Ryan Loh

(1) Background: The objective of this project was to evaluate the relationship between burnout, moral distress, and intent to quit among psychiatric healthcare workers at a safety-net hospital to provide actionable results for leaders and administrators. (2) Methods: This project used a cross-sectional, anonymous survey of burnout, moral distress, and intent to quit. Respondents were healthcare workers (n = 205) of different disciplines in a psychiatry department at a safety-net hospital in the United States. (3) Results: Results showed that 52.7% (n = 108) of healthcare workers reported experiencing burnout, most commonly among technicians and those working in emergency settings. Burnout was associated with both moral distress and intent to quit. The largest driver of moral distress was working with abusive patients and families, followed by compromised care due to lack of resources. (4) Conclusions: Routine monitoring of moral distress may provide leaders with actionable results to address burnout and promote retention of psychiatric healthcare workers.

Sociodemographic differences in opioid use disorder (OUD) treatment engagement have implications for population health. Continuum of care models can guide the opioid epidemic response by identifying differences in treatment patterns. We evaluated one such model at an integrated, safety-net health system in Denver, Colorado and examined the association of patient characteristics with opioid agonist treatment (OAT) receipt and retention. We identified a cohort of patients with OUD from 2023 to 2024 from electronic health records. We used multivariable regression to estimate the association of sociodemographic and health factors with OAT receipt and 90-day retention. Of 8,954 patients with OUD, 40% received OAT and 40% of those were retained on OAT at 90 days. Non-Hispanic Black patients and those with co-occurring alcohol use disorder had a lower likelihood of OAT receipt (Risk Ratio [RR] vs non-Hispanic White 0.68, 95% CI: 0.62-0.76; RR vs no alcohol use disorder: 0.88, 95% CI: 0.83-0.32). Patients without insurance and young adults aged 18-24 years had a lower likelihood of OAT receipt and retention. Those with co-occurring mental health conditions had a higher likelihood of OAT receipt and retention. Co-occurring stimulant use disorder, age 55+, and medical comorbidities had differential associations between OAT receipt and retention. Associations between patient characteristics and OAT receipt and retention suggest three patterns: cumulative disadvantage with factors associated with both lower treatment and retention; uneven disadvantage for factors associated with either decreased treatment or retention; and inverse associations wherein factors showed benefit in one stage but disadvantage in the other.

Background: The youth health problems are very prevalent in the United States. Approximately, one in five children and adolescents experience mental health problems, yet many have limited access to appropriate treatment, contributing to increased suicidal risks and school failure. School-based health centers (SBHCs) offer a promising avenue to deliver care where students spend most of their time. Aim: This study examined associations between SBHC-delivered mental health services and changes in students’ mental health symptoms, functioning, and school-related outcomes in a large urban district. Methods: Mental health symptoms and functioning were assessed using the Ohio Youth Problem Functioning and Satisfaction Scales at baseline and approximately 3 and 6 months after initiation of school-based mental health treatment. Linked educational records provided grade point average (GPA), attendance, and behavioral incident data for 1,238 students receiving services between 2010 and 2019. One-way repeated measures analysis of variance was used to examine within-student changes over time, including analyses stratified by baseline symptom severity and functional impairment. Results: School-based mental health treatment was associated with reduced problem severity, particularly among students with the highest baseline symptom burden, including self-harm, thoughts of death, and sadness/depression, and with improved functioning in those with severe initial impairment. GPA increased modestly and behavioral incidents decreased by about half in the year following treatment compared with the prior year, while attendance showed smaller improvements. Youth and parent reports demonstrated similar patterns of change. Conclusion: In this urban SBHC system, participation in school-based mental health services was associated with improvements in student mental health and favorable changes in school-related behaviors and performance. Although causal inference is limited by the observational design, these results add to evidence that SBHC mental health services may play an important role in supporting youth functioning, behavior, and academic outcomes.

Patients with methamphetamine use disorder (MaUD) face social, financial, and systemic barriers to accessing evidence-based addiction treatment. We designed a care navigation intervention to better engage patients with MaUD in treatment after an acute care encounter. This intervention was modeled after linkage-to-care strategies for infectious diseases and emphasized rapport building, trauma-informed care, and practical assistance in overcoming barriers to treatment. We also added elements of contingency management given its treatment efficacy with MaUD. We describe the development of the care navigation model, characteristics and care needs of subjects receiving the intervention, and intervention engagement outcomes. Among 94 patients who received this intervention as part of a randomized controlled trial, 64% were considered engaged with at least 2 or more visits with the care navigator Patients had substantial barriers to care—85% of patients were not stably housed, 83% were unemployed, and 46% lacked access to a phone—and the most common domains of need were accessing addiction treatment, housing resources, or communication needs such as a phone or interpreter services. This intervention poses a model for connecting patients with MaUD to treatment after acute care encounters.

Background: Adolescent mental health and substance misuse is a growing issue, disproportionately affecting diverse youth and those in low-resourced, high-stress environments. Yet, despite recent advances in evidence-based practices for adolescent substance use, perpetuating factors remain under-explored and marginalized, and underserved groups continue to be underrepresented. The current study aimed to investigate sociocultural factors impacting substance misuse and treatment outcomes. Methods: Data from adolescents receiving combined mental health and substance misuse treatment at a regional safety-net hospital were analyzed. Using Latent Class Analysis (LCA), demographic variables including insurance coverage, area deprivation, race, ethnicity, age, gender, court involvement, and primary mental health diagnoses were used to identify unique adolescent subgroups based on these different sociocultural risk factors. Identified classes were tested as predictors of treatment engagement, length of treatment, future service utilization, substance misuse, and urine drug screen results. Results: Five unique subgroups were identified, differentially impacting substance misuse, future service utilization, and treatment outcomes. Conclusions: These results highlight the need for improved access to resources for adolescents who have been marginalized and traditionally underserved. Furthermore, the identified subgroups can inform future research and practice.

Background: Alcohol use disorder (AUD) accounts for millions of acute care encounters annually in the United States. Hospitalization represents a vital opportunity to intervene pharmacologically, but low medication adherence is a significant barrier. Two single-dose, adherence-independent interventions are well suited for pre-discharge administration: intravenous (IV) ketamine and intramuscular (IM) naltrexone. Their feasibility and readmission-reducing efficacy in hospital settings are not well-established. Methods: A 3-arm, open-label randomized trial was conducted at our safety-net medical hospital among high-utilization inpatients with severe AUD. Consented adults (age 18–65) were randomized to (1) IV ketamine (KET) 0.5 mg/kg over 40 min, (2) IM naltrexone (NTX) 380 mg once, or (3) linkage alone (LA). The primary clinical outcome was 30-day all-cause hospital readmission rate. All were provided enhanced linkage to outpatient addiction clinic. Results: We consented and randomized 44 participants (n = 13, 14, 17 for KET, NTX, LA, respectively), with a mean of 3.2 past-year hospitalizations. Compared to the LA arm, both the KET arm (RR 0.37, p = 0.17) and NTX arm (RR 0.52, p = 0.27) had a lower 30-day readmission rate, though the differences were nonsignificant. Immediate acceptability ratings of KET and NTX were 9.50 and 9.17 out of 10, respectively. No serious adverse events or illicit ketamine use was reported. Conclusions: Both interventions are feasible and showed promise in reducing readmissions for high-utilization AUD inpatients. Despite randomization, baseline characteristics may have differed in ways that biased against the control arm. Additional pragmatic studies—with larger sample size, blinding, and robust follow-up data collection—are needed to verify findings and better understand mediating factors. ClinicalTrials.gov Identifier NCT04562779. Registered 24 September 2020. https://clinicaltrials.gov/ct2/show/NCT04562779

Introduction: The purpose of this study is to compare the prevalence of hospitalization after an emergency department (ED) visit at an urban safety net hospital for youth with and without a substance use disorder. Methods: This study used a retrospective cohort design of adolescents (aged 15–21 y; n = 14,852) treated in the ED and compared the risk of hospitalization within 90 days. Results: A substance use disorder diagnosis in the ED more than doubled the risk of 90-day hospitalization (5.4% vs 2.38%; P < 0.0001). Conclusions: Compared with youth without a substance use disorder, youth with substance use disorders are likely to require additional services after an ED visit.