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D'Aunno T, Neighbors CJ. Innovation in the Delivery of Behavioral Health Services. Annu Rev Public Health 2024; 45:507-525. [PMID: 37871139 DOI: 10.1146/annurev-publhealth-071521-024027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Several factors motivate the need for innovation to improve the delivery of behavioral health services, including increased rates of mental health and substance use disorders, limited access to services, inconsistent use of evidence-based practices, and persistent racial and ethnic disparities. This narrative review identifies promising innovations that address these challenges, assesses empirical evidence for the effectiveness of these innovations and the extent to which they have been adopted and implemented, and suggests next steps for research. We review five categories of innovations: organizational models, including a range of novel locations for providing services and new ways of organizing services within and across sites; information and communication technologies; workforce; treatment technologies; and policy and regulatory changes. We conclude by discussing the need to strengthen and accelerate the contributions of implementation science to close the gap between the launch of innovative behavioral health services and their widespread use.
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Affiliation(s)
- Thomas D'Aunno
- Wagner Graduate School of Public Service, New York University, New York, NY, USA;
| | - Charles J Neighbors
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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Giusto A, Jack HE, Magidson JF, Ayuku D, Johnson S, Lovero K, Hankerson SH, Sweetland AC, Myers B, Fortunato Dos Santos P, Puffer ES, Wainberg ML. Global Is Local: Leveraging Global Mental-Health Methods to Promote Equity and Address Disparities in the United States. Clin Psychol Sci 2024; 12:270-289. [PMID: 38529071 PMCID: PMC10962902 DOI: 10.1177/21677026221125715] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Structural barriers perpetuate mental health disparities for minoritized US populations; global mental health (GMH) takes an interdisciplinary approach to increasing mental health care access and relevance. Mutual capacity building partnerships between low and middle-income countries and high-income countries are beginning to use GMH strategies to address disparities across contexts. We highlight these partnerships and shared GMH strategies through a case series of said partnerships between Kenya-North Carolina, South Africa-Maryland, and Mozambique-New York. We analyzed case materials and narrative descriptions using document review. Shared strategies across cases included: qualitative formative work and partnership-building; selecting and adapting evidence-based interventions; prioritizing accessible, feasible delivery; task-sharing; tailoring training and supervision; and mixed-method, hybrid designs. Bidirectional learning between partners improved the use of strategies in both settings. Integrating GMH strategies into clinical science-and facilitating learning across settings-can improve efforts to expand care in ways that consider culture, context, and systems in low-resource settings.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, 1147B Biology-Psychology Building College Park, MD 20742
| | - David Ayuku
- Department of Mental Health and Behavioural Sciences, College of Health Sciences Moi University, P. O. Box 4606-30100, Eldoret, Kenya
| | - Savannah Johnson
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
| | - Kathryn Lovero
- Department of Clinical Sociomedical Sciences in Psychiatry, Columbia Mailman School of Public Health, New York, NY, USA
| | - Sidney H Hankerson
- Department of Population Health Sciences & Policy, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Annika C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, New York, NY 10032
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Science, Curtin University, Perth, Australia; Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, South Africa
| | - Palmira Fortunato Dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Eve S Puffer
- Department of Neuroscience and Psychology, Duke University. Duke Global Health Institute, Durham, NC, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
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Byrne KA, Mericle AA, Litwin AH. Development and initial findings from the Peer Recovery Coach (PRC) checklist: a new tool to assess the nature of peer recovery coaching service delivery. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:159-169. [PMID: 36745742 DOI: 10.1080/00952990.2022.2164504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Peer recovery coaching is recovery support service for Substance Use Disorder (SUD) that emphasizes shared lived experience and social support. Though a promising intervention for SUD, differences in the roles, responsibilities, and operationalization of peer recovery coaching across studies make objective implementation and evaluation of this service a challenge.Objective: This study sought to develop a tool to better guide and operationalize peer recovery coaching service delivery. This study describes the initial development, acceptability, feasibility, and validity of this tool: The PRC Checklist.Methods: The PRC Checklist was conceptualized and operationalized by drawing from social support theory and recovery capital research. The PRC Checklist was utilized by PRCs in a pilot randomized controlled trial to demonstrate feasibility and acceptability. To further validate the PRC Checklist, recovery coaches (N = 16; 56% female) were recruited to complete a survey about their responsibilities and their perspectives on the content and potential utility of the PRC Checklist.Results: The PRC checklist used in the pilot study delineates personalized from generalized support and tracks 25 specific activities across three domains of support (i.e. socioemotional, informational, and instrumental). PRCs in the pilot study were able to use the PRC Checklist in all in-person initial baseline encounters and 96.4% of follow-up encounters. Qualitative information collected during project meetings was generally positive but also identified potential limitations to its use. All PRCs surveyed reported that they agreed that the PRC Checklist was helpful, encompassed the services they provided, represented a good idea, provided meaningful information, and would be easy to use. All five of the most common activities PRCs engaged in were reflected in the PRC Checklist.Conclusion: Capturing both personal and generalized support provided by PRCs, this work suggests that the PRC Checklist captures key activities engaged in and is a helpful tool for use in healthcare settings.
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Affiliation(s)
| | - Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
| | - Alain H Litwin
- Department of Addiction Medicine, Prisma Health - Upstate, Greenville, SC, USA
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Banks DE, Duello A, Paschke ME, Grigsby SR, Winograd RP. Identifying drivers of increasing opioid overdose deaths among black individuals: a qualitative model drawing on experience of peers and community health workers. Harm Reduct J 2023; 20:5. [PMID: 36639769 PMCID: PMC9839206 DOI: 10.1186/s12954-023-00734-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Black individuals in the USA face disproportionate increases in rates of fatal opioid overdose despite federal efforts to mitigate the opioid crisis. The aim of this study was to examine what drives increases in opioid overdose death among Black Americans based on the experience of key stakeholders. METHODS Focus groups were conducted with stakeholders providing substance use prevention services in Black communities in St. Louis, MO (n = 14). One focus group included peer advocates and volunteers conducting outreach-based services and one included active community health workers. Focus groups were held at community partner organizations familiar to participants. Data collection was facilitated by an interview guide with open-ended prompts. Focus groups were audio recorded and professionally transcribed. Transcripts were analyzed using grounded theory to abstract line-by-line codes into higher order themes and interpret their associations. RESULTS A core theme was identified from participants' narratives suggesting that opioid overdose death among Black individuals is driven by unmet needs for safety, security, stability, and survival (The 4Ss). A lack of The 4Ss was reflective of structural disinvestment and healthcare and social service barriers perpetuated by systemic racism. Participants unmet 4S needs are associated with health and social consequences that perpetuate overdose and detrimentally impact recovery efforts. Participants identified cultural and relationship-based strategies that may address The 4Ss and mitigate overdose in Black communities. CONCLUSIONS Key stakeholders working in local communities to address racial inequities in opioid overdose highlighted the importance of upstream interventions that promote basic socioeconomic needs. Local outreach efforts utilizing peer services can provide culturally congruent interventions and promote harm reduction in Black communities traditionally underserved by US health and social systems.
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Affiliation(s)
- Devin E. Banks
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Alex Duello
- grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Maria E. Paschke
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA
| | - Sheila R. Grigsby
- grid.266757.70000000114809378College of Nursing, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
| | - Rachel P. Winograd
- grid.266757.70000000114809378Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO USA ,grid.266757.70000000114809378Missouri Institute of Mental Health, University of Missouri—St. Louis, One University Blvd., St. Louis, MO USA
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Felton JW, Abidogun TM, Senters K, Maschino LD, Montgomery BW, Tyson R, Furr-Holden CD, Stoddard SA. Peer Recovery Coaches Perceptions of Their Work and Their Implications for Training, Support and Personal Recovery. Community Ment Health J 2023; 59:962-971. [PMID: 36595145 DOI: 10.1007/s10597-022-01080-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/17/2022] [Indexed: 01/04/2023]
Abstract
The peer recovery workforce, including individuals in sustained recovery from substance use, has grown rapidly in the previous decades. Peer recovery coaches represent a scalable, resource-efficient, and acceptable approach to increasing service delivery, specifically among individuals receiving substance use services in low-resource communities. Despite the potential to improve access to care in traditionally underserved settings, there are a number of barriers to successfully integrating peer recovery coaches in existing recovery services. The current study presents results from two focus groups composed of peer recovery coaches. Findings suggest that peer recovery coaches report discordance between their perceived role and their daily responsibilities and experience both inter- and intrapersonal challenges that impact their own recovery processes. These results point to several promising policy and structural changes that may support and enhance this growing workforce.
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Affiliation(s)
- Julia W Felton
- Center for Health Policy & Health Services Research, Henry Ford Health Systems, One Ford Place, Detroit, MI, USA.
| | | | | | - Leah D Maschino
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Barrett W Montgomery
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | | | - C Debra Furr-Holden
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA.,School of Global Public Health, New York University, New York, USA
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Ware OD, Buresh ME, Irvin NA, Stitzer ML, Sweeney MM. Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100093. [PMID: 36644224 PMCID: PMC9835716 DOI: 10.1016/j.dadr.2022.100093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction Brief intervention with peer recovery coach support has been used to generate referrals to substance use disorder treatment from the emergency department (ED). This retrospective study evaluated factors associated with successful linkage to treatment following brief intervention in the ED. Methods Data were extracted from the electronic health record for patients who were referred to substance use treatment from the ED and for whom follow-up data regarding treatment attendance was available (n=666). We examined associations between demographic and insurance variables, substance use, mental health diagnosis, prior abstinence, and stage of change with successful linkage to substance use treatment after ED referral. Results The sample was majority male (68%), White (62%), and had a mean age of 43 years (SD=12). Medicaid was the most common insurance (49%) followed by employer/private (34%). Multivariable logistic regression determined patients with Medicaid (OR=2.94, 95% CI:2.09-4.13, p=<.001), those who had a documented alcohol use disorder diagnosis (OR=1.59, 95% CI:1.074-2.342, p=.02), and those in the "Action" stage of change (OR=2.33, 95% CI:1.47-3.69, p=<.001) had greater odds of being successfully linked to treatment. Conclusions These results identify characteristics of patients available in the health record to determine who is more likely or less likely to attend substance use treatment following ED referral. Given appropriate screening, this information could be used to direct standard care resources to those with high likelihood of treatment attendance and strengthen follow-up interventions with peer recovery coaches for those with lower likelihood of treatment attendance.
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Affiliation(s)
- Orrin D. Ware
- School of Social Work, The University of North Carolina at Chapel Hill, 325 Pittsboro Street, Chapel Hill, NC 27599, USA,Corresponding author. (O.D. Ware)
| | - Megan E. Buresh
- Johns Hopkins University School of Medicine,Department of Medicine, Division of Addiction Medicine, 5200 Mason F. Lord Drive, Baltimore, MD 21224, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Nathan A. Irvin
- Johns Hopkins University School of Medicine,Department of Emergency Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Maxine L. Stitzer
- Johns Hopkins University School of Medicine,Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA,Friends Research Institute, 1040 Park Avenue, Baltimore, MD 21201, USA
| | - Mary M. Sweeney
- Johns Hopkins University School of Medicine,Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
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Speed TJ, Hanks L, Turner G, Gurule E, Kearson A, Buenaver L, Smith MT, Antoine D. A comparison of cognitive behavioral therapy for insomnia to standard of care in an outpatient substance use disorder clinic embedded within a therapeutic community: a RE-AIM framework evaluation. Trials 2022; 23:965. [DOI: 10.1186/s13063-022-06885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Rates of substance use disorders (SUDs) continue to rise in the USA with parallel rises in admissions to outpatient SUD treatment programs. Insomnia symptoms reduce treatment adherence, trigger relapse, and generally undermine SUD recovery efforts. Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended for chronic insomnia. No study has examined the effectiveness of CBT-I for individuals who recently entered an outpatient SUD treatment program embedded within a therapeutic community (i.e., long-term drug-free residential setting).
Methods
A randomized controlled trial conducted at a SUD program embedded in a therapeutic community aimed to compare group-based CBT-I (gCBT-I) (N = 10) with the standard of care (SOC) (N = 11) among individuals who have SUDs and comorbid insomnia. We present a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework evaluation to provide empirical data on gCBT-I feasibility and facilitators and barriers of conducting an insomnia-focused clinical effectiveness study within a therapeutic community.
Results
Participants in both study arms reported moderately severe insomnia symptoms at admission and reductions in insomnia symptoms over time. Among participants who completed the Insomnia Severity Index (ISI) beyond admission, ISI decreased to ≤ 8 (the clinical cutoff for mild insomnia) in 80% of individuals in the gCBT-I group compared with 25% of individuals in the SOC group. A RE-AIM framework evaluation showed initial success with Reach and Adoption while Implementation, and Maintenance were limited. Effectiveness was inconclusive because of challenges with recruitment, intervention integrity, and missing data that precluded meeting the planned recruitment and study aims and led to study termination. Coordination and communication with staff and leadership facilitated gCBT-I implementation, yet well-known CBT-I barriers including time- and resource-intensive sleep medicine training for interventionalists and maintenance of treatment integrity during an 8-week intervention limited gCBT-I sustainability.
Conclusions
This analysis supports the feasibility of conducting behavioral sleep medicine research in outpatient SUD treatment programs embedded within therapeutic communities. Implementation of an insomnia-focused intervention was widely accepted by patients and providers and has potential to address insomnia symptoms in early SUD recovery. Addressing patient- and organizational-level implementation barriers may enhance the sustainability and scalability of sleep interventions and provide new hope to effectively treat insomnia among people living with SUDs.
Trial registration
Clinicaltrials.gov: NCT03208855. Registered July 6, 2017https://clinicaltrials.gov/ct2/show/NCT03208855?term=NCT03208855&draw=2&rank=1
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Crowthers RA, Arya M, Venkataraman A, Lister JJ, Cooper SE, Enich M, Stevens S, Bender E, Sanders R, Stagliano K, Jermyn RT. Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders. J Osteopath Med 2022; 122:521-529. [PMID: 35802066 DOI: 10.1515/jom-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT The United States has witnessed a disproportionate rise in substance use disorders (SUD) and co-occurring mental health disorders, paired with housing instability, especially among racially minoritized communities. Traditional in-patient residential treatment programs for SUD have proven inconsistent in their effectiveness in preventing relapse and maintaining attrition among these patient populations. There is evidence showing that peer recovery programs led by individuals who have lived experience with SUD can increase social support and foster intrinsic motivation within participants to bolster their recovery. These peer recovery programs, when coupled with a standardized training program for peer recovery coaches, may be very efficacious at improving patient health outcomes, boosting performance on Substance Abuse and Mental Health Services Administration (SAMHSA) national outcome measures (NOMs), and helping participants build an overall better quality of life. OBJECTIVES The goal of this study is to highlight the efficacy of a peer recovery program, the Minority Aids Initiative, in improving health outcomes and associated NOMs in men with SUD and/or co-occurring mental health disorder. METHODS Participants received six months of peer recovery coaching from trained staff. Sessions were guided by the Manual for Recovery Coaching and focused on 10 different domains of recovery. Participants and coaches set long-term goals and created weekly action plans to work toward them. Standardized assessments (SAMHSA's Government Performance and Results Act [GPRA] tool, Addiction Severity Index [ASI]) were administered by recovery coaches at intake and at the 6-month time point to evaluate participant progress. Analyses of participant recovery were carried out according to SAMHSA's six NOMs and assessed the outcomes of the intervention and their significance. RESULTS A total of 115 participants enrolled in the program over a 2-year period. Among them, 53 were eligible for 6-month follow-up interviews. In total, 321 sessions were held, with an average of three sessions per participant. Participants showed marked improvement across five of the six NOMs at the end of the 6-month course and across all ASI outcomes, with the exception of three in which participants reported an absence or few symptoms at intake. CONCLUSIONS Our study shows that participants receive benefits across nearly all NOM categories when paired with recovery coaches who are well trained in medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD) over a 6-month period. We see the following: a higher rate of abstinence; increased housing stability; lower health, behavioral, and social consequences; lower depression and anxiety; longer participant-recovery coach exposure time; and higher follow-up rates. We hope that our results can contribute to advancements and greater acceptance in the implementation of peer recovery coaching as well as an improvement in the lives of the communities affected by substance use.
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Affiliation(s)
- Raymond A Crowthers
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Milan Arya
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Arvind Venkataraman
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Jamey J Lister
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Sarah E Cooper
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Michael Enich
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Scott Stevens
- Maryville Addiction Treatment Center, Williamstown, NJ, USA.,Maryville Addiction Treatment Center, Pemberton, NJ, USA
| | - Emily Bender
- Maryville Addiction Treatment Center, Williamstown, NJ, USA.,Maryville Addiction Treatment Center, Pemberton, NJ, USA
| | - Roynell Sanders
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Kenneth Stagliano
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Richard T Jermyn
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
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Stanojlović M, Allen R, Valentine P, Davidson L, O’Connell M. Recovery Coaching In and Out of Emergency Departments: an Overview of the Connecticut Community for Addiction Recovery’s (CCAR) Emergency Department Recovery Coaching Program. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00772-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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