Engaging persons with mental illness and/or substance use disorder in care coordination services: an improvement project at a federally qualified community health center

Background: Mental health and substance use disorders seldom occur in isolation. They frequently accompany each other, as well as a substantial number of chronic general medical illnesses. Consequently, mental health conditions, substance-use disorders, and general health conditions are frequently co-occurring, and coordination of all of these types of health care is essential to improved health outcomes (Institute of Medicine, 2006). The U.S. system of healthcare is failing to identify, engage, and effectively treat people who are suffering from behavioral health conditions (Blanco, Coye, Knickman, Krishnan, Krystal, Pincus, Rauch, Simon, Vitiello, 2016). Because of poor coordination and lack of engagement, people often experience disrupted care and an over-reliance on emergency department and hospital care. At Lowell Community Health Center where this project takes place persons with a primary behavioral health diagnosis contribute to the highest utilization of emergency and inpatient hospital services. In July of 2018, Lowell CHC collaborated with Lowell House, Inc. to form a care coordination program to outreach and engage individuals identified as high utilizers of inpatient and emergency hospital services. Aim: The aim of this project is to describe the attributes of the population of patients who successfully engaged into care for the first six months of this new program, with recommendations for improvement to inform future program design. Method: The population of patients who successfully engaged in care in the first 6 months of the program described by independent variables consisting of age, gender, race, and preferred language. Dependent variable consisting of type of outreach. Data was evaluated to determine attributes of patients who successfully engaged in care and if correlations exist between variables and successful engagement. Results: The first six months of the program implementation demonstrated successful engagement and activation of 17.5% of patients. The average patient is described as low-income, 50-64 years of age, non-English speaking female with dual-diagnosis residing in the greater Lowell area. Themes regarding successful outreach type included telephonic and face-to-face being the most successful method of engagement. Although successful engagement was noted, longer-term efforts and analysis should focus on successful outreach and engagement strategies, emergency room utilization, treatment adherence and service adherence. Conclusions: The findings of this project indicate that having a team-based, multidisciplinary and multi-cultural approach to care coordination has led to successful engagement of 186 individuals within the first 6 months of this new program

Gamma-ray Burst Positions from the ASM on RXTE

The RXTE/ASM has detected and positioned 14 confirmed GRB bursts (at this writing, Jan. 1999) including six whose positions were comunicated to the community 2 to 32 hours after the burst. Two of these latter bursts led to measurements of optical red shifts but one, despite an easily detected x-ray afterglow, produced no detectable optical or radio afterglow.Comment: 2 pages, 1 Figure, A&A format, accepted to appear in the proceedings of the conference "Gamma-Ray Bursts in the Afterglow Era", Rome, 3-6 Nov, 199

The bearable lightness of being

How are philosophical questions about what kinds of things there are to be understood and how are they to be answered? This paper defends broadly Fregean answers to these questions. Ontological categories-such as object, property, and relation-are explained in terms of a prior logical categorization of expressions, as singular terms, predicates of varying degree and level, etc. Questions about what kinds of object, property, etc., there are are, on this approach, reduce to questions about truth and logical form: for example, the question whether there are numbers is the question whether there are true atomic statements in which expressions function as singular terms which, if they have reference at all, stand for numbers, and the question whether there are properties of a given type is a question about whether there are meaningful predicates of an appropriate degree and level. This approach is defended against the objection that it must be wrong because makes what there depend on us or our language. Some problems confronting the Fregean approach-including Frege's notorious paradox of the concept horse-are addressed. It is argued that the approach results in a modest and sober deflationary understanding of ontological commitments

Courage to Capital? A Model of the Effects of Rating Agencies on Sovereign Debt Role-over

We propose a model of rating agencies that is an application of global game theory in which heterogeneous investors act strategically. The model allows us to explore the impact of the introduction of a rating agency on financial markets. Our model suggests that the addition of the rating agency affects the probability of default and the magnitude of the response of capital flows to changes in fundamentals in a non–trivial way, and that introducing a rating agency can bring multiple equilibria to a market that otherwise would have the unique equilibrium.Credit rating, Rating agency, Sovereign debt, Global game