Journal of Behavioral Health Services & Research最新文献

{"title":"Embedded Psychological Services and Lower 60-Day Acute-Care Utilization in High-Need, High-Cost Adults: A Target Trial Emulation.","authors":"Sasha R Sioni, Jay Al-Hashimi, Mohammad Al Mouslmani, Lesley Manson","doi":"10.1007/s11414-026-10021-7","DOIUrl":"https://doi.org/10.1007/s11414-026-10021-7","url":null,"abstract":"<p><p>In safety-net care management, high-need, high-cost (HNHC) adults often receive bundled services. The independent contribution of embedded psychological-services engagement is unclear. This retrospective cohort study used target trial emulation under the ICH E9(R1) estimand framework to evaluate an opt-out embedded psychological-services pathway nested within a manualized social-determinants-of-health-focused care-management program at four Phoenix Federally Qualified Health Centers. Eligible HNHC adults had ≥ 1 inpatient admission or ≥ 2 emergency department visits in the prior 12 months. Each received a scripted opt-out engagement protocol with structured warm-handoff referral where operationally available. Accepted/engaged status was classified as attendance at ≥ 1 behavioral health session within 60 days; the comparator was declined/no-show after the standardized offer. The 60-day composite outcome combined hospital admissions and emergency department visits ascertained from claims linked to a shared electronic health record. Stabilized inverse-probability-of-engagement weighting addressed measured confounders. Sensitivity analyses spanned engagement timing or classification, missing data, unmeasured confounding, propensity-score specification, and clinic-level dependence. Among 1038 adults, 485 (46.7%) were classified as accepted/engaged. Accepted/engaged status was associated with a 33% lower 60-day composite acute-care rate (adjusted incidence-rate ratio [aIRR] 0.665; 95% CI, 0.585-0.757; P < .001). The lower composite rate was driven by ED visits (aIRR 0.619; 95% CI, 0.536-0.715; P < .001). The 60-day admissions component alone was not statistically significant (aIRR 0.891; 95% CI, 0.669-1.188; P = .43). All five Holm-Bonferroni-corrected endpoints survived correction: the 60-day composite outcome, 60-day EQ-5D-5L, 30-day WHO-5 wellbeing, 30-day PHQ-9, and 30-day GAD-7. The E-value (point 2.37; CI-bound 1.97) implies that an unmeasured confounder would need strong association with both engagement and outcome to fully explain the result. Observed accepted/engaged status with embedded psychological services was associated with lower short-term acute-care utilization in safety-net HNHC adults already enrolled in multicomponent care management.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Information Technology Infrastructure and Availability of Medications for Opioid Use Disorder and Naloxone in U.S. Substance Use Disorder Treatment Facilities.","authors":"Gregory A Carter, Aidan Clifford, Beth E Meyerson","doi":"10.1007/s11414-026-10024-4","DOIUrl":"https://doi.org/10.1007/s11414-026-10024-4","url":null,"abstract":"<p><p>Medications for opioid use disorder (MOUD) reduce overdose mortality, yet most individuals with opioid use disorder receive no pharmacotherapy. Facility-level health information technology may reflect broader organizational capacity, but it has rarely been examined as a marker associated with readiness to offer evidence-based opioid care. This cross-sectional secondary analysis of the 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS) Public Use File included a base sample of 20,813 substance use disorder treatment facilities and used complete-case adjusted logistic regression to examine whether exclusive electronic health record (EHR) use, defined as reliance on an EHR with no paper charts, was associated with the availability of buprenorphine, naltrexone, take-home naloxone with overdose education, and co-occurring opioid use disorder services. Models adjusted for ownership, program focus, opioid treatment program (OTP) registration, and financial access characteristics; federally regulated OTP methadone availability served as a regulatory contrast. Among facilities with valid EHR responses (n = 16,107), 68.3% reported exclusive EHR use. Exclusive EHR use was associated with higher adjusted odds of buprenorphine (aOR = 3.05), naltrexone (aOR = 2.90), take-home naloxone with overdose education (aOR = 3.18), and co-occurring services (aOR = 2.33), and more weakly with federally regulated OTP methadone availability (aOR = 1.23). Exclusive EHR use is an organizational marker associated with service availability, but the cross-sectional design and potential residual confounding preclude causal conclusions about whether EHR investment would expand opioid treatment access.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Mental Health Task Sharing in Community-Based Services to Engage Older Chinese Immigrants in the U.S. in Mental Health Services: A Qualitative Study.","authors":"Yuanyuan Hu, Whitney Wortham, Victoria Stanhope","doi":"10.1007/s11414-026-09994-2","DOIUrl":"10.1007/s11414-026-09994-2","url":null,"abstract":"<p><p>Older Chinese immigrant adults in the United States, the fastest-growing population among older immigrants, have low service utilization rates despite a high prevalence of mental health disorders. Mental health task-sharing, the delegation of low-intensity mental health tasks to non-licensed providers in community-based settings, has been implemented to improve access, yet research on engaging older Chinese immigrants remains limited, particularly in immigrant-serving community-based organizations. This study aimed to identify barriers and facilitators to engage older Chinese immigrants in the implementation of mental health task-sharing in community-based social services. Semi-structured interviews were conducted in 2023 with 30 frontline providers and administrators from 17 community-based organizations, including older adult centers, social adult day care, and Naturally Occurring Retirement Communities in New York City. Two coders coded transcripts independently and conducted thematic analysis using ATLAS.ti 24, guided by the Consolidated Framework for Implementation Research (CFIR). Results suggest barriers to engagement included community-level stigma and cultural beliefs, with older Chinese immigrant adults fearing negative social consequences within close-tie communities. Facilitators included building rapport, rephrasing mental health terminology, connecting mental health and physical health, and offering payment assistance. Addressing stigma and cultural beliefs was crucial for engagement in task-sharing implementation. Older Chinese immigrants can be effectively engaged by using culturally informed strategies to facilitate mental health task-sharing implementation.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":"590-606"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal Suicide Screening in the Hospital Setting: Risk and Implications.","authors":"Mairin Cotter, Dinan Noor, Kimberly S Barrier, Kailey N Clinton, John B Britt, Cynthia W Karlson","doi":"10.1007/s11414-026-09997-z","DOIUrl":"10.1007/s11414-026-09997-z","url":null,"abstract":"<p><p>Suicide risk screening is a pivotal step in improving hospital safety and quality of care, with the potential to prevent suicide and facilitate mental health intervention. The Ask Suicide-Screening Questions (ASQ) is a brief, validated tool for pediatric and adult populations. This retrospective cross-sectional study sought to identify prevalence rates of suicide risk among pediatric and adult patients at an academic medical center in the Southeastern United States, examine demographic factors associated with ASQ outcomes, and compare suicide risk rates across presenting medical diagnoses. The ASQ was administered to patients 12 years and older upon admission to the ED or inpatient unit. Partial proportional odds modeling was used to examine associations between demographic factors and suicide risk. Chi-square analyses were used to identify differences in suicide risk across medical diagnoses. On the ASQ, 5% of pediatric patients (12-24 years) and 1% of adults (25-113 years) screened as potential risk, and 1% of both samples screened as imminent risk. Higher-risk groups included early adolescents (12-14 years), young adults (25-34 years), pediatric females, adult males, and adult patients with government insurance or no insurance The psychiatric/substance use category had significantly higher rates of suicide risk compared to other diagnostic categories. Among non-psychiatric pediatric patients, neurological, chronic condition, and general medical diagnoses exhibited higher potential risk than women's health, trauma, and orthopedic diagnoses. Results highlight need for universal suicide risk screening in hospital settings and indicate elevated risk among younger adolescents, young adults, and adults with government insurance or no insurance.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":"536-550"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recounting Workforce: The Impact of Multi-licensure on Behavioral Health Provider Estimates.","authors":"Sarah Y T Hartzell, Sarah A Friedman, Aileen Y Lovitt, Vallabhi G Shah, Sara Hunt","doi":"10.1007/s11414-026-10025-3","DOIUrl":"https://doi.org/10.1007/s11414-026-10025-3","url":null,"abstract":"<p><p>Accurate behavioral health workforce estimates are essential for workforce planning, shortage designation, and policy development. However, workforce reports often rely on license counts rather than unique providers, which can inflate workforce estimates when clinicians hold multiple licenses. This study examined the prevalence and geographic distribution of multi-licensure among Nevada behavioral health providers and assessed its impact on workforce estimates. A cross-sectional analysis was conducted using administrative licensure data from Nevada licensing boards for Marriage and Family Therapists (MFTs), Clinical Professional Counselors (CPCs), Alcohol and Drug Counselors (ADCs), and Problem Gambling Counselors (PGCs). Active licenses through December 2025 were linked at the individual level to identify unique providers and patterns of multi-licensure. Descriptive statistics summarized licensure combinations, while chi-square tests and logistic regression examined geographic differences by county type. Among 3259 unique providers, 382 (11.7%) held two or more licenses. The most common multi-licensure combinations were MFT/ADC (n = 189) and CPC/ADC (n = 143). Providers collectively held 3660 licenses, meaning license counts alone would overestimate the workforce by approximately 12.3%. In this Nevada methodological demonstration, summing records across four overlapping credentials produced a higher estimate than linking records at the individual level. States using licensing data for workforce surveillance should deduplicate records across boards and distinguish the number of credentials from the number and clinical capacity of unique practitioners. Multi-state replication across a broader set of behavioral health professions is needed.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missing Elements in Child Welfare Systems of Care.","authors":"Paul Block, John Farley, Robert Kinscherff","doi":"10.1007/s11414-026-09990-6","DOIUrl":"10.1007/s11414-026-09990-6","url":null,"abstract":"<p><p>This paper describes conclusions from an expert report prepared for litigation against the Office of Refugee Resettlement (ORR) with relevance for all children at risk for placement in restrictive settings. The claims that ORR refused to release unaccompanied immigrant children to appropriate custodians, improperly retained children in restrictive placements, and placed children with behavioral, mental health, or intellectual and/or developmental disabilities in restrictive facilities because of their disabilities rather than their needs have universal relevance to systems of care for children. These conclusions could be used by regulators, funders, advocates, family members, and others to improve decision-making about the management of children at risk for placement in restrictive settings. 1. Children can often be safely maintained in least restrictive settings with effective, individualized, community-based services and behavior management strategies. 2. Services must be based on adequate, evidence-based evaluation of children's needs. 3. Criteria for placement of children in more restrictive settings must include a specific determination that each child could not be maintained safely in a lower level of care, and the specific basis for that determination. 4. Effective systems of care require internal mechanisms to evaluate decisions and promote best services in the least restrictive setting.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":"664-676"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-Like Peptide-1 Use and Healthcare Resource Utilization for Depression and Anxiety Among Adults with Type 2 Diabetes: 2019 to 2023.","authors":"Duy Do, Tiffany Lee, Angela Inneh, Urvashi Patel","doi":"10.1007/s11414-025-09950-6","DOIUrl":"10.1007/s11414-025-09950-6","url":null,"abstract":"<p><p>Mental health disorders, including depression and anxiety, are common comorbidities in individuals with type 2 diabetes mellitus (T2DM), contributing to increased healthcare resource utilization (HCRU) and the financial burden of the disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are commonly used for T2DM management, and emerging evidence suggests they may help alleviate mental health symptoms. This study examined the association between GLP-1RA (versus DPP-4 inhibitor [DPP-4i]) initiation and mental health-related HCRU in T2DM patients. Using data from the Komodo Healthcare Map, a national database of pharmacy and medical claims, this study conducted a retrospective cohort analysis with 774,968 adults who initiated GLP-1RAs or DPP-4i between January 2019 and March 2022. Patients were followed for 12 months, and mental health-related HCRU (emergency department, inpatient, outpatient hospital, and office visits) for depression and anxiety was assessed. A difference-in-differences analysis compared HCRU before and after medication initiation, adjusting for sociodemographic and clinical variables. GLP-1RA use was associated with significant reductions in outpatient hospital visits (IRR: 0.96; 95% CI: 0.95-0.98) for depression, and office visits for depression (IRR: 0.87; 95% CI: 0.82-0.92) and anxiety (IRR: 0.85; 95% CI: 0.81-0.90) compared to DPP-4i. However, no significant changes were observed in emergency or inpatient visits. Reductions were more pronounced with semaglutide, liraglutide, and dulaglutide. These findings suggest that GLP-1RAs may help reduce depression- and anxiety-related HCRU in patients with T2DM, indicating potential benefits beyond glycemic control. Further research is needed to explore long-term outcomes and the cost-effectiveness of GLP-1RAs for managing mental health comorbidities.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":"622-638"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Regular Symptom Monitoring on Depression Treatment Outcomes in Psychiatric Specialty Outpatient Care.","authors":"Sorabh Singhal, Allison G Dempsey, Alejandra C Santisteban, Susan K Mikulich-Gilbertson","doi":"10.1007/s11414-026-10002-w","DOIUrl":"10.1007/s11414-026-10002-w","url":null,"abstract":"<p><p>Depression remains a common and debilitating condition, and measurement-based care is widely recommended to guide treatment decisions. The study examined whether regular versus irregular completion of standardized symptom monitoring predicted differential improvement in depression outcomes within psychiatric specialty care. The research team analyzed electronic health record data from 502 adult outpatients between October 2023 and September 2024. The study categorized patients as regular (> 50% of visits) or irregular (≤ 50%) completers of standardized measures and compared percent change in Patient Health Questionnaire-9 (PHQ-9) scores from early to late treatment using linear regression. Patients with irregular monitoring demonstrated significantly greater symptom improvement than regular completers (27.9% vs. 16.4%; p = 0.002). Demographic and clinic characteristics showed no significant association with improvement. These findings suggest that monitoring frequency may influence outcomes in complex ways and underscore the need to clarify when and for whom routine symptom monitoring adds value in specialty behavioral health settings.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":"639-650"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Police and Behavioral Health Professionals' Experiences with a Hybrid Co-response Approach to Mental Health Crisis Intervention: Qualitative Findings.","authors":"Anna Davidson Abella, Kimberly Menendez, Kelsey Greenfield, Monica Landers","doi":"10.1007/s11414-026-09995-1","DOIUrl":"10.1007/s11414-026-09995-1","url":null,"abstract":"<p><p>As initiatives to address mental health crises are expanding throughout the United States, many efforts are focused on police, who often respond first to these emergencies. Co-response models have grown substantially over the past several decades. However, there is a limited evidence base for hybrid models that pair in-person police officers with virtual, on-demand behavioral health professionals (BHPs). This hybrid modality is important to assess given the increased use of telehealth for behavioral health services more generally to improve accessibility. Drawing from semi-structured interviews with 21 co-responders (police officers, n = 15; BHPs, n = 6) involved in a hybrid co-response program in Central Florida, this study provides insights into co-responders' experiences with the partnership and perceptions of the model's benefits and challenges. Findings revealed that co-responders valued the partnership for providing on-scene mental health support and assessment, real-world training during live emergencies, safety for both partners, and promoting trust with individuals in crisis. The hybrid model expanded service connections beyond mental health crises for substance use, grief counseling, and housing support. However, differing views on averting involuntary mental health examinations highlighted role conflicts rooted in liability concerns, alongside challenges such as securing consent for virtual consultations and limited partnership interactions. These data can guide agencies in refining hybrid models to align with frontline perspectives, especially in the absence of standardized interprofessional policies. Overall, this study has implications for broader behavioral health co-response teams that may involve other partners, such as paramedics in substance use crises.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":"551-573"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of and Barriers to Mental Health Services for Youth with Physical-Mental Multimorbidity: A Nationally Representative Study.","authors":"Alex Luther, Danielle Fearon, Laura Duncan, Scott T Leatherdale, Dillon Browne, Ian Colman, Joel A Dubin, Mark A Ferro","doi":"10.1007/s11414-026-10004-8","DOIUrl":"10.1007/s11414-026-10004-8","url":null,"abstract":"<p><p>Evidence suggests that 10-30% of youth have co-occurring physical and mental or neurodevelopmental disorders (multimorbidity) and that up to 40% of youth with multimorbidity that require mental health services report unmet mental health care needs. This study examined mental health service use (i.e., perceived need or utilization) and access barriers among youth with multimorbidity (n = 3307) in comparison to youth with mental or neurodevelopmental disorders only (n = 2391). Data come from the 2019 Canadian Health Survey on Children and Youth (youth aged 5-17 years). Physical health conditions and mental and neurodevelopmental disorders were measured using a standard checklist. Participants were asked about the reasons for youth mental health services, professional consults, and among those who endorsed need/use of services if they had experienced barriers to access. Overall, 66.1% of youth in the sample perceived a need for or used services related to focusing/controlling behaviors, mental health, or learning difficulties; of these, 39.5% experienced barriers to accessing services. Compared to youth with mental or neurodevelopmental disorders only, those with multimorbidity were more likely to perceive need for services for mental health (AOR = 1.29 [1.10, 1.48]), and to consult psychiatrists (AOR = 1.32 [1.14, 1.62]). There was no significant difference in the overall difficulty in accessing services (AOR = 1.11 [0.92, 1.28]); however, youth with multimorbidity were more likely to experience barriers due to service unavailability (AOR = 1.48 [1.09, 2.13]). Findings underscore the importance for health systems to adopt models of care that integrate physical and mental health services, and for policies that eliminate mental health service barriers for youth with multimorbidity.</p>","PeriodicalId":49040,"journal":{"name":"Journal of Behavioral Health Services & Research","volume":" ","pages":"651-663"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}