90 days after release from state prisons, county jails, and psychiatric hospitals in Washington State

Connecting Mentally Ill Detainees in Large Urban Jails with Community Care

Large urban jails have become a collection point for many persons with severe mental illness. Connections between jail and community mental health services are needed to assure in-jail care and to promote successful community living following release. This paper addresses this issue for 2855 individuals with severe mental illness who received community mental health services prior to jail detention in King County (Seattle), Washington over a 5-year time period using a unique linked administrative data source. Logistic regression was used to determine the probability that a detainee with severe mental illness received mental health services while in jail as a function of demographic and clinical characteristics. Overall, 70 % of persons with severe mental illness did receive in-jail mental health treatment. Small, but statistically significant sex and race differences were observed in who received treatment in the jail psychiatric unit or from the jail infirmary. Findings confirm the jail's central role in mental health treatment and emphasize the need for greater information sharing and collaboration with community mental health agencies to minimize jail use and to facilitate successful community reentry for detainees with severe mental illness

Changes in Treatment Content of Services During Trauma-informed Integrated Services for Women with Co-occurring Disorders

The experience of trauma is highly prevalent in the lives of women with mental health and substance abuse problems. We examined how an intervention targeted to provide trauma-informed integrated services in the treatment of co-occurring disorders has changed the content of services reported by clients. We found that the intervention led to an increased provision of integrated services as well as services addressing each content area: trauma, mental health and substance abuse. There was no increase in service quantity from the intervention. Incorporation of trauma-specific element in the treatment of mental health and substance abuse may have been successfully implemented at the service level thereby better serve women with complex behavioral health histories

Advances in computational and translational approaches for malignant glioma

Gliomas are the most common primary brain tumors in adults and carry a dismal prognosis for patients. Current standard-of-care for gliomas is comprised of maximal safe surgical resection following by a combination of chemotherapy and radiation therapy depending on the grade and type of tumor. Despite decades of research efforts directed towards identifying effective therapies, curative treatments have been largely elusive in the majority of cases. The development and refinement of novel methodologies over recent years that integrate computational techniques with translational paradigms have begun to shed light on features of glioma, previously difficult to study. These methodologies have enabled a number of point-of-care approaches that can provide real-time, patient-specific and tumor-specific diagnostics that may guide the selection and development of therapies including decision-making surrounding surgical resection. Novel methodologies have also demonstrated utility in characterizing glioma-brain network dynamics and in turn early investigations into glioma plasticity and influence on surgical planning at a systems level. Similarly, application of such techniques in the laboratory setting have enhanced the ability to accurately model glioma disease processes and interrogate mechanisms of resistance to therapy. In this review, we highlight representative trends in the integration of computational methodologies including artificial intelligence and modeling with translational approaches in the study and treatment of malignant gliomas both at the point-of-care and outside the operative theater in silico as well as in the laboratory setting

Short-term effects of marijuana smoking on cognitive behavior in experienced male users

The effects of smoking marijuana on the ability to use abstract concepts was tested in 12 experienced marijuana users. Each subject was tested three times, after smoking prepared 300 mg cigarettes containing either 0, 1.5 or 2.9% δ 9 -THC in different sessions according to a Latin Square design. The same number of whole and/or partial cigarettes was smoked by each subject in each of the three sessions. This was determined for individual subjects by the number of 2.9% δ 9 -THC marijuana cigarettes that the subject had been willing to smoke in a pre-experimental session up to a maximum of 1200 mg. The following tests of concept formation and usage were used: 1. a letter series test; 2. a word grouping test; 3. a conceptual clustering memory test; 4. a closure speed test; 5. Witkin's Embedded Figures Test; 6. a size weight illusion test; 7. Luchin's Water Jar Test; 8. Luchin's Hidden Word Test; and 9. an anagram test. Marijuana smoking led to a dose-related impairment on the letter series, word grouping, closure speed, and Embedded Figures test. Performance on the size-weight illusion, Luchin's Water Jar, Luchin's Hidden Word, and the anagram tests were unaffected. Conceptual clustering decreased after marijuana smoking. In most cases only the differences between 0 and 2.9% δ 9 -THC marijuana were statistically significant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46387/1/213_2004_Article_BF00429295.pd

Expedited Medicaid Enrollment, Mental Health Service Use, and Criminal Recidivism Among Released Prisoners With Severe Mental Illness

OBJECTIVE: To investigate whether Washington State’s 2006 policy of expediting Medicaid enrollment for offenders with severe mental illness released from state prisons increased Medicaid access and use of community mental health services while decreasing criminal recidivism. METHODS: A quasi-experimental design with linked administrative data was used to select all prisoners with a severe mental illness (schizophrenia or bipolar disorder) released during the policy’s first two years (January 1, 2006 through December 31, 2007), separating those referred for expedited Medicaid (n= 895) from a propensity-weighted control group of those not referred (n= 2191). Measures included binary indicators of Medicaid enrollment; other public insurance enrollment; post-release use of inpatient and outpatient health services; and any post-release criminal justice contacts. All data were collapsed to person-level observations during the 12 months following index release and outcomes were estimated via propensity-weighted logit models. RESULTS: Referral for expedited Medicaid upon release from prison greatly increased Medicaid enrollment (p< .01) and use of community mental health and medical services (p< .01) for persons with severe mental illness. No evidence was found that expediting Medicaid reduced criminal recidivism. CONCLUSIONS: Expediting Medicaid was associated with increased Medicaid enrollment and mental health service use but study findings strongly suggest that, rather than relying on indirect spill-over effects from Medicaid to reduce criminal recidivism, advocates and policymakers would better address the needs of offenders with severe mental illness through direct interventions targeted at underlying causes of recidivism

Outcomes of intraoperative ultrasound for endoscopic endonasal transsphenoidal pituitary surgery in adenomas with parasellar extension

Background: Pituitary adenomas with parasellar extension present a technical challenge for adequate visualization and gross total resection (GTR). The endoscope improves identification of parasellar extension, however, additional intraoperative imaging adjuncts can further augment visualization. Intraoperative ultrasound (iUS) may provide a viable and cost-effective solution for intraoperative imaging. We sought to assess the ability of intraoperative ultrasound to predict extent of resection on 3-month postoperative magnetic resonance imaging (MRI) in pituitary adenomas with parasellar extension. Methods: Twenty consecutive patients undergoing endoscopic endonasal transsphenoidal surgery for pituitary adenomas with the assistance of intraoperative ultrasound were prospectively collected. Intraoperative ultrasound findings were recorded during each case. 3-month postoperative MRI studies were reviewed in a blinded fashion to assess for residual tumor and compared with the intraoperative ultrasound findings. Results: Median preoperative Knosp grade was 2. Cavernous sinus invasion was encountered intraoperatively in 3 patients, all of whom were Knosp grade 3 preoperatively. Median operative time was 152 min. Based on iUS findings, 17 patients were expected to have a GTR while 3 patients underwent subtotal resection. 18 patients completed a 3-month postoperative MRI. The iUS and MRI findings were concordant in 16 cases (88.9%) with only two instances of discordance. Conclusion: Intraoperative ultrasound can reliably predict tumor resection as assessed by 3-month postoperative MRI in pituitary adenomas with parasellar extension. Image capture and interpretation may vary based on operator experience. Ultrasound provides reliable immediate assessment of extent of resection, identification of normal pituitary gland and other important neurovascular structures

Differential Service Utilization Associated With Trauma-informed Integrated Treatment for Women With Co-occurring Disorders

Women with co-occurring mental health and substance use disorders and trauma histories vary greatly in symptom severity and use of support services. This study estimated differential effects of an integrated treatment intervention (IT) across sub-groups of women in this population on services utilization outcomes. Data from a national study were used to cluster participants by symptoms and service utilization, and then estimate the effect of IT versus usual care on 12-month service utilization for each sub-group. The intervention effect varied significantly across groups, in particular indicating relative increases in residential treatment utilization associated with IT among women with predominating trauma and substance abuse symptoms. Understanding how IT influences service utilization for different groups of women in this population with complex needs is an important step toward achieving an optimal balance between need for treatment and service utilization, which can ultimately improve outcomes and conserve resources