Homelessness in the youth population is associated with elevated rates of mental illness, substance abuse, and suicidality compared to the housed population in the United States (Berdahl, Hoyt, and Whitbeck, 2005; Hodgson, Shelton, Van den Bree, 2014; Hughes et al., 2010). With a survival-focused perspective, exacerbating issues, stigmatization, and transience housing; homeless youth require special consideration to meet their diverse health needs. When barriers impede homeless youth's access to necessary health resources, their health concerns are left untreated and impound until emergency services are required. This review of literature is focused on identifying and synthesizing barriers and facilitators for homeless youth to access and utilize mental health care services. When untreated mental illness reaches a crisis point, it becomes more expensive to treat (Taylor, Stuttaford, and Vostanis, 2006). For youth experiencing homelessness, various factors influence their decisions to wait until a crisis to reach out to emergency services. Within the literature, barriers and facilitators were bracketed into personal, social, and structural factors. These factors ranged from financial concerns, communication with health care providers and between health care service locations, stigmatization, lack of awareness, and administrative requirements. While further research is required, evidence from the literature shows promise in developing and altering interventions and communication to meet homeless youth's mental health and substance abuse needs.

For over 40 years, HIV has been seen as an epidemic and problem on health care that disproportionately affects the African American women (AAW) and population. This epidemic represents 12% of the total U.S. population, yet accounts for 37% of the commutative HIV cases, and 45% of the new HIV cases reported since 1998. Research in this case was needed for increased understanding to this health care problem, between AAW and HIV. A review in the literature indicated the problem and found new alternatives that helped support aspects on today's health care. The purpose of the study was to help explore the experiences of the AAW with HIV and make an effort to identify the barriers in the health care system. This was by using a narrative design and qualitative approach that helped address the overall questions, on the economic and environmental risk factors associated with HIV, and how one compensates for barriers to HIV treatment and resources. The current results by the narrative provided new knowledge for AAW with HIV. They are seen as the new generation of AAW with new challenges on health care and HIV treatment. Therefore, in an effort to make further recommendations and deal with the challenges on social change, the older generation of AAW need to educate their younger generation on HIV prevention strategies. They are implementations of strategies for positive social change that will help make a difference, by educating today's youths and correct the miss-educated, among our black population of society.

Background: Viral hepatitis C (HCV) represents a major public health problem worldwide and also in the Czech Republic. There are as many as 80,000 people have been living with chronic HCV in Czechia since 2015, most of them are/were drug addicts who have been infected by contaminated syringes. Global and national efforts to eliminate HCV are currently underway, focusing primarily on improving the quality of treatment continuity (sustainability, uninterrupted treatment) which involves ensuring the availability of testing for all patients, patients' involvement in their own treatment, sustaining treatment, achieving a response rate and the necessary follow-up care. Objective: To describe the HCV continuum of care in people who inject drugs (mapping testing rate, treatment uptake and treatment completion), and to describe the factors that affect this process. Based on the collected data, to formulate recommendations for addiction care professionals in order to improve HCV continuum of care. Methodology: A questionnaire survey among clients of low-threshold centres in Prague was carried out. The convenient sample consisted of a total of 60 respondents, 20 from each of the three centres. Data were analyzed using descriptive statistics. Data collection was realised in August 2019. Results: Out of the 60...

Background: Perinatal depression affects 1 in 7 childbearing individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at increased risk of perinatal depression, and little is known about how experiences with the mental health care pathway may differ between these individuals and those without a psychiatric history. Methods: This was a secondary analysis of data from the PRISM (PRogram in Support of Moms) study, a cluster randomized controlled trial of two interventions for perinatal depression. Care access and barriers to care were evaluated in perinatal individuals who screened positive for depression using the EPDS (N=280). Results: Individuals with no psychiatric history prior to pregnancy (N=113), compared to those with such history (N=267), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, though equally likely to attend when referred. In adjusted models, those without a psychiatric history had 0.59 times the odds of attending therapy (95% CI 0.28-1.25), 0.23 times the odds of utilizing medication (95% CI 0.11-0.47), and overall, 0.22 times the odds of receiving any depression care (95% CI 0.11-0.43). Participants reported on average 3 barriers as preventing them from receiving care “a lot” or “quite a lot”. The proportion of individuals endorsing each barrier was similar between groups, excepting “concerns about treatments available” and “thinking the problem would get better by itself”, which were more prevalent in those without a prior psychiatric history. Conclusions: There exist meaningful differences in the way perinatal individuals access care for depression based on psychiatric history. An understanding of these differences is crucial in addressing gaps between mental health care need and care receipt.

Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic. For the present study 136 surveys were completed by providers working in primary care practices across the Appalachian region of Tennessee. The results showed that only about one fifth of the primary care clinics in Appalachian Tennessee reported engaging in moderate to high levels of primary care behavioral health (PCBH) collaboration (e.g., colocated or integrated models of care). Among community health clinics, however, nearly half reported moderate or high levels of collaboration. The findings of this study underscore the importance policy change (e.g., changes in reimbursement patterns, increases in incentives, introduction of PCBH models in training programs) in facilitating the uptake of high levels of PCBH collaboration in Appalachian Tennessee (especially in regards to nonpublicly funded clinics). Further, the methodology used in this study could provide policymakers and researchers in other regions of the U.S. with a means for obtaining baseline data regarding local trends in PCBH collaboration and could serve as first step in developing a standardized methodology for comparing the overall uptake of PCBH collaboration models across regions.

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