Validation of a Multivariable Model to Predict Suicide Attempt in a Mental Health Intake Sample
Given that suicide rates have been increasing over the past decade and the demand for mental health care is at an all-time high, targeted prevention efforts are needed to identify individuals seeking to initiate mental health outpatient services who are…
On- and Off-Label Atypical Antipsychotic Prescription Trends Across a Nine-Year Period Among Adolescents Pre- to Post-COVID-19
This study examined atypical antipsychotic prescribing by Food and Drug Administration (FDA) approved-use (on-label) status for adolescents before and during the COVID-19 pandemic. Retrospective data were collected from electronic health records (EHRs) of adolescents aged 10-17 years in Kaiser Permanente…
Addiction Medicine Treatment Utilization by Race/Ethnicity Among Adolescents With Substance Use Problems Before Versus During the COVID-19 Pandemic
To examine changes in addiction medicine treatment utilization during the COVID-19 pandemic among adolescents (aged 13-17 years) and differences by race/ethnicity. We compared treatment initiation (overall and telehealth), engagement, and 12-week retention between insured adolescents with substance use problems during pre-COVID-19…
Adolescent utilization of eating disorder higher level of care: roles of family-based treatment adherence and demographic factors
Outpatient family-based treatment (FBT) is effective in treating restrictive eating disorders among adolescents. However, little is known about whether FBT reduces higher level of care (HLOC) utilization or if utilization of HLOC is associated with patient characteristics. This study examined…
Telehealth Collaborative Care Led by Clinical Pharmacists for People With Psychosis or Bipolar Disorder: A Propensity Weighted Comparison With Usual Psychiatric Care
Objective: People with psychosis or bipolar disorder (severe and persistent mental illness [SPMI]) are at high risk for poor psychiatric and chronic illness outcomes, which could be ameliorated through improved health care quality. This study assessed whether a telehealth, collaborative…
Leveraging Genetic and Electronic Health Records Data to Identify Novel Targets and Drugs for Treating Alcohol Use Disorder
This pharmacoepidemiologic study conducted in collaboration with Dr. Joshua Gray at the Uniformed Services University of the Health Sciences will examine L-type calcium channel blockers (e.g., nifedipine, felodipine) as a potential novel therapeutic target for treatment of alcohol use disorder.…
Cardiovascular Disease Risk Factor Control in People With and Without Human Immunodeficiency Virus
Management of hypertension, dyslipidemia, diabetes and other modifiable factors may mitigate the cardiovascular disease (CVD) risk in people with human immunodeficiency virus (HIV, PWH) compared with people without HIV (PWoH). This was a retrospective cohort study of 8285 PWH and…
Development and validation of a machine learning model using electronic health records to predict trauma- and stressor-related psychiatric disorders after hospitalization with sepsis
A significant minority of individuals develop trauma- and stressor-related disorders (TSRD) after surviving sepsis, a life-threatening immune response to infections. Accurate prediction of risk for TSRD can facilitate targeted early intervention strategies, but many existing models rely on research measures…
Risk profiles of adults with heavy alcohol use: Drinking patterns, behavioral and metabolic factors, health problems, and racial and ethnic disparities
Heavy alcohol use is a growing risk factor for chronic disease, yet little is known about its co-occurrence with other risk factors and health problems. This study aimed to identify risk profiles of adults with heavy alcohol use and examined…
Stability of Suicide Risk Prediction Models During Changes in Health Care Delivery
The authors aimed to use health records data to examine how the accuracy of statistical models predicting self-harm or suicide changed between 2015 and 2019, as health systems implemented suicide prevention programs. Data from four large health systems were used…
Cardiometabolic Monitoring and Sociodemographic and Clinical Characteristics of Youths Prescribed Antipsychotic Medications
This study examined time trends and patient characteristics related to guideline-recommended cardiometabolic risk factor monitoring among youths treated with antipsychotic medications. This observational study assessed participant sociodemographic and clinical characteristics and year of antipsychotic medication initiation, with receipt of glycemic…
Associations between Adverse Childhood Experiences (ACEs) and Prenatal Mental Health and Substance Use
Adverse childhood experiences (ACEs) are common and increase the risk of poor health outcomes. Resilience may offer protection against the impacts of ACEs. This study examined the association between maternal ACEs and mental/behavioral health outcomes during pregnancy overall and by…
Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes
Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization. To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during…
Cannabis use for medical reasons among patients in a large California health care system after legalization of non-medical use
In 2018, California legalized the sale of cannabis for adult non-medical use. To understand use of cannabis after legalization, we surveyed a stratified random sample of adults in a large health system (aged 19-64) with and without documented chronic pain…
Performance of a Prediction Model of Suicide Attempts Across Race and Ethnicity
This study examines whether race disparities exist in the prediction of suicide attempts and if have they have detrimental effects on individuals and health care systems.
Racial-Ethnic Differences in Treatment Initiation for New Diagnoses of Perinatal Depression
The adverse consequences of untreated perinatal depression highlight the need to identify populations to target in order to increase treatment rates. The authors sought to evaluate treatment initiation for a new diagnosis of depression during pregnancy or postpartum and to…
Doctors less likely to ask women about their drinking
Disparities in the Receipt of Alcohol Brief Intervention: The Intersectionality of Sex, Age and Race/ethnicity
The increasing trend in alcohol consumption among women, exacerbated by the COVID-19 pandemic, is of growing concern. Screening, Brief Intervention, and Referral to Treatment in primary care is an efficacious and cost-effective treatment approach for unhealthy alcohol use. However, disparities…
Influenza Vaccination Uptake and Associated Factors Among Adults With and Without HIV in a Large, Integrated Health Care System
Influenza vaccination is recommended for adults regardless of HIV status. There may be facilitators or barriers to vaccinating people with HIV (PWH) that differ from people without HIV (PWoH). We sought to describe the uptake of influenza vaccination by HIV…
Alcohol check-in at primary care visit may benefit other conditions
Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study
To evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D). A population-based observational study using electronic health records data. An integrated healthcare…
Patients more likely to start treatment for alcohol problems during early pandemic
COVID-19 pandemic-related changes in utilization of telehealth and treatment overall for alcohol use problems
During the COVID-19 pandemic, specialty alcohol treatment transitioned rapidly to telehealth, which may have created barriers for some patients but increased access for others. This study evaluated the impact of the COVID-19 pandemic on alcohol treatment utilization and potential disparities.…
Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial
Alcohol use problems are associated with serious medical, mental health and socio-economic consequences. Yet even when patients are identified in healthcare settings, most do not receive treatment, and use of pharmacotherapy is rare. This study will test the effectiveness of…
Accuracy of ICD-10-CM encounter diagnoses from health records for identifying self-harm events
Assess the accuracy of ICD-10-CM coding of self-harm injuries and poisonings to identify self-harm events. In 7 integrated health systems, records data identified patients reporting frequent suicidal ideation. Records then identified subsequent ICD-10-CM injury and poisoning codes indicating self-harm as…
Virtual SBIRT for Pediatric Primary Care: Increasing Access to Screening, Brief Intervention and Referral to Treatment for Alcohol and Other Drug Use via Telehealth
This type I hybrid effectiveness-implementation pragmatic randomized clinical trial will examine how virtually-delivered Screening, Brief Intervention and Referral to Treatment (V-SBIRT) can be cost-effectively implemented in pediatric primary care to improve early identification and treatment for alcohol, other drug problems,…
Patterns of Health Care Use 5 Years After an Intervention Linking Patients in Addiction Treatment With a Primary Care Practitioner
Substance use disorders are associated with high rates of emergency department (ED) use and challenges engaging with primary care services. To examine 5-year health care engagement and utilization outcomes for participants in the LINKAGE trial, given previously reported associations of…
Predicting severe alcohol use disorders in primary care using number of heavy drinking days
Although screening for unhealthy alcohol use is becoming more common, severe alcohol use disorders (AUDs) associated with the most severe medical and socio-economic sequelae still often go unidentified in primary care. To improve identification of severe AUDs and aid clinical…
Young Adult Substance Use and Healthcare Use Associated With Screening, Brief Intervention and Referral to Treatment in Pediatric Primary Care
Screening, brief intervention, and referral to treatment (SBIRT) may impact future comorbidity and healthcare utilization among adolescents screening positive for substance use or mood problems. In a randomized trial sample, we compared an SBIRT group to usual care for substance…
Comparing the effectiveness of a brief intervention to reduce unhealthy alcohol use among adult primary care patients with and without depression: A machine learning approach with augmented inverse probability weighting
The combination of unhealthy alcohol use and depression is associated with adverse outcomes including higher rates of alcohol use disorder and poorer depression course. Therefore, addressing alcohol use among individuals with depression may have a substantial public health impact. We…
Characterizing Unhealthy Alcohol Use Patterns and Their Association with Alcohol Use Reduction and Alcohol Use Disorder During Follow-Up in HIV Care
Outcomes of PWH with unhealthy alcohol use, such as alcohol use reduction or progression to AUD, are not well-known and may differ by baseline patterns of unhealthy alcohol use. Among 1299 PWH screening positive for NIAAA-defined unhealthy alcohol use in…
Intervening with at-risk adolescents shows long-term benefits
Cost-Effectiveness of Motivational Interviewing to Reduce Alcohol and Cannabis Use Among Patients With Depression
Motivational interviewing (MI) is a promising intervention for helping patients with mental health problems reduce their substance use. Examining the cost-effectiveness of MI and associations between MI and the use of health services can inform appropriate intervention strategies for these…
Threshold for problem drinking identified in Kaiser Permanente study
Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: Results from a systematic alcohol screening and brief intervention initiative in adult primary care
Alcohol screening, brief intervention and referral to treatment (SBIRT) in adult primary care is an evidence-based, public health strategy to address unhealthy alcohol use, but evidence of effectiveness of alcohol brief intervention (ABI) in real-world implementation is lacking. We fit…
Health Service Utilization Among Children and Adolescents with Posttraumatic Stress Disorder: A Case-Control Study
Trauma exposure is widely prevalent, with more than 60% of adolescents having experienced at least 1 traumatic event and a third of those at high risk to develop posttraumatic stress disorder (PTSD). Data are scarce and out of date on…
Substance use disorders among primary care patients screening positive for unhealthy alcohol use
Despite high prevalence of polysubstance use, recent data on concurrent alcohol use in patients with specific substance use disorders (SUDs) are lacking. To examine associations between specific SUDs and alcohol consumption levels. Using electronic health record data, we conducted a…
Online quiz can help parents assess if their teen has a substance use problem
Connecting Research and Practice: Implementation of Suicide Prevention Strategies in Learning Health Care Systems
The health care systems affiliated with the Mental Health Research Network strive to be learning health care systems that identify and address evidence gaps of importance to clinicians, patients, and funders. This column describes how research guides clinical care and…
Alcohol Use Among Young Adults in Northern California During the COVID-19 Pandemic-An Electronic Health Records-Based Study
Individuals globally were affected by the COVID-19 pandemic in myriad of ways, including social isolation and economic hardship, resulting in negative impacts on mental health and substance use. Young adults have been subjected to extraordinary challenges such as job loss,…
Parent-focused prevention of adolescent health risk behavior: Study protocol for a multisite cluster-randomized trial implemented in pediatric primary care
Evidence-based parenting interventions play a crucial role in the sustained reduction of adolescent behavioral health concerns. Guiding Good Choices (GGC) is a 5-session universal anticipatory guidance curriculum for parents of early adolescents that has been shown to reduce substance use,…
Predicting adolescent alcohol and other drug problems using electronic health records data
Alcohol and other drug (AOD) use problems may cause significant burden on affected adolescents and their families, yet treatment providers often do not identify these problems early enough. To develop, and internally and externally validate a multivariable prediction model of…
Predictors of Early and Sustained Cessation of Heavy Drinking Over 5 Years Among Adult Primary Care Patients
To identify factors asociated with early and sustained cessation of heavy drinking. Retrospective cohort study over 5 years. Kaiser Permanente Northern California, United States. Adults reporting heavy drinking during primary care-based alcohol screening between 1 June 2013 and 31 May 2014. The…
Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention opportunities
Cardiovascular disease (CVD) continues to be a leading cause of morbidity in the U.S. Managing CVD risk factors, such as diabetes or hypertension, can be challenging for many individuals. We investigated the barriers experienced by patients who persistently struggled to…
Adult Suicide-Related emergency department encounters during the COVID-19 Pandemic: a Cross-Sectional study
Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in widespread psychosocial disruption, which may impact suicidal thoughts and behaviours. This study characterizes adult suicide-related emergency department (ED) encounters and patient characteristics during the COVID-19 pandemic in 2020 compared to the…
Adult Suicide-Related emergency department encounters during the COVID-19 Pandemic a Cross-Sectional study
Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in widespread psychosocial disruption, which may impact suicidal thoughts and behaviours. This study characterizes adult suicide-related emergency department (ED) encounters and patient characteristics during the COVID-19 pandemic in 2020 compared to the…
Treatment for alcohol use disorder among persons with and without HIV in a clinical care setting in the United States
Alcohol use disorders (AUD) can lead to poor health outcomes. Little is known about AUD treatment among persons with HIV (PWH). In an integrated health system in Northern California, 2014-2017, we compared AUD treatment rates between PWH with AUD and…
Emergency Department Encounters Among Youth With Suicidal Thoughts or Behaviors During the COVID-19 Pandemic
Population-level reports of suicide-related emergency department (ED) encounters among youth during the COVID-19 pandemic are lacking, along with youth characteristics and preexisting psychiatric service use. To characterize population-level and relative change in suicide-related ED encounters among youth during the COVID-19…
Embedded Mental Health Services Postdoctoral Research Training in Health Systems
This program, funded by a National Institute of Mental Health Institutional Research Training Grant (T32), has 2 Mental Health Research Network (MHRN) systems serving as postdoctoral training host sites: Henry Ford Health System (Michigan) and Kaiser Permanente Northern California. Each…
Effectiveness of spironolactone dispensation in reducing weekly alcohol use: a retrospective high-dimensional propensity score-matched cohort study
There is a need to increase the armamentarium of pharmacotherapies for alcohol use disorder (AUD). Recent research suggests that mineralocorticoid receptor (MR) antagonism via spironolactone may represent a novel pharmacological treatment for AUD. We conducted a pharmacoepidemiologic retrospective cohort study…
Psychotropic medication prescribing during the COVID-19 pandemic
This study examined changes in psychotropic medication use associated with the early months of the coronavirus disease 2019 (COVID-19) pandemic. Using Kaiser Permanente Northern California electronic health records, the authors identified adult patients with fills for psychotropic medications and a…
Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care
Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little…
Physical, Mental Health and Developmental Conditions, and Sociodemographic Characteristics Associated With Adverse Childhood Experiences Among Young Children in Pediatric Primary Care
To examine associations between patient characteristics and adverse childhood experiences (ACEs) in a population-based sample of pediatric primary care patients, using electronic health records and clinical, administrative data. An observational study was conducted in an integrated health care delivery system.…
Identifying Best Practices of Early Phase Pediatric Eating Disorder Care
This study examines associations between different degrees of adherence to components of the Family Based Therapy model of care for adolescent eating disorders and clinical quality outcomes among the outpatient programs in medical centers across Kaiser Permanente Northern California. We…
Engagement in perinatal depression treatment: a qualitative study of barriers across and within racial/ethnic groups
To better understand previously observed racial/ethnic disparities in perinatal depression treatment rates we examined care engagement factors across and within race/ethnicity. Obstetric patients and women's health clinician experts from a large healthcare system participated in this qualitative study. We conducted focus…
Accounting for quality improvement during the conduct of embedded pragmatic clinical trials within healthcare systems: NIH Collaboratory case studies
Embedded pragmatic clinical trials (ePCTs) and quality improvement (QI) activities often occur simultaneously within healthcare systems (HCSs). Embedded PCTs within HCSs are conducted to test interventions and provide evidence that may impact public health, health system operations, and quality of…
Nicotine and cannabis vaping among adolescents in treatment for substance use disorders
This study examined nicotine and cannabis vaping among adolescents in treatment for substance use disorders. Participants were 363 adolescents aged 12-17 (66% male, mean age = 15.5 [SD = 1.3], 46% non-Hispanic white) seen for a specialty addiction intake evaluation between 2017 and 2019…
Screening for Gender Identity in Adolescent Well Visits: Is It Feasible and Acceptable?
This study aimed to pilot systematic gender identity screening during adolescent well checks and examine perceptions of feasibility and acceptability of screening from adolescents, parents/guardians, and clinicians. Adolescents aged 12-18 years with a well visit between July 1, 2018, and…
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes, Covid-19 Supplement
This study examines the increase in alcohol consumption during the Covid-19 pandemic and the major shift to virtual treatment modalities for alcohol problems, with a focus on potential disparities in treatment access, by race, ethnicity, age and gender. Understanding potential…
Adverse Childhood Experiences and Early and Continued Breastfeeding: Findings from an Integrated Health Care Delivery System
Purpose: To examine whether adverse childhood experiences (ACEs) are associated with breastfeeding behaviors. Methods: Women in three Kaiser Permanente Northern California medical centers were screened for ACEs during standard prenatal care (N = 926). Multivariable binary and multinomial logistic regression was used…
The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system
Smoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination. Participants were people with HIV (PWH) in Kaiser Permanente Northern California. Predictors included smoking status and unhealthy alcohol use (exceeding…
An implementation evaluation of “Zero Suicide” using normalization process theory to support high-quality care for patients at risk of suicide
Suicide rates continue to rise across the United States, galvanizing the need for increased suicide prevention and intervention efforts. The Zero Suicide (ZS) model was developed in response to this need and highlights four key clinical functions of high-quality health…
Three-Year Outcomes After Brief Treatment of Substance Use and Mood Symptoms
Screening, brief intervention, and referral to treatment (SBIRT) for adolescents exhibiting co-occurring substance use and mental health problems may improve outcomes and have long-lasting effects. This study examined the relationship between access to SBIRT and substance use, depression and medical…
Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system
Research has reported shortened lifespans (by 15-30 years) for those with severe mental illness (SMI) or substance use disorder (SUD), particularly among public mental health treatment consumers. We assessed SMI- and SUD-associated mortality in the understudied setting of a large, nonprofit…
HIV Stigma and Its Associations with Longitudinal Health Outcomes Among Persons Living with HIV with a History of Unhealthy Alcohol Use
This study examined the demographic and clinical correlates of HIV stigma and evaluated how HIV stigma was associated with physical and mental health outcomes one year later in a primary-care based cohort of persons living with HIV (PLHIV; N = 584). HIV…
A Telemedicine Approach to Increase Treatment of Alcohol Use Disorder in Primary Care: A Pilot Feasibility Study
Unhealthy drinking is a leading threat to health, yet few people with alcohol use disorder (AUD) receive treatment. This pilot tested the feasibility of addiction medicine video consultations in primary care for improving AUD medication adoption and specialty treatment initiation.…
Pediatrician screening of young people with substance use, mood problems can have long-term results
Treatment for Anxiety and Substance Use Disorders During the COVID-19 Pandemic: Challenges and Strategies
: The COVID-19 pandemic is likely to exacerbate existing anxiety and substance use disorders (SUDs) and increase vulnerability among individuals previously free of these conditions. Numerous pandemic-related stressors-coronavirus infection fears, social distancing and isolation, activity restrictions, financial insecurity and unemployment,…
Associations Between Psychiatric Disorders and Alcohol Consumption Levels in an Adult Primary Care Population
Unhealthy alcohol use frequently co-occurs with psychiatric disorders; however, little is known about the relationship between psychiatric disorders and alcohol consumption levels. Understanding varying levels of unhealthy alcohol use among individuals with a variety of psychiatric disorders in primary care…
Health System-Based Unhealthy Alcohol Use Screening and Treatment Comparing Demographically-Matched Participants With and Without HIV
Unhealthy alcohol use among persons living with HIV (PLWH) is linked to significant morbidity, and use of alcohol services may differ by HIV status. Our objective was to compare unhealthy alcohol use screening and treatment by HIV status in primary…
Addiction Telemedicine Consultation in Primary Care: Increasing Access to Pharmacotherapy and Specialty Treatment for Alcohol Problems
A cluster-randomized trial of Addiction Medicine consultation (AMC) for primary care physicians (PCPs) and patients examining the effectiveness of a telehealth AMC intervention on initiation of alcohol use treatment, anti-craving medication and/or specialty addiction treatment initiation, and on patient alcohol…
Smoking and cessation treatment among persons with and without HIV in a U.S. integrated health system
Persons with HIV (PWH) are more likely to smoke and are more susceptible to the harmful effects of smoking than persons without HIV. We examined smoking patterns and use of cessation treatment among PWH and persons without HIV in a…
The Kaiser Permanente Northern California Adult Alcohol Registry, an Electronic Health Records-Based Registry of Patients With Alcohol Problems: Development and Implementation
Electronic health record (EHR)-based disease registries have aided health care professionals and researchers in increasing their understanding of chronic illnesses, including identifying patients with (or at risk of developing) conditions and tracking treatment progress and recovery. Despite excessive alcohol use…
Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data
Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder…
People with medical conditions more likely to abstain from drinking heavily
Associations Between Medical Conditions and Alcohol Consumption Levels in an Adult Primary Care Population
Excessive alcohol consumption is associated with increased incidence of several medical conditions, but few nonveteran, population-based studies have assessed levels of alcohol use across medical conditions. To examine associations between medical conditions and alcohol consumption levels in a population-based sample…
The role of substance use disorders in experiencing a repeat opioid overdose, and substance use treatment patterns among patients with a non-fatal opioid overdose
A non-fatal opioid overdose (NFOO) increases the risk of another overdose and identifies high-risk patients. We estimated the risk of repeat opioid overdose for patients with and without substance use disorder (SUD) diagnoses and the change in substance use treatment…
PROMIS® Pediatric Depressive Symptoms as a Harmonized Score Metric
To conduct an evidence-based review of adolescent self-report depression measures and to demonstrate how various measures can be rescored onto a harmonized metric. Six widely used person-reported outcome measures (PROMs) were reviewed. Psychometric properties were evaluated using previously published guidance…
Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness
Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to…
Mental Health Research Network III
The Mental Health Research Network (MHRN) is a consortium of 13 health system research centers, embedded in large and diverse healthcare systems, dedicated to improving patient mental health through research, practice, and policy; with expertise in mental health research as…
Changing Results-Engage and Activate to Enhance Wellness: A Randomized Clinical Trial to Improve Cardiovascular Risk Management
Background Despite the success of current cardiovascular disease (CVD) management programs, many patients do not achieve optimal control of CVD-related risk factors. New strategies are needed to better activate and engage these patients. Methods and Results We conducted a parallel,…
Behavioral health researchers seek new ways to problem-solve for patients
Interventions to Reduce Unhealthy Alcohol Use among Primary Care Patients with HIV: the Health and Motivation Randomized Clinical Trial
Unhealthy alcohol use has adverse effects on HIV treatment. Screening, brief intervention, and referral to treatment (SBIRT) has some evidence of efficacy but may not be sufficient for those with low motivation or comorbid substance use. To examine the effectiveness…
Effects of Medical Products on Suicidal Ideation and Behavior: Real World Evidence
This study will provide a comprehensive program of infrastructure development, methods development, and innovative research to generate real-world evidence addressing critical gaps in the regulation of medical products. We will explore four related issues: Potential for existing medical products to…
Association of Anxiety With High-Cost Health Care Use Among Individuals With Type 2 Diabetes
People with type 2 diabetes vary greatly in their use of high-cost health care resources. We examined the association of anxiety with high-cost use after accounting for depression and medical comorbidity. Using electronic health record data, we assessed past anxiety…
Expanding the Scope and Reach of Adolescent Substance Use Early Intervention Research
This study explores the enduring impact of screening, brief intervention, and referral to treatment (SBIRT) delivered in pediatric primary care, on young adults. We will examine substance use, mental health and medical outcomes, and health services utilization and cost over…
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity, and Patient Outcomes
Using a theory-driven conceptual framework, this multimethod study examines factors that facilitate or impede the successful implementation and long-term sustainability of screening, brief intervention, and referral to treatment (SBIRT) for risky alcohol use in real-world health care settings. This study…
Health Care Use Over 3 Years After Adolescent SBIRT
Most studies on adolescent screening, brief intervention, and referral to treatment (SBIRT) have examined substance use outcomes. However, it may also impact service use and comorbidity-an understudied topic. We address this gap by examining effects of SBIRT on health care…
Challenges of Population-based Measurement of Suicide Prevention Activities Across Multiple Health Systems
Suicide is a preventable public health problem. Zero Suicide (ZS) is a suicide prevention framework currently being evaluated by Mental Health Research Network investigators embedded in six Health Care Systems Research Network (HCSRN) member health systems implementing ZS. This paper…
5 Questions for … Stacy Sterling
Adverse Childhood Experiences and Mental and Behavioral Health Conditions During Pregnancy: The Role of Resilience
Little is known about how exposure to adverse childhood experiences (ACEs) and protective factors, such as resilience, influence prenatal mental and behavioral health. This study examined associations between exposure to ACEs and mental and behavioral health during pregnancy overall and…
Adverse childhood experiences, mental health, substance use, and HIV-related outcomes among persons with HIV
While persons with HIV (PWH) have benefited from significant advances in treatment and resulting longevity, mental health problems remain elevated in this population. Adverse childhood experiences (ACEs) are common among PWH and may negatively affect mental health and HIV-related outcomes.…
Evaluating the Impact of Changes in Opioid Prescribing Across Health Systems Implementing Zero Suicide
Henry Ford Health System, Kaiser Permanente Colorado, Kaiser Permanente Northern California, Kaiser Permanente Northwest, and Kaiser Permanente Southern California are implementing the National Zero Suicide Model (NZSM), and have received funding from the National Institute of Mental Health to evaluate…
A Pragmatic Trial of Parent-Focused Prevention in Pediatric Primary Care: Implementation and Adolescent Health Outcomes in Three Health Systems
This study involves a partnership between Kaiser Permanente Northern California, Kaiser Permanente Colorado, Henry Ford Health System, and the University of Washington Social Development Research Group. The collaborators will conduct a pragmatic trial testing the feasibility and health impact of…
Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study
Latinos face unique challenges engaging with their health care providers for risk management of cardiovascular disease (CVD). To better understand differences in how Latinos and non-Latino whites (NLWs) experience CVD care. We examined self-reported activation, engagement, confidence, and communication comparing…
Patient characteristics associated with treatment initiation and engagement among individuals diagnosed with alcohol and other drug use disorders in emergency department and primary care settings
Background: Treatment initiation and engagement rates for alcohol and other drug (AOD) use disorders differ depending on where the AOD use disorder was identified. Emergency department (ED) and primary care (PC) are 2 common settings where patients are identified; however,…
Feasibility of expanded emergency department screening for behavioral health problems
Behavioral health conditions and social problems are common yet underrecognized among emergency department (ED) patients. Traditionally, ED-based behavioral health screening is limited. We evaluated the feasibility of expanded behavioral health screening by a trained nonclinician. Prospective observational study of a…
Medical and non-medical marijuana use in depression: Longitudinal associations with suicidal ideation, everyday functioning, and psychiatry service utilization
Marijuana use is clinically problematic in depression, and non-medical and medical use may both contribute to barriers to care in this population. Among outpatients with depression, we examined the differential impact of medical or non-medical marijuana use, relative to no-use,…
Depression Screening Rates and Symptom Severity by Alcohol Use Among Primary Care Adult Patients
Hazardous alcohol use with depression may exacerbate health conditions and complicate medical care. We examined the rate of depression screening by alcohol use severity among primary care patients screened for hazardous alcohol use and, among those screened, examined patterns of…
Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs
A high proportion of U.S. health care costs are attributable to a relatively small proportion of patients. Understanding behavioral and social factors that predict initial and persistent high costs for these "high utilizers" is critical for health policy-makers. This prospective…
Pediatrician and Behavioral Clinician-Delivered Screening, Brief Intervention and Referral to Treatment: Substance Use and Depression Outcomes
Early intervention for adolescent substance use and mental health problems may mitigate potential harm. We examined patient outcomes from a pragmatic trial of two modalities of delivering screening, brief intervention, and referral to treatment (SBIRT) and usual care (UC) in…
Evaluation of a Clinical Quality Improvement Pilot of Adverse Childhood Experiences Screening and Brief Intervention in Pediatric Primary Care
This study will evaluate a quality improvement pilot project being conducted at pediatrics departments in the greater Kaiser Permanente Southern Alameda County area. The pilot project involves screening children at 1-to-5-year-old well child visits for adverse childhood experiences or trauma…
Adverse impact of marijuana use on clinical outcomes among psychiatry patients with depression and alcohol use disorder
This study examined whether marijuana use was associated with clinically problematic outcomes for patients with depression and alcohol use disorder (AUD). The sample consisted of 307 psychiatry outpatients with mild to severe depression and past 30-day hazardous drinking/drug use, who…
An Evaluation of the National Zero Suicide Model Across Learning Health Care Systems
This study seeks to develop metrics for evaluation of the Zero Suicide model across five integrated health care systems. These metrics will be used to investigate model fidelity and suicide behavior outcomes across sites. More specifically, this project aims to:…
Population-Based Screening and Brief Intervention in Primary Care: Health and Drinking Outcomes, Cost and Utilization
In June 2013, Kaiser Permanente Northern California incorporated alcohol screening, brief intervention, and referral to treatment (SBIRT) into the clinical workflow of its Adult Medicine program, alongside other preventive health measures (e.g., smoking screening, exercise, cancer screening, etc.). SBIRT has…
CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management
Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting…
Specialty addiction and psychiatry treatment initiation and engagement: Results from an SBIRT randomized trial in pediatrics
Many adolescents needing specialty addiction or psychiatry treatment never access care. We examined initiation and engagement with addiction and/or psychiatry treatment among adolescents referred to treatment from a trial comparing two different modalities of delivering Screening, Brief Intervention and Referral…
Alcohol brief intervention in primary care: Blood pressure outcomes in hypertensive patients
In clinical trials alcohol brief intervention (BI) in adult primary care has been efficacious in reducing alcohol consumption, but we know little about its impact on health outcomes. Hypertension is a prevalent and costly chronic condition in the U.S. and…
Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes
Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term…
Patterns of marijuana use among psychiatry patients with depression and its impact on recovery
Depression is associated with substance-related problems that worsen depression-related disability. Marijuana is frequently used by those with depression, yet whether its use contributes to significant barriers to recovery in this population has been understudied. Participants were 307 psychiatry outpatients with…
Detection, Treatment and Follow-up of Unrecognized Behavioral Health Problems in the Emergency Department
Behavioral health (BH) problems frequently exacerbate medical conditions of emergency department (ED) patients and contribute to ongoing suboptimal healthcare utilization. Because non-crisis BH problems are often undetected in the ED, we evaluate an innovative model of care that incorporates a…
Video Consultation to Increase Integration of Primary Care and Addiction Medicine and Improve Alcohol-Related Health Outcomes
KPNC has been a leader in implementing alcohol SBIRT as part of routine primary care with its Alcohol as a Vital Sign initiative, which involves medical assistants (MAs) screening all patients in Adult Medicine and Family Practice for alcohol problems,…
Development of Predictive Models for the Development of Adolescent Substance Use Problems
The objective of this study is to develop models to predict the development of substance use disorders (SUDs) among adolescents in four health systems: KPNC, KPHI, Henry Ford and Geisinger. We will focus on EHR data available during study period…
Evaluation of SBIRT for Adolescents in School and Pediatric Health Settings
This study examines the effectiveness of a group intervention (“Teen MPower”) for adolescents with behavioral health problems at improving patient outcomes and increasing specialty behavioral health treatment access, and examining barriers to and facilitators of implementation. Behavioral health problems –…
Examination of New Treatment Endpoints Based on World Health Organization Consumption Levels
Five risk categories have been determined based on WHO criteria for risk of consumption on a single drinking day in relation to acute problems (very high risk: 4.4+ drinkers per drinking day in the prior month; high risk: 2.9-4.3 drinks…
Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers
This is a renewal of a study in which we examioned barriers and facilitators to intervening with alcohol and drug (AOD) problems for adolescents in primary care (PC). The behavioral health fields have failed to persuade primary care providers (PCPs)…
The role of hazardous drinking reductions in predicting depression and anxiety symptom improvement among psychiatry patients: A longitudinal study
Co-occurrence of depression, anxiety, and hazardous drinking is high in clinical samples. Hazardous drinking can worsen depression and anxiety symptoms (and vice versa), yet less is known about whether reductions in hazardous drinking improve symptom outcomes. Three hundred and seven…
Marijuana use and service utilization among adolescents 7 years post substance use treatment
In an environment of increasingly liberal attitudes towards marijuana use and legalization, little is known about long-term trajectories of marijuana use among clinical samples of adolescents, and how these trajectories relate to health services utilization over time. Latent growth curve…
Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial
Research has shown that higher activation and engagement with health care is associated with better self-management. To our knowledge, the linkage intervention (LINKAGE) is the first to engage patients receiving addiction treatment with health care using the electronic health record…
A Randomized Clinical Trial of Motivational Interviewing to Reduce Alcohol and Drug Use Among Patients With Depression
This study examined the efficacy of Motivational Interviewing (MI) to reduce hazardous drinking and drug use among adults in treatment for depression. Randomized controlled trial based in a large outpatient psychiatry program in an integrated health care system in Northern…
Point Prevalence of Co-Occurring Behavioral Health Conditions and Associated Chronic Disease Burden AmongAdolescents
To examine the point prevalence of behavioral health conditions (BHCs) and co-occurring chronic medical conditions among adolescents in an integrated health system. The sample consisted of adolescents in an integrated health care system diagnosed with at least 1 of the…
Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care: A Cluster Randomized Trial
Early intervention for substance use is critical to improving adolescent outcomes. Studies have found promising results for Screening, Brief Intervention, and Referral to Treatment (SBIRT), but little research has examined implementation. To compare SBIRT implementation in pediatric primary care among…
Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial
Unhealthy alcohol use is a major contributor to the global burden of disease and injury. The US Preventive Services Task Force has recommended alcohol screening and intervention in general medical settings since 2004. Yet less than one in six US…
Motivational interviewing to reduce hazardous drinking and drug use among depression patients
This randomized study examined the efficacy of motivational interviewing (MI) to reduce substance use among adults with depression in outpatient psychiatry. The sample consisted of 104 participants ages 18 and over who reported hazardous drinking (three drinks or more per…
12-step participation and outcomes over 7 years among adolescent substance use patients with and without psychiatric comorbidity
This study examines the associations between 12-step participation and outcomes over 7 years among 419 adolescent substance use patients with and without psychiatric comorbidities. Although level of participation decreased over time for both groups, comorbid adolescents participated in 12-step groups…
Integrating Substance Use Treatment Into Adolescent Health Care
Substance use (SU) problems are common among adolescents, a serious health risk for them and a major public health problem, but are inadequately addressed in most pediatric health care settings. Primary care offers an excellent context for SU assessment and…
Functional disability among chronic pain patients receiving long-term opioid treatment
This study of 2,163 adult chronic, non-cancer-pain, long-term opioid therapy patients examines the relationship of depression to functional disability by measuring average pain interference, activity limitation days, and employment status. Those with more depression symptoms compared to those with fewer…
Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy
This paper used data from a study of pediatric primary care provider (PCP) screening practices to examine barriers to and facilitators of adolescent alcohol and other drug (AOD) screening in pediatric primary care. A web-based survey (N?=?437) was used to…
Patterns of alcohol and drug use among depressed older adults seeking outpatient psychiatric services
OBJECTIVE: Alcohol and drug use and related problems may compromise depression treatment, and older adults may be especially at risk for poor outcomes. However, alcohol and drug use among older adults have not been studied in settings in which depression…
The time is now: missed opportunities to address patient needs in community clinics in Cape Town, South Africa
SUMMARY OBJECTIVE: To investigate the prevalence and correlates of missed opportunities for addressing reproductive and mental health needs during patients' visits to primary healthcare facilities. METHODS: We selected a random sample of participants from 14 of the 49 clinics in…
Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities
OBJECTIVE: To review the research on economic and systemic barriers faced by adolescents needing treatment for alcohol and drug problems, particularly those with co-occurring conditions. METHOD: We reviewed the literature on adolescent access to alcohol and drug services, including early…
Cognitive functioning is related to physical functioning in a longitudinal study of women at midlife
BACKGROUND: Studies have reported declines with age in cognitive or physical functioning, but rarely identify whether these are parallel or linked events in the same study. Furthermore, most research in this area has focused on persons in late life rather…
Medical Conditions of Hazardous Drinkers and Drug Users in Primary Care Clinics in Cape Town, South Africa
Research has identified a wide range of health conditions related to alcohol and drug use in studies conducted primarily in developed countries and in populations with severe alcohol and drug problems. Little is known about medical conditions in those with…
Three-year chemical dependency and mental health treatment outcomes among adolescents: the role of continuing care
BACKGROUND: Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long-term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This…
Twelve-Step affiliation and 3-year substance use outcomes among adolescents: social support and religious service attendance as potential mediators
AIMS: Twelve-Step affiliation among adolescents is little understood. We examined 12-Step affiliation and its association with substance use outcomes 3 years post-treatment intake among adolescents seeking chemical dependency (CD) treatment in a private, managed-care health plan. We also examined the…
Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization
PURPOSE: Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation could compromise other SU abstinence. This study…
Prevalence and correlates of substance use among South African primary care clinic patients
We aimed to assess prevalence and correlates of hazardous use of tobacco, alcohol and other drugs in a primary care population in Cape Town, South Africa. Stratified random sampling was used to select 14 of the 49 clinics in the…
Adolescents entering chemical dependency treatment in private managed care: ethnic differences in treatment initiation and retention
PURPOSE: There has been little research on adolescents of different ethnicities in chemical dependency (CD) treatment, despite a focus on ethnic disparities in health care in recent years. In particular, little is known about ethnic differences in utilization of adolescent…
Adolescents with co-occurring substance use and mental conditions in a private managed care health plan: prevalence, patient characteristics, and treatment initiation and engagement
This study examined the prevalence, patient characteristics, and treatment initiation and engagement of adolescents with co-occurring substance use (SU) and serious mental health (MH) diagnoses in a private, managed care health plan. We identified 2,005 adolescents aged 12-17, who received…
Translating research findings into practice: example of treatment services for adolescents in managed care
An important question in the alcoholism treatment field is how research findings can be translated into real-world clinical practice. Researchers have developed a new research-practice integration (RPI) model that can both drive the formulation of studies and new research questions…
Adolescents in private chemical dependency programs: who are most at risk for HIV?
Consecutive intakes (N = 419) between ages 13 and 18 years to chemical dependency (CD) programs in a large private health plan were interviewed. The prevalence of six HIV risk behaviors was measured and categorized into zero, one, and multiple…
Chemical dependency and psychiatric services for adolescents in private managed care: implications for outcomes
BACKGROUND: Many adolescents with alcohol and drug problems have mental health comorbidities. The literature suggests that patients entering chemical dependency (CD) treatment with co-occurring problems have less successful outcomes, including treatment dropout and relapse. We examined the impact of psychiatric…
Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town
Objective: To document prevalence of, and association between, substance use and HIV risk behaviours among primary care patients. Method: Cross-sectional survey. Four primary care clinics in Cape Town. We selected clinics using stratified sampling, and systematically selected 131 patients from…
Pathways to chemical dependency treatment for adolescents in an HMO
This study examines pathways to chemical dependency (CD) treatment for adolescents in a prepaid health plan, including factors influencing treatment referral and access. Data were collected from 419 adolescent CD treatment intakes ages 13 to 18 in a large, private…
Family environment factors and substance abuse severity in an HMO adolescent treatment population
To examine how parental limit setting, family conflict, and perception of family experience influence severity of alcohol and drug problems, and important gender differences in these relationships, we interviewed consecutive intakes, aged 12 to 18 years, at 4 chemical dependency…
Adolescents with substance diagnoses in an HMO: factors associated with medical provider referrals to substance abuse and mental health treatment
This study examines the factors related to referrals of adolescents with substance use disorders to substance abuse or mental health treatment by their medical providers. Administrative and chart review data from the membership of a large private health maintenance organization…
Services integration and cost-effectiveness
Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these…
