OBJECTIVEEarly intervention programs are designed to address the needs of youths experiencing first-episode psychosis (FEP). Washington State developed New Journeys, a network of coordinated specialty care programs for FEP. In this study, the authors have outlined components of the New Journeys model and preliminary findings since its initial implementation.METHODSYouths and young adults diagnosed as having psychosis (N=112) completed measures at and after intake on a range of mental health assessments and functional outcomes for the first 12 months of treatment. Administrative data including state-funded emergency department and psychiatric hospitalizations were assessed 24 months before and after intake. Generalized estimating equations were used to assess change over time on multiple measures of mental health status.RESULTSCompared with their condition at intake, clients had significant decreases in symptoms of anxiety (β=-2.48, p<0.001), psychotic experiences (β=-3.37, p<0.05), and clinician-rated psychotic symptoms (β=-1.47, p<0.05) during treatment. Additionally, quality of life (β=-5.95, p<0.001) and school attendance (odds ratio=1.42, p<0.05) significantly improved during treatment. Administrative data indicated that postintake, clients were less likely to visit the emergency department for psychiatric reasons (β=0.22, p<0.05), utilize community psychiatric inpatient services (β=0.31, p<0.001), and utilize public assistance (β=0.71, p<0.05) compared with 24 months before intake.CONCLUSIONSNew Journeys clients experienced improved clinical and functional outcomes during their first year of treatment, and rates of state-funded service utilization decreased during their treatment.

PURPOSE Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. METHODS We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal health care use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use. RESULTS Nine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14). CONCLUSIONS State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children.

ObjectiveThe study used administrative data to identify the social determinants that have the greatest impact on Medicaid expenditures in adolescence.Data SourcesData were compiled using the Washington State Department of Social and Health Services Integrated Client Databases, which link data from state systems including Medicaid claims and social services receipt.Study DesignMedical system and behavioral health service costs of over 180 000 Medicaid‐enrolled adolescents aged 12‐17 were measured using integrated administrative data from Washington State. Social determinants of health, including child maltreatment and parent risk factors, were also measured. Two‐stage regression models were used to identify factors associated with increased health care utilization and costs.Principal FindingsRegression models revealed that the factors most predictive of higher health care costs were child abuse, child neglect, and instability in out‐of‐home placements related to foster care. Other social determinants of health, such as parent risk factors, were not associated with health care costs. Child maltreatment and placement instability impacted health care costs primarily through large increases in behavioral health utilization and costs.ConclusionsPrevention and early interventions for children and families to decrease child maltreatment and increase foster care placement stability could reduce overall health care costs.

This study examines risk and protective factors associated with experiencing homelessness in the year after "aging out" of foster care. Using a state-level integrated administrative database, we identified 1,202 emerging adults in Washington State who exited foster care between July 2010 and June 2012. Initial bivariate analyses were conducted to assess the association between candidate predictive factors and an indicator of homelessness in a 12-month follow-up period. After deploying a stepwise regression process, the final logistic regression model included 15 predictive factors. Youth who were parents, who had recently experienced housing instability, or who were African American had approximately twice the odds of experiencing homelessness in the year after exiting foster care. In addition, youth who had experienced disrupted adoptions, had multiple foster care placements (especially in congregate care settings), or had been involved with the juvenile justice system were more likely to become homeless. In contrast, youth were less likely to experience homelessness if they had ever been placed with a relative while in foster care or had a high cumulative grade point average relative to their peers.

This study aimed to measure the relative contribution of adverse experiences to adolescent behavioral health problems using administrative data. Specifically, we sought to understand the predictive value of adverse experiences on the presence of mental health and substance abuse problems for youth receiving publicly funded social and health services. Medicaid claims and other service records were analyzed for 125,123 youth age 12-17 and their biological parents. Measures from administrative records reflected presence of parental domestic violence, mental illness, substance abuse, criminal justice involvement, child abuse and/or neglect, homelessness, and death of a biological parent. Mental health and substance abuse status of adolescents were analyzed as functions of adverse experiences and other youth characteristics using logistic regression. In multivariate analyses, all predictors except parental domestic violence were statistically significant for substance abuse; parental death, parental mental illness, child abuse or neglect and homelessness were statistically significant for mental illness. Odds ratios for child abuse/neglect were particularly high in both models. The ability to identify risks during childhood using administrative data suggests the potential to target prevention and early intervention efforts for children with specific family risk factors who are at increased risk for developing behavioral health problems during adolescence. This study illustrates the utility of administrative data in understanding adverse experiences on children and the advantages and disadvantages of this approach.

OBJECTIVE The aims of this study were to compare client characteristics at admission to chemical dependency (CD) treatment by sexual orientation, examine sexual orientation as a predictor of co-occurring CD and mental health problems (hereafter referred to as co-occurring disorders [COD]), and to examine the effect of sexual orientation and COD on 1-year CD treatment outcomes (treatment completion, treatment reentry, and arrest) among men and women. METHOD This retrospective cohort study used 2004-2008 data from publicly funded CD treatment programs in Washington State (n = 69,525 clients). Bivariate comparisons were made using chi-square tests; logistic and Cox regressions were to estimate risk in multivariate analyses. RESULTS Risk factors associated with sexual minority status (lesbian/gay/bisexual) included COD, primary drug (vs. alcohol) use, and greater substance use. In multivariate analyses, sexual minority clients were more than twice as likely as their heterosexual counterparts to have COD. COD, but not sexual orientation, negatively predicted treatment completion and arrest overall in the year following treatment among male and female clients and positively predicted treatment reentry and intimate partner violence-related arrest among women. COD moderated the effect of sexual orientation on arrest; gay men with COD were less likely to be arrested, particularly for substance use and other violence-related crimes. CONCLUSIONS These findings highlight the importance of assessing mental health among sexual minority clients in treatment settings and addressing issues specific to both female and male sexual minorities.

1-6 Although the majority of these studies have focused on adults, the impact of these experiences are likely to become apparent during childhood and adolescence. However, collecting self-reported experiences and symptoms for children is challenging and costly. This report shows that it is possible to use state administrative data to measure adverse experiences and other household risk factors similar to those presented in the ACE studies, and to quantify associations between these experiences and behavioral health problems identified during adolescence. The adverse experiences presented here include the occurrence of the following in the child’s birth family: child abuse and/or neglect; parental substance abuse, criminal justice involvement, mental illness, or death; domestic violence; and homelessness. Behavioral health risks associated with the number and type of adverse experiences are explored in detail.

Substance abuse (SA) represents a significant public health problem that impacts tens of millions of persons in the US and imposes over $400 billion in annual economic costs on a national basis in the form of lost productivity, premature death, criminal activity and use of medical care. The objective of this study was to estimate the economic costs associated with drug and alcohol abuse for Washington State in 2005. We used standard cost of illness (COI) methods, relying on the prevalence approach, to estimate the costs of SA in six areas, including mortality, morbidity, treatment costs, crime, and health care. We obtained data for the analysis from various sources, including the Washington State Health Department, the National Survey on Drug Use and Health, the State Department of Corrections, and the Washington Association of County Sheriffs, and the Washington State Department of Transportation. We estimated costs of SA for 2005 for Washington State at $5.21 billion, $832 per non-institutionalized person in the state. Alcohol abuse accounted for 56% of total costs. The per-capita, inflation-adjusted costs increased by 47% from 1996. Categories accounting for the greatest costs were mortality ($2.03 billion), crime ($1.09 billion), morbidity ($1.03 billion) and health care ($791 million). There were 3,224 deaths (7% of all deaths), 89,000 years of productive life lost, and 29,000 hospital discharges in 2005 in Washington associated with SA. SA imposes significant costs on society. Its economic costs far outweigh the resources expanded to treat persons with SA. For every $1 dollar the state collected in tax revenue for treatment from alcohol sales in 2005, $20 in economic loss was incurred from alcohol abuse. Renewed attention needs to be directed at finding more effective ways to reduce the economic and human loss arising from SA.

This study examined the mental health impact of reported direct and indirect killing among 2,797 U.S. soldiers returning from Operation Iraqi Freedom. Data were collected as part of a postdeployment screening program at a large Army medical facility. Overall, 40% of soldiers reported killing or being responsible for killing during their deployment. Even after controlling for combat exposure, killing was a significant predictor of posttraumatic disorder (PTSD) symptoms, alcohol abuse, anger, and relationship problems. Military personnel returning from modern deployments are at risk of adverse mental health conditions and related psychosocial functioning related to killing in war. Mental health assessment and treatment should address reactions to killing to optimize readjustment following deployment.

This retrospective cohort study examined risk factors for co-occurring substance use and mental disorders (COD) and the effect of COD and intimate partner violence (IPV) victimization among women and IPV-related arrest among men on 1-year substance abuse treatment outcomes. The study sample included clients admitted to Washington State publicly funded substance abuse treatment facilities in 2004–2007. COD was associated with a high substance use and IPV risk profile at admission. Having a COD decreased the odds of completing treatment by 30% among men and women and increased the risk of treatment reentry by 9% and 12% among men and women, respectively. IPV also decreased the odds of completing treatment among women and increased the risk of treatment reentry among men. Men with COD were less likely than those without COD to be arrested for substance-related crimes but more likely to be arrested for violence-related crimes in the follow-up period. Implications of these findings are discussed.

In 2004, the federal government made a major commitment to support expanded substance abuse (SA) recovery services by initiating the Access to Recovery (ATR) program. The initial ATR I program awarded grants to 14 states, including Washington State. We evaluated Washington's ATR I program to determine its effect on Medicaid costs for working age disabled clients. We compared per member per month (PMPM) Medicaid costs during 1 year follow-up for clients who received ATR services (N = 1,347) with costs for a matched comparison group of 1,243 clients and used multiple regression techniques to estimate changes in Medicaid costs associated with ATR. ATR was found to be associated with reductions in PMPM Medicaid costs of $66 (p = .11) to $136 (p = .05) depending upon months of Medicaid eligibility. Recovery services aimed at facilitating engagement in SA treatment and aftercare appear to foster modest savings in Medicaid costs for working age disabled clients.

The purpose of this study was to assess the impact of providing recovery support services to clients receiving publicly funded chemical dependency (CD) treatment through the Access to Recovery (ATR) Program in Washington State. Services included case management, transportation, housing, and medical. A comparison group composed of clients who received CD treatment only was constructed using a multistep procedure based on propensity scores and exact matching on specific variables. Outcomes were obtained from administrative data sources. Results indicated that ATR services were associated with a number of positive outcomes including increased length of stay in treatment, increased likelihood of completing treatment, and increased likelihood of becoming employed. The beneficial effects of ATR services on treatment retention were most pronounced when they were provided between 31 and 180 days after treatment began. The results reported here offer evidence for the value of ATR services.

The Department of Defense mandates a health reassessment at 90 to 180 days following return from deployment. Essential components include a review of mental and physical health symptoms and follow-up referral. Fort Lewis developed a program that exceeds these basic requirements to provide additional screening and on-site services, including face-to-face visits with a credentialed mental health provider for all soldiers. This program, the Soldier Wellness Assessment Program (SWAP), also extends these services to the predeployment window (120 to 45 days) to identify problems before deployment early enough to treat them. Data from the anonymous SWAP Quality Improvement Questionnaire (N=7880) suggested that the majority of service members felt their experience at the SWAP increased their willingness to seek out behavioral health (BH) services in the future, if needed. SWAP provides a model for a deployment-related individual mental health visit for all soldiers, customized for their specific health concerns.

Significant recent effort has been directed toward screening and describing military populations in relation to deployment. Missing from these recent efforts is information describing screened mental health symptoms for the population of active duty military that are seen for mental health services. This article presents mental health screening data for 2,882 soldiers seeking services at a military facility outpatient behavioral health clinic. Screening positive for multiple symptom domains was common, with >60% of the sample screening positive for more than one clinical symptom domain. Post-traumatic stress disorder and depression were among the most commonly identified disorders, followed by alcohol abuse. This screening data, gathered using measures similar to those used in published deployment-related screening efforts, suggest differences that exist between the clinical population and the overall military population, providing some insights into the rates of clinical symptomatology within the military health system and providing a point of comparison for population- screening efforts. Clinical implications include the importance of provider awareness to the high rates of comorbidity across symptom domains.

The Washington State Department of Social and Health Services, Division of Developmental Disabilities (DDD) was directed by the Governor to design, implement, and manage a new Intensive Behavioral Support Services program beginning in FY 2009. The intent of this new program is to provide services for families of children as a preventive alternative to out-of-home placement or institutionalization. DDD contracted with the Research and Data Analysis Division to establish an out-of-home risk prediction model using DDD assessment information to support decision making about which children will receive these services.