Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities.
Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities.
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DOI：
10.1016/j.jaac.2010.03.019
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发表时间：
2010-07
影响因子：
13.3
通讯作者：
Parthasarathy S
中科院分区：
文献类型：
--
作者：
Sterling S;Weisner C;Hinman A;Parthasarathy S
审查关于需要治疗酒精和毒品问题的青少年，特别是那些同时患有疾病的青少年所面临的经济和系统障碍的研究。我们回顾了关于青少年获得酒精和药物服务的文献，包括早期干预，以及对那些同时发生疾病的人进行综合和专业的精神健康治疗，研究了卫生保健系统、公共政策（卫生改革）、治疗融资和报销系统（公共和私人）的作用，循证实践的实施，保密实践，以及治疗成本和成本/收益。治疗的障碍，特别是综合治疗的障碍，很大程度上源于我们组织上分散的医疗保健系统，它包括公共和私人，分割和综合系统，以及不同的资助机制（医疗补助与整体拨款与包括“高免赔额”计划和其他成本控制的私人保险）。在这两个系统中，精心设计的项目将服务与其他精神卫生和一般卫生保健分开。障碍还源于精神病学、初级保健和药物使用之间的学科差异和薄弱的临床联系，以及在保护患者隐私的同时阻碍沟通和协调的保密政策。在这个卫生保健改革的时代，我们有机会增加青少年获得服务的机会，并为那些同时患有疾病的人开发综合服务的新模式。我们讨论了改善治疗机会和实施循证实践的机会，研究了精神病学和药物使用治疗的卫生改革和平等立法的影响，并评论了关键的未解问题和未来的研究机会。
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. We reviewed the literature on adolescent access to alcohol and drug services, including early intervention, and integrated and specialty mental health treatment for those with co-occurring disorders, examining the role of health care systems, public policy (health reform), treatment financing and reimbursement systems (public and private), implementation of evidence-based practices, confidentiality practices, and treatment costs and cost/benefits. Barriers to treatment, particularly integrated treatment, are largely rooted in our organizationally fragmented health care system, which encompasses public and private, carved-out and integrated systems, and different funding mechanisms (Medicaid versus block grants versus private insurance that include “high deductible” plans and other cost controls.) In both systems, carved-out programs de-link services from other mental health and general health care. Barriers are also rooted in disciplinary differences and weak clinical linkages between psychiatry, primary care and substance use, and in confidentiality policies that inhibit communication and coordination, while protecting patient privacy. In this era of health care reform, we have the opportunity to increase access for adolescents and develop new models of integrated services for those with co-occurring conditions. We discuss opportunities for improving treatment access and implementation of evidence-based practices, examine implications of health reform and parity legislation for psychiatric and substance use treatment, and comment on key unanswered questions and future research opportunities.
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影响因子：
1.1
作者：
Brindis, C;Park, MJ;Irwin, CE
通讯作者：
Irwin, CE
影响因子：
120.7
作者：
Blumenthal, D;Gokhale, M;Weissman, JS
通讯作者：
Weissman, JS
影响因子：
3.9
作者：
Ammon, L;Sterling, S;Weisner, C
通讯作者：
Weisner, C
DOI：
10.1007/s11414-007-9095-x
发表时间：
2009-01-01
影响因子：
1.9
作者：
Balsa, Ana I.;Homer, Jenny F.;Weisner, Constance M.
通讯作者：
Weisner, Constance M.
影响因子：
0.9
作者：
French, MT;Roebuck, MC;Tims, FM
通讯作者：
Tims, FM