Young adults with untreated major depressive episode (MDE) occupy different positions before care, but planning based on expressed need may overlook those who do not perceive a need for treatment. This cross-sectional analysis used public use data from a 2024 nationally representative survey of respondents aged 18–25 years and was conducted in 2025–2026. Survey-weighted estimates and descriptive logistic models accounted for the complex design. Among 886 untreated young adults, 56.3
Insurance coverage may shape whether adults with behavioral health conditions receive corresponding services. This study examined insurance-related differences in condition-concordant treatment among adults reporting past-year probation or parole. Public-use data from the 2022–2023 National Survey on Drug Use and Health identified 967 adults with any mental illness, a substance use disorder, or both. Insurance categories were private coverage; Medicare, military, or other coverage without private coverage; Medicaid/Children’s Health Insurance Program (CHIP) only; and uninsured. Survey-weighted logistic models adjusted for condition group, mental illness and substance use disorder severity, supervision type, demographic and socioeconomic characteristics, health status, county type, and survey year. Compared with uninsured adults, those with Medicaid/CHIP only had higher odds of any condition-concordant treatment (adjusted odds ratio = 3.14, 95
Florida faces a critical behavioral health workforce shortage, with provider supply falling approximately 14,000 positions short of demand. Understanding the factors that predict workforce attrition is essential for developing targeted retention strategies. This study used a mixed-methods survey design to examine workforce retention among licensed behavioral health professionals in Florida. Surveys were administered to providers across seven professions and all regions of Florida (N = 330). Quantitative analyses included descriptive statistics, exploratory factor analysis (EFA), and ordinal regression predicting three indices of retention intention. Qualitative analyses included content analysis with investigator triangulation. Themes were derived inductively from the data itself, following the principles of emergent coding in qualitative content analysis. EFA yielded a robust two-factor structure comprising a Workload Strain and Overload and largely independent Positive Organizational Climate and Professional Satisfaction factors (r = −.17). Both factors independently predicted retention intentions in ordinal regression models. Qualitative analysis identified seven themes promoting retention, including meaningful purpose, client progress, professional autonomy, and collegial support, alongside ten themes reflecting retention risk, most prominently inadequate compensation, administrative burden, emotional exhaustion, and organizational dysfunction. Triangulation revealed strong convergence between quantitative strain indicators and qualitative themes, while qualitative data provided additional context regarding professional devaluation, safety concerns, and the tension between mission alignment and structural barriers. Retention requires a two-factor strategy: reducing sources of strain while investing in organizational conditions that sustain meaning. Implications for policy, employer practice, and workforce development are discussed.
Medications for opioid use disorder (MOUD) reduce overdose mortality, yet most individuals with opioid use disorder receive no pharmacotherapy. Facility-level health information technology may reflect broader organizational capacity, but it has rarely been examined as a marker associated with readiness to offer evidence-based opioid care. This cross-sectional secondary analysis of the 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS) Public Use File included a base sample of 20,813 substance use disorder treatment facilities and used complete-case adjusted logistic regression to examine whether exclusive electronic health record (EHR) use, defined as reliance on an EHR with no paper charts, was associated with the availability of buprenorphine, naltrexone, take-home naloxone with overdose education, and co-occurring opioid use disorder services. Models adjusted for ownership, program focus, opioid treatment program (OTP) registration, and financial access characteristics; federally regulated OTP methadone availability served as a regulatory contrast. Among facilities with valid EHR responses (n = 16,107), 68.3
In safety-net care management, high-need, high-cost (HNHC) adults often receive bundled services. The independent contribution of embedded psychological-services engagement is unclear. This retrospective cohort study used target trial emulation under the ICH E9(R1) estimand framework to evaluate an opt-out embedded psychological-services pathway nested within a manualized social-determinants-of-health–focused care-management program at four Phoenix Federally Qualified Health Centers. Eligible HNHC adults had ≥ 1 inpatient admission or ≥ 2 emergency department visits in the prior 12 months. Each received a scripted opt-out engagement protocol with structured warm-handoff referral where operationally available. Accepted/engaged status was classified as attendance at ≥ 1 behavioral health session within 60 days; the comparator was declined/no-show after the standardized offer. The 60-day composite outcome combined hospital admissions and emergency department visits ascertained from claims linked to a shared electronic health record. Stabilized inverse-probability-of-engagement weighting addressed measured confounders. Sensitivity analyses spanned engagement timing or classification, missing data, unmeasured confounding, propensity-score specification, and clinic-level dependence. Among 1038 adults, 485 (46.7
