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Montoya ID, Watson C, Aldridge A, Ryan D, Murphy SM, Amuchi B, McCollister KE, Schackman BR, Bush JL, Speer D, Harlow K, Orme S, Zarkin GA, Castry M, Seiber EE, Barocas JA, Linas BP, Starbird LE. Cost of start-up activities to implement a community-level opioid overdose reduction intervention in the HEALing Communities Study. Addict Sci Clin Pract 2024; 19:23. [PMID: 38566249 PMCID: PMC10988809 DOI: 10.1186/s13722-024-00454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility. METHODS This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states-Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars. RESULTS State-level average and median start-up cost (representing 8-10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost. CONCLUSION We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.
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Affiliation(s)
- Iván D Montoya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Danielle Ryan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Brenda Amuchi
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Joshua L Bush
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Drew Speer
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Kristin Harlow
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stephen Orme
- RTI International, Research Triangle Park, NC, USA
| | | | - Mathieu Castry
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Eric E Seiber
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Joshua A Barocas
- Sections of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin P Linas
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Laura E Starbird
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
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Siddiqui ST, La Manna A, Connors E, Smith R, Vance K, Budesa Z, Goulka J, Beletsky L, Wood CA, Marotta P, Winograd RP. An evaluation of first responders' intention to refer to post-overdose services following SHIELD training. Harm Reduct J 2024; 21:39. [PMID: 38351046 PMCID: PMC10863209 DOI: 10.1186/s12954-024-00957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND First responders [law enforcement officers (LEO) and Fire/Emergency Medical Services (EMS)] can play a vital prevention role, connecting overdose survivors to treatment and recovery services. This study was conducted to examine the effect of occupational safety and harm reduction training on first responders' intention to refer overdose survivors to treatment, syringe service, naloxone distribution, social support, and care-coordination services, and whether those intentions differed by first responder profession. METHODS First responders in Missouri were trained using the Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model. Trainees' intent to refer (ITR) overdose survivors to prevention and supportive services was assessed pre- and post-training (1-5 scale). A mixed model analysis was conducted to assess change in mean ITR scores between pre- and post-training, and between profession type, while adjusting for random effects between individual trainees and baseline characteristics. RESULTS Between December 2020 and January 2023, 742 first responders completed pre- and post-training surveys. SHIELD training was associated with higher first responders' intentions to refer, with ITR to naloxone distribution (1.83-3.88) and syringe exchange (1.73-3.69) demonstrating the greatest changes, and drug treatment (2.94-3.95) having the least change. There was a significant increase in ITR score from pre- to post-test (β = 2.15; 95% CI 1.99, 2.30), and LEO-relative to Fire/EMS-had a higher score at pre-test (0.509; 95% CI 0.367, 0.651) but a lower score at post-test (0.148; 95% CI - 0.004, 0.300). CONCLUSION Training bundling occupational safety with harm reduction content is immediately effective at increasing first responders' intention to connect overdose survivors to community substance use services. When provided with the rationale and instruction to execute referrals, first responders are amenable, and their positive response highlights the opportunity for growth in increasing referral partnerships and collaborations. Further research is necessary to assess the extent to which ITR translates to referral behavior in the field.
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Affiliation(s)
- Saad T Siddiqui
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA.
| | - Anna La Manna
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Elizabeth Connors
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Ryan Smith
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Kyle Vance
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Zach Budesa
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Jeremiah Goulka
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Leo Beletsky
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Phillip Marotta
- Department of Social Work, Brown School, Washington University in St. Louis, St. Louis, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
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Gelberg KH, Chase R, Lindstrom M, Hochstatter KR, Larochelle L, Hunt T. Need for Improved Timeliness of Reporting on Drug Overdose Fatalities: The HEALing Communities Study. Public Health Rep 2024; 139:72-78. [PMID: 36951207 PMCID: PMC10905759 DOI: 10.1177/00333549231161339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE Timely data on drug overdose deaths can help identify community needs, evaluate the effectiveness of interventions, and allocate resources. We identified variations in death investigation and reporting systems within and between states that affect the timeliness and accuracy of death certificate information. METHODS The HEALing Communities Study (HCS) is a community-engaged, data-driven approach to combating the opioid crisis in 67 communities in 4 states: Kentucky, Massachusetts, New York, and Ohio. HCS conducted a survey of coroners and medical examiners to understand variability in drug overdose death data. We compared survey results in Massachusetts, New York, and Ohio with national data to investigate the completeness of provisional death counts by type of death investigation system. RESULTS Communities in each HCS state had different ways of collecting and reporting mortality data. Completion of death certificates for drug overdoses ranged from <2 weeks in 23% (7 of 31) of those surveyed to more than 3 months in 10% (3 of 31) of those surveyed. Variabilities in the timeliness of reporting drug overdose deaths were not associated with type of coroner or medical examiner office in each state, urban versus rural setting, or specificity of drug information on the death certificate. CONCLUSION Having specific drug information on the death certificate may increase death certificate quality, comparability, and accuracy. We recommend the following: (1) all coroners and medical examiners should be trained on conducting death investigations, interpreting toxicology reports, and completing death certificates; (2) 1 office in each state should oversee all coroners and medical examiners to increase data consistency; and (3) communities should identify and address barriers to timely death certification.
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Affiliation(s)
| | - Rachel Chase
- HEALing Communities Study, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan Lindstrom
- HEALing Communities Study, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Lauren Larochelle
- Injury Surveillance Program, Massachusetts Department of Public Health, Boston, MA, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
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Agley J, Gassman R, Reho K, Roberts J, Heil SKR, Golzarri-Arroyo L, Eddens K. Organizational Network Analysis of SAMHSA's Technology Transfer Center (TTC) Network. J Behav Health Serv Res 2024; 51:123-131. [PMID: 37872261 PMCID: PMC10733212 DOI: 10.1007/s11414-023-09867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
Technology transfer centers (TTCs) facilitate the movement of evidence-based practices in behavioral healthcare from theory to practice. One of the largest such networks is the Substance Abuse and Mental Health Services Administration's (SAMHSA) TTC Network. This brief report shares findings from an organizational network analysis (ONA) of the network conducted as part of an external evaluation. For non-supervisory TTCs (n = 36) across three focus areas (addiction, prevention, and mental health), the authors computed network density, harmonic closeness, and non-null dyadic reciprocity for five types of interactions (e.g., "collaborated in workgroups"), then, for each interaction type, used Welch's T-test to compare mean harmonic closeness of standalone TTC grantees versus multiple-TTC grantees. ONA identified potentially isolated regional TTCs as well as mismatches between some centers' desired scope and their network centrality and enabled investigation of broader questions around behavioral health support systems. The approach appears useful for evaluating TTCs and similar support networks.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA.
| | - Ruth Gassman
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Kaitlyn Reho
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Jeffrey Roberts
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Susan K R Heil
- American Institutes for Research (AIR), Arlington, VA, USA
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
| | - Kate Eddens
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
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Chung DH, Slat S, Rao A, Thomas J, Kehne A, Macleod C, Madden EF, Lagisetty P. Improving Medical Student Knowledge and Reducing Stigmatizing Attitudes Toward Treating Patients With Opioid Use Disorder. Subst Use 2024; 18:11782218241234808. [PMID: 38433746 PMCID: PMC10908233 DOI: 10.1177/11782218241234808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
Objectives Stigma and lack of knowledge are barriers to clinicians when caring for individuals with opioid use disorder (OUD). In 2018, only about 15 out of 180 American medical schools had comprehensive addiction programs. The AAMC reports that institutions are increasingly incorporating competencies to address the OUD and opioid epidemic. There have been few evaluated curriculums focused on reducing stigmatizing attitudes. This study evaluated whether a 4-hour case-based curriculum focused on improving stigmatizing attitudes toward patients with OUD could reduce medical student perceptions around viewing addiction as a punitive condition and other substitution-based misconceptions around opioid agonist-based medication. Methods Medical students completed a 4-hour curricular workshop which included learning objectives focusing on barriers to healthcare/stigmatizing attitudes, effective behavioral therapy options, and appropriate use of opioid medications. We measured changes in knowledge and attitudes using validated scales on stigma. Non-parametric repeated measure tests determined statistically significant differences between pre and post assessments between OUD related perceptions and a control condition (diabetes). Results Of 135 eligible participants, 99 (76%) students completed both pre- and post-surveys. Mean scores across knowledge questions improved (60%-81%, P < .001) and stigmatizing attitudes regarding perceived violence of people with OUD decreased (2.04-1.82, P = .016). There was significant improvement in mean scores for OUD-related opinions including desire to work with and effectively treat patients with OUD (3.58-3.88, P < .001) while no significant concurrent change was observed in mean opinion scores of a non-OUD comparator, diabetes (3.88-3.97, P = .201). Conclusions Results indicate that the workshop was associated with measurable changes in knowledge and attitudinal forms of OUD stigma. With recent policy changes eliminating the X-waiver, healthcare institutions are eager to design curriculum around OUD management and treatment. This study provides a blueprint for an effective curriculum that improves clinician knowledge and reduces stigmatizing attitudes.
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Affiliation(s)
- Dana H. Chung
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aditi Rao
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Thomas
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Adrianne Kehne
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Colin Macleod
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erin F. Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA
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Sternberger L, Sorensen-Alawad A, Prescott T, Sakai H, Brown K, Finkelstein N, Salomon A, Schiff DM. Lessons Learned Serving Pregnant, Postpartum, and Parenting People with Substance Use Disorders in Massachusetts: The Moms Do Care Program. Matern Child Health J 2023; 27:67-74. [PMID: 37792152 PMCID: PMC10692242 DOI: 10.1007/s10995-023-03775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The purpose of this paper is to describe the design and implementation of a multidisciplinary, integrated approach to supporting pregnant, postpartum, and parenting people (PPPP) and their families affected by substance use disorders (SUD). DESCRIPTION Between 2015 and 2022, the Moms Do Care (MDC) Program, sponsored by the Massachusetts Department of Public Health Bureau of Substance Addiction Services, established or expanded 11 co-located medical and behavioral health teams in locations across Massachusetts. These teams provided trauma-informed primary and obstetrical health care, SUD treatment and recovery services, parenting support, and case management for approximately 1048 PPPP with SUD. ASSESSMENT By enhancing the capacity of medical and behavioral health providers offering integrated care across the perinatal health care continuum, MDC created a network of support for PPPP with SUD. Lessons learned include the need to continually invest in staff training to foster teambuilding and improve integrated service delivery, uplift the peer recovery coach role within the care team, improve engagement with and access to services for communities of color, and conduct evaluation and sustainability planning. CONCLUSION MDC prioritizes trauma-informed integrated care, peer recovery, and commits to addressing inequities and stigma; thus, this program represents a promising approach to supporting PPPP impacted by SUD. The MDC model is relevant for those working to build multidisciplinary, integrated systems of health care and perinatal SUD services for marginalized populations.
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Affiliation(s)
| | | | | | - Hibiki Sakai
- Advocates for Human Potential, Inc. Center for Research and Evaluation, Chicago, USA
| | - Kayla Brown
- Advocates for Human Potential, Inc. Center for Research and Evaluation, Sudbury, USA
| | | | - Amy Salomon
- Advocates for Human Potential, Inc. Center for Research and Evaluation, Sudbury, USA
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Marks KR, Oyler DR, Strickland JC, Jaggers J, Roberts MF, Miracle DK, Barnes C, Lei F, Smith A, Mackin E, Martin MC, Freeman PR. Bystander preference for naloxone products: a field experiment. Harm Reduct J 2023; 20:171. [PMID: 38017424 PMCID: PMC10685501 DOI: 10.1186/s12954-023-00904-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Bystander administration of naloxone is a critical strategy to mitigate opioid overdose mortality. To ensure bystanders' willingness to carry and administer naloxone in response to a suspected overdose, it is critical to select products for community distribution with the highest likelihood of being utilized. This study examines bystanders' preference for and willingness to administer three naloxone products approved by the FDA for bystander use and identify product features driving preference. METHODS The population was a convenience sample of individuals who attended the Kentucky State Fair, August 18-28, 2022, in Louisville, Kentucky. Participants (n = 503) watched a standardized overdose education and naloxone training video, rated their willingness to administer each of three products (i.e., higher-dose nasal spray, lower-dose nasal spray, intramuscular injection), selected a product to take home, and rated factors affecting choice. RESULTS After training, 44.4% chose the higher-dose nasal spray, 30.1% chose the intramuscular injection, and 25.5% chose the lower-dose nasal spray. Factors most influencing choice on a 10-point Likert scale were ease of use (9 [7-10]), naloxone dose (8 [5-10]), and product familiarity (5 [5-9]). CONCLUSIONS Bystanders expressed high willingness to administer all studied formulations of naloxone products. Product choice preference varied as a function of product features. As the number and variety of available products continue to increase, continuous evaluation of formulation acceptability, in addition to including individuals with lived experience who are receiving and administering overdose reversal agents, is critical to support adoption and save lives.
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Affiliation(s)
- Katherine R Marks
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA.
- Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, 275 E. Main Street, Frankfort, KY, 40621, USA.
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jody Jaggers
- Kentucky Pharmacy Education and Research Foundation, Frankfort, KY, USA
| | - Monica F Roberts
- Substance Use Priority Research Area, University of Kentucky, Lexington, KY, USA
| | - Dustin K Miracle
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Chase Barnes
- Kentucky Department for Public, Health Division of Public Health Protection & Safety, Frankfort, KY, USA
| | - Feitong Lei
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Amanda Smith
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Eric Mackin
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Martika C Martin
- Kentucky Pharmacy Education and Research Foundation, Frankfort, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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Dahlem CH, Patil R, Khadr L, Ploutz-Snyder RJ, Boyd CJ, Shuman CJ. Effectiveness of take ACTION online naloxone training for law enforcement officers. Health Justice 2023; 11:47. [PMID: 37979100 PMCID: PMC10656891 DOI: 10.1186/s40352-023-00250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Training law enforcement officers (LEOs) to administer naloxone is a recommended strategy to reduce overdose deaths in the United States. To achieve this, an evidence-based and scalable naloxone training curriculum that is easy to use and readily scalable is needed. Convenient web-based training is a flexible method for delivering educational interventions particularly for LEOs who have irregular or shifting schedules. This study examined the effectiveness of a comprehensive web-based naloxone training that was created in partnership with LEOs on their knowledge, confidence, and attitudes regarding naloxone. METHODS From May 2019 to September 2020, five law enforcement departments from Michigan participated in web-based naloxone training. A total of 182 LEOs (77% male) were in the final sample based on matching pre-and post-test surveys. LEOs were assessed on knowledge, confidence, and attitudes towards naloxone. Negative binomial and Poisson regression was conducted to assess associations between knowledge, confidence, and attitudes towards naloxone before and after training. RESULTS Significant improvements in overdose knowledge and confidence were revealed across all departments with median (IQR) total composite scores for knowledge increasing from 35 (32, 37) to 40 (39, 42) (p < 0.01) and confidence increasing from 18.5 (15, 20) to 20 (20, 25) (p < 0.01). Median (IQR) attitude scores did not change. CONCLUSION Our web-based naloxone training was effective in improving knowledge and confidence for LEOs but did not significantly improve LEOs attitudes towards naloxone across most departments. The web-based format is readily scalable and quickly disseminated and meets the immediate need for LEO overdose training. Additional intervention is needed to address the negative attitudes of LEOs regarding naloxone.
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Affiliation(s)
- Chin Hwa Dahlem
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA.
| | - Rohan Patil
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
| | - Lara Khadr
- Applied Biostatistics Laboratory, Ann Arbor, USA
| | | | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
| | - Clayton J Shuman
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
- Department of System Populations and Leadership, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
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Mueller-Williams AC, Hopson J, Momper SL. Evaluating the Effectiveness of Suicide Prevention Gatekeeper Trainings as Part of an American Indian/Alaska Native Youth Suicide Prevention Program. Community Ment Health J 2023; 59:1631-1638. [PMID: 37558869 PMCID: PMC10598093 DOI: 10.1007/s10597-023-01154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/04/2023] [Indexed: 08/11/2023]
Abstract
According to the Centers for Disease Control suicide rates in 2022 for American Indian/Alaska Native youth are 2.5 times higher than the national average. An Urban Indian Health Organization's response to this crisis was to provide community and State-wide Gatekeeper trainings between 2012 and 2019 to teach trainees (N = 810) to respond appropriately to youth at-risk of suicide. We report data on pre-, post-, and six-month follow-up surveys with trainees. Data were analyzed using generalized linear models repeated measures to test within-subject, and between-subject mean score changes on suicide prevention-related measures "knowledge," "ask directly," "respond," "comfort," and "preparedness." Results indicated improved capacity to be prepared to address suicide in the short term and that having a graduate degree enhanced baseline suicide prevention knowledge. Over time those with less education benefited the most and better retained content. Future Trainings should engage young people and those with less education to realize the largest benefit.
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Affiliation(s)
| | - Jennifer Hopson
- School of Social Work, University of Michigan, Ann Arbor, USA
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10
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Evans B, Kamon J, Turner WC. Lessons in Implementation from a 5-Year SBIRT Effort Using a Mixed-Methods Approach. J Behav Health Serv Res 2023; 50:431-451. [PMID: 37027121 PMCID: PMC10081296 DOI: 10.1007/s11414-023-09835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 04/08/2023]
Abstract
SBIRT is an effective process to target unhealthy alcohol and other substance use in medical settings, yet gaps persist on how best to integrate SBIRT into routine clinical practice. Utilizing a mixed-methods design, the current study examined a statewide SBIRT implementation effort to identify key components of successful implementation. Quantitative patient-level data (n = 61,121) were analyzed to assess characteristics associated with implementation, and key informant interviews were conducted with stakeholders to understand the implementation process. Findings demonstrated variation in intervention rates, and both site- and patient-level factors influenced SBIRT service delivery. Qualitative results highlighted critical factors shaping these differences, including staff perceptions, type of leadership, degree of flexibility, and the health reform context. Study findings illustrate the importance of a supportive outer context, key facilitators such as buy-in, dynamic leadership, and flexibility during implementation, and the impact of site and patient characteristics for the successful integration of SBIRT into medical settings.
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Affiliation(s)
| | - Jody Kamon
- The Center for Behavioral Health Integration, Montpelier, VT, USA
| | - Win C Turner
- The Center for Behavioral Health Integration, Montpelier, VT, USA
- Stonybrook University, Long Island, NY, USA
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11
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De Oliveira JM, Dueñas JM, Morales-Vives F, Gallardo-Nieto E. Educational agents and institutions called into action in suicide prevention, intervention, and postvention. Front Psychol 2023; 14:1213751. [PMID: 37780143 PMCID: PMC10539586 DOI: 10.3389/fpsyg.2023.1213751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Suicide is the second leading cause of death in the 15 to 29 age group worldwide, and is a severe public health problem. Adolescent and young adult individuals attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to identify what educational institutions and agents are called into action in suicide prevention, intervention, and postvention. Methods The method of systematic review of the literature based on the PRISMA protocol was used. The review protocol was registered in PROSPERO (PROSPERO 2020 CRD42020189127). The systematic review yielded 66 articles published between 1990 and February 2023. Results The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention, interventions and postvention between primary education and college. The study describes the different programs that have been provided, the countries in which they have been implemented and the agents who have been targeted. It also identifies gaps in the research on suicide in the educational field. Discussion Overall, educational suicide initiatives report positive effects on participants' understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution.
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Affiliation(s)
| | - Jorge-Manuel Dueñas
- Research Center for Behavior Assessment, Psychology Department, Universitat Rovira i Virgili, Tarragona, Spain
| | - Fabia Morales-Vives
- Research Center for Behavior Assessment, Psychology Department, Universitat Rovira i Virgili, Tarragona, Spain
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12
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Lin VJT, Rieck H, Gunaseelan V, Wixson M, Waljee JF, Brummett CM, Englesbe MJ, Bicket MC. The acceptability and utility of opioid and other high-risk substance use screening as implemented within the perioperative workflow. Pain Med 2023; 24:1116-1118. [PMID: 37040080 PMCID: PMC10472483 DOI: 10.1093/pm/pnad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Victor J T Lin
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Heidi Rieck
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Vidhya Gunaseelan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
| | - Matthew Wixson
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jennifer F Waljee
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
| | - Michael J Englesbe
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
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Tom MA, Edson TC, Louderback ER, Nelson SE, Amichia KA, LaPlante DA. Second Session at the Virtual Poker Table: A Contemporary Study of Actual Online Poker Activity. J Gambl Stud 2023; 39:1295-1317. [PMID: 35882744 PMCID: PMC9325659 DOI: 10.1007/s10899-022-10147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 12/01/2022]
Abstract
Technological advancements and worldwide television exposure led to a poker boom in the early 2000s, and poker (both live and online) has retained some of that popularity today. The present study examined online poker playing trends based on actual electronic betting records data for 2489 subscribers to a major global internet gambling operator from 2015 to 2017. We found that overall financial involvement (median total overall spend: €439.7) and time commitment (median number of sessions: 43) during the two-year study period were relatively moderate. We identified the top 1% by total overall spend as a subgroup of highly involved players with disproportionately higher financial involvement (median total overall spend: €272,581.4) and time commitment (median number of sessions: 1149). Our results were similar to those reported in LaPlante et al.'s (Comput Hum Behav 25(3):711-717, 2009. https://doi.org/10.1016/j.chb.2008.12.027 ) study of online poker betting records, suggesting that players' levels of involvement are similar to those from ten years ago despite numerous changes to the online poker environment. We also analyzed records of deposits and withdrawals, and we observed similar indicators of moderate gambling behavior within the overall sample (median two-year total amount deposited: €176.4). In contrast to popular beliefs about internet gambling, in our sample, most online poker play was arguably moderate. However, a small percentage of highly involved players play poker at extreme levels and require closer scrutiny.
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Affiliation(s)
- Matthew A Tom
- Division on Addiction, Suite 630, Cambridge Health Alliance, Malden, MA, 02148, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Timothy C Edson
- Division on Addiction, Suite 630, Cambridge Health Alliance, Malden, MA, 02148, USA
- Harvard Medical School, Boston, MA, USA
| | - Eric R Louderback
- Division on Addiction, Suite 630, Cambridge Health Alliance, Malden, MA, 02148, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah E Nelson
- Division on Addiction, Suite 630, Cambridge Health Alliance, Malden, MA, 02148, USA
- Harvard Medical School, Boston, MA, USA
| | - Karen A Amichia
- Division on Addiction, Suite 630, Cambridge Health Alliance, Malden, MA, 02148, USA
| | - Debi A LaPlante
- Division on Addiction, Suite 630, Cambridge Health Alliance, Malden, MA, 02148, USA
- Harvard Medical School, Boston, MA, USA
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14
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Sprang G, Gusler S, LaJoie S, Eslinger J, Smith E. Using Project ECHO to Keep Professionals Well at Work: Individual and Organizational Outcomes. Acad Psychiatry 2023; 47:385-389. [PMID: 36795276 PMCID: PMC9933790 DOI: 10.1007/s40596-023-01754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The toll of COVID-19 stress on the mental health of the workforce has been well-documented. The present study examined the use of the Project ECHO framework to provide practices and resources on stress management and emotion regulation to increase individual and organizational health and well-being. METHODS Three independent ECHOs were designed and conducted over an 18-month period. Data was collected on the implementation of new learning and comparisons of organizational efforts toward being more secondary trauma responsive from baseline to post initiative, using cloud-based survey methods. RESULTS Findings suggest that the use of micro-interventions at the organizational level improved over time in the areas of resilience-building and policy-making, and that individuals were actively integrating skills related to managing their stress. CONCLUSIONS Lessons learned adapting and implementing ECHO strategies in the midst of a pandemic are offered, as well as how to cultivate wellness champions in the workforce.
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15
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Fernandez AC, Aslesen H, Golmirzaie G, Stanton S, Gunaseelan V, Waljee J, Brummett CM, Englesbe M, Bicket MC. Patient Responses to Surgery-relevant Screening for Opioid and Other Risky Substance Use Before Surgery: A Pretest-posttest Study. Pain Med 2023; 24:896-899. [PMID: 36478099 PMCID: PMC10321761 DOI: 10.1093/pm/pnac190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 12/01/2022] [Indexed: 07/20/2023]
Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Heidi Aslesen
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Goodardz Golmirzaie
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sofea Stanton
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
| | - Vidhya Gunaseelan
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Waljee
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Englesbe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Correspondence to: Mark Bicket, MD, PhD, Department of Anesthesiology, University of Michigan School of Medicine, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA. E-mail:
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16
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Moore KE, Wyatt JP, Phillips S, Burke C, Bellamy C, McKee SA. The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis. Health Justice 2023; 11:25. [PMID: 37191937 PMCID: PMC10186797 DOI: 10.1186/s40352-023-00225-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND People with substance use disorders (SUD) who have been involved in the legal system often experience stigma upon reentry into the community after incarceration. Although substance use treatment can sometimes be a source of stigma, it may also reduce stigma by facilitating connections with providers, reducing distress, or helping people feel more integrated in their community. However, research has rarely examined the potential for treatment to reduce stigma. METHODS This study examined stigma experiences and the degree to which substance use treatment reduced stigma among 24 people with SUDs who were receiving care in an outpatient treatment facility after release from incarceration. Qualitative interviews were conducted and analyzed using a content analysis approach. RESULTS Participants reported negative self-judgements as well as perceiving negative judgments from the community upon reentry. With regard to stigma reduction, themes emerged around substance use treatment repairing strained family relationships and reducing participants' self-stigma. Aspects of treatment that reportedly reduced stigma included the treatment facility having a nonjudgmental atmosphere, patients trusting the staff, and working with peer navigators who had lived experience of SUD and incarceration. CONCLUSIONS Results from this study suggest that substance use treatment has the potential to decrease the negative impacts of stigma upon release from incarceration, which continues to be a major barrier. Though more research on stigma reduction is needed, we suggest some preliminary considerations for treatment programs and providers.
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Affiliation(s)
- Kelly E Moore
- East Tennessee State University, 420 Rogers-Stout Hall, P.O. Box 70649, Johnson City, TN, 37614, USA.
| | - Janan P Wyatt
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Sarah Phillips
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Catherine Burke
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Chyrell Bellamy
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
| | - Sherry A McKee
- Yale University School of Medicine, 2 Church St. South, #109, New Haven, CT, 06519, USA
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17
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Stanojlović M, O’Connell M, Asby D, Lanteri S, Davidson L, Tondora J. Implementing Person-Centered Recovery Planning: New England Mental Health Technology Transfer Center Learning Collaborative Evaluation Report. Glob Implement Res Appl 2023; 3:173-181. [PMID: 37304056 PMCID: PMC10088648 DOI: 10.1007/s43477-023-00078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/27/2023] [Indexed: 06/13/2023]
Abstract
Person-centered recovery planning (PCRP) has been a key aspect in mental health system transformation and delivering quality health care. Despite the mandate to deliver this practice and a growing evidence base, its implementation and understanding of implementation processes in behavioral health settings remain a challenge. New England Mental Health Technology Transfer Center (MHTTC) launched the PCRP in Behavioral Health Learning Collaborative to support agencies' implementation efforts through training and technical assistance. In an effort to explore and understand the internal implementation process changes facilitated by the learning collaborative, the authors conducted qualitative key informant interviews with the participants and the leadership of the PCRP learning collaborative. The interviews revealed the processes that are part of the PCRP implementation efforts, including staff training, changing agency policies and procedures, modifying treatment planning tools, and the structure of the electronic health records. The higher prior organizational investment and readiness for change, building staff's competencies in PCRP, leadership investment, and frontline staff buy-in act as factors that facilitate the implementation of PCRP in behavioral health settings. Our findings inform both the implementation of PCRP in behavioral health settings and future efforts of organizing multi-agency learning collaboratives to support PCRP implementation. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00078-3.
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Affiliation(s)
- Milena Stanojlović
- Program for Recovery and Community Health (PRCH), Department of Psychiatry, School of Medicine, Yale University, 319 Peck Street, Erector Square, Bldg. 1, New Haven, CT 06513 USA
| | - Maria O’Connell
- Program for Recovery and Community Health (PRCH), Department of Psychiatry, School of Medicine, Yale University, 319 Peck Street, Erector Square, Bldg. 1, New Haven, CT 06513 USA
| | - Dana Asby
- Program for Recovery and Community Health (PRCH), Department of Psychiatry, School of Medicine, Yale University, 319 Peck Street, Erector Square, Bldg. 1, New Haven, CT 06513 USA
| | - Stephanie Lanteri
- Program for Recovery and Community Health (PRCH), Department of Psychiatry, School of Medicine, Yale University, 319 Peck Street, Erector Square, Bldg. 1, New Haven, CT 06513 USA
| | - Larry Davidson
- Program for Recovery and Community Health (PRCH), Department of Psychiatry, School of Medicine, Yale University, 319 Peck Street, Erector Square, Bldg. 1, New Haven, CT 06513 USA
| | - Janis Tondora
- Program for Recovery and Community Health (PRCH), Department of Psychiatry, School of Medicine, Yale University, 319 Peck Street, Erector Square, Bldg. 1, New Haven, CT 06513 USA
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18
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Sprang G, Eslinger J, Whitt-Woosley A, Gusler S, Clemans T. Child Traumatic Stress and COVID-19: The Impact of the Pandemic on a Clinical Sample of Children in Trauma Treatment. J Child Adolesc Trauma 2023:1-12. [PMID: 37359464 PMCID: PMC10034234 DOI: 10.1007/s40653-023-00531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 06/28/2023]
Abstract
Given the scope and duration of the COVID-19 pandemic, it is not surprising that research has documented negative effects to youth's mental health. Yet, there is negligible research on the impact of the pandemic among clinical samples of youth receiving treatment for pre-existing trauma exposure and symptoms. The current study investigates COVID-19 as an index trauma, and if prior traumatic stress scores mediate the relationship between pandemic-related exposure and subsequent traumatic stress. METHODS This is a study of 130 youth ages 7-18 receiving trauma treatment at an academic medical center. The University of California Los Angeles Post-traumatic Stress Disorder-Reaction Index (UCLA-PTSD-RI) was completed by all youth during intake as part of routine data collection. From April, 2020 to March, 2022 the UCLA Brief COVID-19 Screen for Child/Adolescent PTSD was also administered to assess trauma exposures and symptoms specifically-related to the pandemic experience. Univariate and bivariate analyses were conducted on all variables of interest to describe response patterns cross-sectionally and longitudinally; a mediational analysis was used to determine if prior trauma symptoms mediate the relationship between COVID-19 exposure and response. Additionally, interviews were conducted with youth using a series of open-ended questions about their perceptions of safety, threat and coping related to the pandemic. RESULTS A quarter of the sample reported COVID-19 related exposures that would meet Criterion A for PTSD. Participants whose UCLA-COVID scores that exceeded the clinical cutoff had lower scores on two items measuring social support. There was no evidence of full or partial mediation. Responses to interview questions revealed low levels of threat reactivity, perceptions of no to little impact, positive changes, varying opinions on social isolation, some evidence of inaccurate messaging and adaptive coping using strategies learned in treatment. IMPLICATIONS The findings broaden our understanding of the impact of COVID-19 on vulnerable children and provide insight into how prior trauma history and the provision of evidence-based trauma treatment impact a youth's response to pandemic conditions.
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Affiliation(s)
- Ginny Sprang
- Department of Psychiatry, Center On Trauma and Children, University of Kentucky, Lexington, USA
| | - Jessica Eslinger
- Department of Psychiatry, Center On Trauma and Children, University of Kentucky, Lexington, USA
| | - Adrienne Whitt-Woosley
- Department of Psychiatry, Center On Trauma and Children, University of Kentucky, Lexington, USA
| | - Stephanie Gusler
- Department of Psychiatry, Center On Trauma and Children, University of Kentucky, Lexington, USA
| | - Tracy Clemans
- Department of Psychiatry, Center On Trauma and Children, University of Kentucky, Lexington, USA
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Salvador JG, Bolaños-Sacoman SL, Katzman JG, Morrison AE, Fox LE, Schneider JS, Bhatt SR, Kincaid TW, Waldorf VA. Evaluation and guide for embedding opioid use disorder education in health professions' curricula. BMC Med Educ 2023; 23:135. [PMID: 36859298 PMCID: PMC9975819 DOI: 10.1186/s12909-023-04088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Morbidity and mortality from Opioid Use Disorder is a health crisis in the United States. During the COVID-19 pandemic, there was a devastating increase of 38.4% in overdose deaths from the 12-month period leading up to June 2019 compared with the 12-month period leading up to May 2020, primarily driven by synthetic opioids. Buprenorphine is an effective medication for opioid use disorder but uptake is slow due in part to lack of provider knowledge, confidence, and negative attitudes/stigma toward patients with OUD. Addressing these barriers in academic training is a promising approach to building workforce able to effectively treat opioid use disorder. METHODS Our university developed a training for pre-licensure physicians, physician assistants and psychiatric nurse practitioners that included the DATA Waiver training and a shadowing experience. Expected outcomes included improved knowledge, skills and attitudes about persons with OUD and buprenorphine treatment, plans to provide this treatment post-graduation, for pre-licensure learners to have completed all requirements to prescribe buprenorphine post-graduation, and for the training to be embedded into school's curricula. RESULTS Results were positive overall including improved knowledge and attitudes toward persons with OUD, better understanding of the benefits of this treatment for patients, increased confidence and motivation to provide this treatment post-graduation. The training is now embedded in each program's graduation requirements. CONCLUSION Developing a didactic and experiential training on buprenorphine treatment for opioid use disorder and embedding it into medical, physician assistant, and psychiatric nurse practitioner licensure programs can help prepare future providers to treat opioid use disorder in a range of settings. Key to replicating this program in other university settings is to engage faculty members who actively provide treatment to persons with OUD to ensure shadowing opportunities and serve as role models for learners.
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Affiliation(s)
- Julie G Salvador
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA.
| | | | - Joanna G Katzman
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA
| | - Ann E Morrison
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA
| | - Lindsay E Fox
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA
| | - Jennifer S Schneider
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA
| | - Snehal R Bhatt
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA
| | - Tyler W Kincaid
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA
| | - V Ann Waldorf
- Health Sciences Center, University of New Mexico, 1 UNM, Albuquerque, NM, MSC09 5030, USA
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Perry EW, Osborne MC, Kinnish K, Lee N, Self-Brown SR. The PTSD Symptom Presentation and the Effect of Polytrauma on PTSD Symptom Clusters Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking. J Child Adolesc Trauma 2023; 16:81-93. [PMID: 36776638 PMCID: PMC9908799 DOI: 10.1007/s40653-022-00474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 06/18/2023]
Abstract
Purpose The purpose of this study was to describe the PTSD symptom presentation (including dissociative symptoms) of PTSD using the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition diagnostic criteria and explore associations between the symptom severity for each of the four PTSD symptom clusters and polytrauma, defined as multiple exposures to different categories of potentially traumatic events. Methods This is a secondary analysis of cross-sectional program evaluation data among 95 young people (aged 11-19) at therapy initiation in a southeastern state in the U.S. We used descriptive statistics and multivariable linear regression to test study objectives. Results Eighty-one respondents (90.0%) experienced a potentially traumatic event in ≥ 2 trauma categories, in addition to experiencing CSE/T. Approximately two-thirds of respondents experienced clinically significant PTSD symptoms for each symptom cluster. Of the 31 young people who met full criteria for PTSD, 9 met criteria for the standard PTSD diagnosis, while 22 met criteria for the dissociative subtype of PTSD. On average, experiencing additional trauma categories was associated with substantively higher PTSD symptom cluster scores for each cluster. Conclusions These findings support the need for a comprehensive assessment of trauma symptoms that includes cluster-specific PTSD symptoms. They also underscore the need to assess the full breadth and chronicity of trauma experiences to guide treatment planning and delivery, targeting specific domains of trauma impact. These findings can also inform the tailoring and adaptation of evidence-based interventions and strategies to better meet the needs of young people who have experienced CSE/T.
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Affiliation(s)
- Elizabeth W. Perry
- School of Public Health, Georgia State University, Atlanta, GA USA
- National SafeCare Training and Research Center, Georgia State University, Atlanta, GA USA
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA USA
| | - Melissa C. Osborne
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA USA
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA USA
| | - Kelly Kinnish
- School of Public Health, Georgia State University, Atlanta, GA USA
- National Center On Child Trafficking, Georgia State University, Atlanta, GA USA
| | - NaeHyung Lee
- School of Public Health, Georgia State University, Atlanta, GA USA
| | - Shannon R. Self-Brown
- School of Public Health, Georgia State University, Atlanta, GA USA
- National SafeCare Training and Research Center, Georgia State University, Atlanta, GA USA
- Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA USA
- National Center On Child Trafficking, Georgia State University, Atlanta, GA USA
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21
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Edwards A, Ozer F, Cueva K. Feasibility of a Supportive Text Messaging Intervention in Northwest Alaska. J Technol Behav Sci 2023; 8:113-117. [PMID: 37215393 PMCID: PMC9973232 DOI: 10.1007/s41347-022-00293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 05/24/2023]
Abstract
Suicide disproportionately impacts young Alaska Native people in the northwestern region of Alaska. As part of its efforts to address this challenge, Maniilaq Association developed a program to determine the feasibility of sending short text messages of caring and support. Process evaluation measures included the number of enrollees and the number of text messages sent each month. To determine participant satisfaction and seek recommendations for improvements, a short, online survey was disseminated to enrollees via text message in 2021 and 2022. Between January 2020 and September 2021, text messages were sent each month to about 100 participants, each with an accompanying image. Messages included "You are capable of amazing things" and "You are enough". Twenty-five individuals completed the 2021 survey and 11 the 2022 survey; three quarters lived in Northwest Arctic. Respondents said the messages improved their mood and made them feel like they mattered a lot or a great deal. The intervention was well-received by participants, inspiring individuals to reach out to others and reach out for help for themselves. Recommendations for improvements included increasing culturally relevant and meaningful quotes and the frequency and consistency of messages. Due to concerns around confidentiality, it is unclear if the initiative reached those most at-risk for suicide. However, participants sharing the messages among the small population of the region may have facilitated a broader reach than would otherwise be expected. Supplementary Information The online version contains supplementary material available at 10.1007/s41347-022-00293-z.
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Affiliation(s)
- Alexandra Edwards
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Faith Ozer
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Katie Cueva
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, Alaska, USA
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Rivers AS, Winston-Lindeboom P, Atte T, Rosen P, Wintersteen M, Watkins NK, Tien A, Diamond G. Differentiating Between Youth with a History of Suicidal Thoughts, Plans, and Attempts. School Ment Health 2023; 15:1-10. [PMID: 36855560 PMCID: PMC9951160 DOI: 10.1007/s12310-023-09575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
Limited research has examined factors distinguishing between patterns of adolescent suicidal thoughts and behaviors. The current study examined demographic, school, family, and mental health differences across patterns identified by Romanelli and colleagues (2022): history of thoughts only, plans with thoughts, attempt with thoughts and/or plans, and attempt without thoughts. The current study includes 4,233 students (M age = 14.65 years, SD = 2.06) with a history of suicide risk referred to school Student Assistance Program teams. The sample was approximately 60.7% female, 59.8% White (16.0% Black, 15.4% multiracial, 8.8% other), and 14.4% Hispanic. Results indicated that the "attempt without thoughts" group was small with no differentiating characteristics. However, membership in the other three groups was predicted by demographic, school, family, and mental health factors. These results support the importance of examining suicidal thoughts, plans, and attempts as distinct indicators and assessing key biopsychosocial factors. Further research could improve how behavioral health systems identify at risk youth.
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Affiliation(s)
- Alannah Shelby Rivers
- Center for Family Intervention Science, College of Nursing and Health Professions, Drexel University, Philadelphia, PA USA
- Social Work, Psychology, and Philosophy, Texas Woman’s University, Denton, TX USA
| | - Payne Winston-Lindeboom
- Center for Family Intervention Science, College of Nursing and Health Professions, Drexel University, Philadelphia, PA USA
| | - Tita Atte
- Center for Family Intervention Science, College of Nursing and Health Professions, Drexel University, Philadelphia, PA USA
| | - Perri Rosen
- Pennsylvania Garrett Lee Smith Youth Suicide Prevention Grant, Harrisburg, PA USA
| | - Matt Wintersteen
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
| | - Nicole Kathleen Watkins
- Center for Family Intervention Science, College of Nursing and Health Professions, Drexel University, Philadelphia, PA USA
| | - Allen Tien
- Medical Decision Logic, Inc, Baltimore, MD USA
| | - Guy Diamond
- Center for Family Intervention Science, College of Nursing and Health Professions, Drexel University, Philadelphia, PA USA
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McGuier EA, Aarons GA, Byrne KA, Campbell KA, Keeshin B, Rothenberger SD, Weingart LR, Salas E, Kolko DJ. Associations between teamwork and implementation outcomes in multidisciplinary cross-sector teams implementing a mental health screening and referral protocol. Implement Sci Commun 2023; 4:13. [PMID: 36765402 PMCID: PMC9921625 DOI: 10.1186/s43058-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Teams play a central role in the implementation of new practices in settings providing team-based care. However, the implementation science literature has paid little attention to potentially important team-level constructs. Aspects of teamwork, including team interdependence, team functioning, and team performance, may affect implementation processes and outcomes. This cross-sectional study tests associations between teamwork and implementation antecedents and outcomes in a statewide initiative to implement a standardized mental health screening/referral protocol in Child Advocacy Centers (CACs). METHODS Multidisciplinary team members (N = 433) from 21 CACs completed measures of team interdependence; affective, behavioral, and cognitive team functioning; and team performance. Team members also rated the acceptability, appropriateness, and feasibility of the screening/referral protocol and implementation climate. The implementation outcomes of days to adoption and reach were independently assessed with administrative data. Associations between team constructs and implementation antecedents and outcomes were tested with linear mixed models and regression analyses. RESULTS Team task interdependence was positively associated with implementation climate and reach, and outcome interdependence was negatively correlated with days to adoption. Task and outcome interdependence were not associated with acceptability, appropriateness, or feasibility of the screening/referral protocol. Affective team functioning (i.e., greater liking, trust, and respect) was associated with greater acceptability, appropriateness, and feasibility. Behavioral and cognitive team functioning were not associated with any implementation outcomes in multivariable models. Team performance was positively associated with acceptability, appropriateness, feasibility, and implementation climate; performance was not associated with days to adoption or reach. CONCLUSIONS We found associations of team interdependence, functioning, and performance with both individual- and center-level implementation outcomes. Implementation strategies targeting teamwork, especially task interdependence, affective functioning, and performance, may contribute to improving implementation outcomes in team-based service settings.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California-San Diego, San Diego, CA, USA
- ACTRI Dissemination and Implementation Science Center, University of California-San Diego, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Kara A Byrne
- David Eccles School of Business, Kem C. Gardner Policy Institute, University of Utah, Salt Lake City, UT, USA
| | - Kristine A Campbell
- Center for Safe and Healthy Families, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Brooks Keeshin
- Center for Safe and Healthy Families, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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Baker O, Wellington C, Price CR, Tracey D, Powell L, Loffredo S, Moscariello S, Meyer JP. Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity. BMC Public Health 2023; 23:222. [PMID: 36732685 PMCID: PMC9892679 DOI: 10.1186/s12889-023-15108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND People returning to communities from prison or jail face stressors related to securing housing, including discrimination, restrictions based on prior felony convictions, and limited economic and social resources. Existing housing programs can effectively reduce housing instability but often do not fully address the needs of people involved in the criminal justice system experiencing homelessness who often have co-occurring chronic medical issues, and psychiatric and substance use disorders. METHODS Project CHANGE is an ongoing program to deliver person-centered, integrated care and services to individuals involved with the criminal justice system and experiencing homelessness. Applying a Screening, Brief Intervention, (Referral to) Treatment framework, a comprehensive needs assessment is followed by delivery of intensive housing and vocational case management; and psychiatric, substance use, and medical services in a single location by an interdisciplinary team. Participants are followed with study interviews for 12 months. The current analysis was designed to assess the baseline characteristics and needs of the sample population, and the intensity of contact required for integrated service delivery. RESULTS Between November 2019 and September 2021, 86 participants were enrolled, of whom 64% had been released from prison/jail in the past 6 months; the remainder were on parole, probation, or intensive pretrial supervision. Participants were unstably housed (64%) or residing outdoors (26.7%) or in a shelter (24.4%). Most participants had high medical need and frequent healthcare engagement through outpatient and emergency department visits. Most participants were at-risk for clinical depression, and half were diagnosed with anxiety, dissociative, stress-related, somatoform, and other non-psychotic psychiatric disorders. Over 12-month follow-up, the interdisciplinary team made over 500 contact encounters, over half of which resulted in direct services provided, including obtaining vital documents for homelessness verification, housing applications, and employment coaching. CONCLUSION Navigation of services can be particularly challenging for individuals experiencing criminal justice involvement, homelessness, and co-occurring medical, psychiatric, and substance use issues, which can be addressed holistically in an integrated service model. Integrated service delivery was time-, resource-, and staffing-intensive, and challenged by the COVID-19 pandemic, requiring innovative solutions to sustain participant engagement.
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Affiliation(s)
- Olivia Baker
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | | | - Carolina R Price
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - DeShana Tracey
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Lindsay Powell
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale School of Nursing, New Haven, CT, USA
| | | | | | - Jaimie P Meyer
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, USA.
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Schapiro NA, Moore E, Garcia E, Gomes E, Stimbra-Mora M, Greswold W. When silence feels safer: Challenges and successes of delivering a school-based cognitive behavioral intervention to Central American unaccompanied immigrant youth. Psychol Trauma 2022:2023-28992-001. [PMID: 36534436 DOI: 10.1037/tra0001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To explore cultural and immigration-related factors, among Central American unaccompanied immigrant youth (UIY), affecting the safety and acceptability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a group intervention designed to treat trauma symptoms. METHOD Thematic analysis of data from grounded theory study of group interventions to support resilience in UIY, consisting of interviews with 10 key stakeholders (5 CBITS facilitators) and 16 UIY (6 CBITS participants) from El Salvador, Guatemala, or Honduras, interviews conducted in Spanish, English, or Mam. RESULTS Five themes emerged from interviews with CBITS facilitators and UIY: (a) Todo está bién: self-protective silence about trauma and symptom denial, (b) Chisme goes around: personal risks of disclosure, (c) marginalizing the language and world view of indigenous youth, (d) "CBITS didn't really quite land for them": adapting the curriculum and delivery, and (e) "I learn to appreciate things": benefits of the CBITS group. CBITS facilitators endorsed skill-building aspects of the groups and expressed concerns about a curriculum relying on written homework and parental support for youth with limited home country schooling, currently living with distant relatives. CBITS participants endorsed hearing about other youths' stories and learning coping skills. CONCLUSIONS Models for group intervention that emphasize coping skill development and group support, while de-emphasizing the trauma narrative, should be explored and tested. Group intervention leaders should consider the impact of differences in gender, country of origin, and native language on group dynamics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Abstract
Simultaneous co-ingestion of prescription medication (e.g., opioid, tranquilizer/sedative, stimulant) and alcohol is associated with overdose and elevated substance use, but no studies have examined prescription drug misuse (PDM) and alcohol co-ingestion in U.S. young adults (18-25 years), despite the high rates of PDM in this age group. We used the 2015-19 National Survey on Drug Use and Health (young adult N = 69,916) to examine prevalence of past-month PDM-alcohol co-ingestion, PDM characteristics, and sociodemographic, physical health, mental health, and substance use correlates. Logistic regression examined correlates, comparing those without past-year PDM, those with past-year but not past-month PDM, those with past-month PDM without alcohol co-ingestion, and those with past-month PDM and alcohol co-ingestion. An estimated 585,000 young adults engaged in any past-month PDM-alcohol co-ingestion, or between 32.7% (opioids) and 44.6% (tranquilizer/sedatives) of those who were engaged in past-month PDM. Co-ingestion varied by educational status and was more common in males and white or multiracial young adults. All PDM-involved groups had elevated odds of suicidal ideation and other psychopathology, but substance use and substance use disorder (SUD) odds were significantly higher in young adults with co-ingestion, versus all other groups. To illustrate, 41.1% with opioid-alcohol co-ingestion had multiple past-year SUDs, versus 2.0% in those without past-year PDM. Young adults with co-ingestion are particularly likely to have problematic alcohol use and higher rates of SUD. Counseling about the risks of PDM-alcohol co-ingestion and screening for co-ingestion among those at risk are warranted to limit poor outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Ty S. Schepis
- Department of Psychology, Texas State University, San Marcos, Texas
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Jason A. Ford
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Department of Sociology, University of Central Florida, Orlando, Florida
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Sprang G, Garcia A. An Investigation of Secondary Traumatic Stress and Trauma-informed Care Utilization in School Personnel. J Child Adolesc Trauma 2022; 15:1095-1103. [PMID: 36439655 PMCID: PMC9684366 DOI: 10.1007/s40653-022-00465-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
Trauma-informed practices in schools are designed to address the impacts of trauma on students and increase supports for school personnel who are delivering this care The impact of a trauma-informed school-based intervention. Journal of Adolescence, 43, 142-147, Mendelsonet al., 2015. Research has established that professionals trained to implement the approach may have secondary traumatic stress (STS) reactions that could interfere with successful implementation (Stevens al., 2020). In this study it was hypothesized that increased use of trauma-informed care strategies would be associated with decreases in total STS scores, as well as all STS subscale scores at the end of a system's transformation initiative, controlling for sex, age, education, years worked in schools, and exposure to student trauma awareness at baseline. The Trauma Sensitive Schools Checklist (TSSC) and the Secondary Traumatic Stress Scale (STSS) were used to measure study outcomes in a sample of 205 school personnel at baseline and follow up. Statistically significant improvement in STSS scores and TSSC score were noted from Time 1 to Time 2. As hypothesized, improvements in TSSC scores were associated with decreased levels of STS over time, controlling for the covariates. However, the symptom domains of intrusion and arousal impacted this relationship in a differential manner than avoidance and alterations in cognitions and mood. This study provides evidence that increased use of trauma-informed care practices can positively impact the STS levels of school personnel, though special attention should be paid to those with high levels of intrusion or arousal.
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Affiliation(s)
- Ginny Sprang
- College of Medicine/Department of Psychiatry, University of Kentucky, Lexington, KY USA
- Center On Trauma and Children, 3470 Blazer Parkway Suite 100, Lexington, KY 40515 USA
| | - Antonio Garcia
- University of Kentucky College of Social Work, 655 Patterson Office Tower, Lexington, KY 40506 USA
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Eucker SA, Glass O, Staton CA, Knisely MR, O'Regan A, De Larco C, Mill M, Dixon A, TumSuden O, Walker E, Dalton JC, Limkakeng A, Maxwell AMW, Gordee A, Kuchibhatla M, Chow S. Acupuncture for acute musculoskeletal pain management in the emergency department and continuity clinic: a protocol for an adaptive pragmatic randomised controlled trial. BMJ Open 2022; 12:e061661. [PMID: 36153034 PMCID: PMC9511597 DOI: 10.1136/bmjopen-2022-061661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain causes a significant burden on health and quality of life and may result from inadequate treatment of acute musculoskeletal pain. The emergency department (ED) represents a novel setting in which to test non-pharmacological interventions early in the pain trajectory to prevent the transition from acute to chronic pain. Acupuncture is increasingly recognised as a safe, affordable and effective treatment for pain and anxiety in the clinic setting, but it has yet to be established as a primary treatment option in the ED. METHODS AND ANALYSIS This pragmatic clinical trial uses a two-stage adaptive randomised design to determine the feasibility, acceptability and effectiveness of acupuncture initiated in the ED and continued in outpatient clinic for treating acute musculoskeletal pain. The objective of the first (treatment selection) stage is to determine the more effective style of ED-based acupuncture, auricular acupuncture or peripheral acupuncture, as compared with no acupuncture. All arms will receive usual care at the discretion of the ED provider blinded to treatment arm. The objective of the second (effectiveness confirmation) stage is to confirm the impact of the selected acupuncture arm on pain reduction. An interim analysis is planned at the end of stage 1 based on probability of being the best treatment, after which adaptations will be considered including dropping the less effective arm, sample size re-estimation and unequal treatment allocation ratio (eg, 1:2) for stage 2. Acupuncture treatments will be delivered by licensed acupuncturists in the ED and twice weekly for 1 month afterward in an outpatient clinic. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Duke University Health System Institutional Review Board. Informed consent will be obtained from all participants. Results will be disseminated through peer-review publications and public and conference presentations. TRIAL REGISTRATION NUMBER NCT04290741.
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Affiliation(s)
- Stephanie A Eucker
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oliver Glass
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Catherine A Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | - Amy O'Regan
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Christi De Larco
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michelle Mill
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Austin Dixon
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Olivia TumSuden
- UNC Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Erica Walker
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Juliet C Dalton
- Duke Office of Clinical Research, Duke University, Durham, North Carolina, USA
| | - Alexander Limkakeng
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Alex Gordee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Maggie Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
- Center for Aging, Duke University, Durham, North Carolina, USA
| | - Sheinchung Chow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
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Powell KG, Chaple MJ, Henry M, Morton C, Becker SJ, Gotham HJ, Hagle HN, Helle AC, Krom LJ, Martin R, Molfenter TD, Roget N, Rutkowski BA, Velez-Echevarria II, Yanez R. Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions. BMC Med Educ 2022; 22:575. [PMID: 35897014 PMCID: PMC9326150 DOI: 10.1186/s12909-022-03598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. METHOD Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. RESULTS Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. CONCLUSIONS Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.
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Affiliation(s)
- Kristen G Powell
- Rutgers University School of Social Work, New Brunswick, NJ, USA.
| | | | - Maxine Henry
- National Latino Behavioral Health Association, Peña Blanca, NM, USA
| | - Cory Morton
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Sara J Becker
- Brown University School of Public Health, Providence, RI, USA
| | - Heather J Gotham
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Holly N Hagle
- University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | - Ashley C Helle
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Laurie J Krom
- University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | | | | | - Nancy Roget
- University of Nevada, Reno, Reno, Nevada, USA
| | - Beth A Rutkowski
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
| | | | - Ruth Yanez
- National Latino Behavioral Health Association, Peña Blanca, NM, USA
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Hazzard VM, Barry MR, Leung CW, Sonneville KR, Wonderlich SA, Crosby RD. Food insecurity and its associations with bulimic-spectrum eating disorders, mood disorders, and anxiety disorders in a nationally representative sample of U.S. adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1483-1490. [PMID: 34175963 PMCID: PMC8235999 DOI: 10.1007/s00127-021-02126-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine cross-sectional associations between food insecurity and 12-month eating disorders, mood disorders, and anxiety disorders among U.S. adults. METHODS This study used data collected between 2001 and 2003 from 2914 participants in the National Comorbidity Survey-Replication, a nationally representative sample of U.S. adults (mean age = 44.9 years; 53.4% female). Twelve-month food insecurity was assessed with a modified version of the Short Form U.S. Household Food Security Scale. Twelve-month DSM-IV diagnoses of mental disorders were based on the World Health Organization Composite International Diagnostic Interview. Modified Poisson regression models were conducted, adjusting for age, sex, race/ethnicity, education, and income-to-poverty ratio. RESULTS Food insecurity was experienced by 11.1% of participants. Food insecurity was associated with greater prevalence of bulimic-spectrum eating disorders (prevalence ratio [PR] = 3.81; 95% confidence interval [CI] 2.26-6.42), mood disorders (PR = 2.53; 95% CI 1.96-3.29), and anxiety disorders (PR = 1.69; 95% CI 1.39-2.07). CONCLUSION Results indicate that food insecurity is associated with a range of internalizing mental disorders, though these findings should be confirmed with contemporary data to reflect DSM-5 diagnostic updates and the economic effects of the COVID-19 pandemic. Findings from this study emphasize the need to expand food insecurity interventions and improve access to mental health services for food-insecure populations.
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Affiliation(s)
- Vivienne M Hazzard
- Sanford Center for Biobehavioral Research, 120 Eighth Street South, Fargo, ND, 58103, USA.
| | - Mikayla R Barry
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Cindy W Leung
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Stephen A Wonderlich
- Sanford Center for Biobehavioral Research, 120 Eighth Street South, Fargo, ND, 58103, USA
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, 120 Eighth Street South, Fargo, ND, 58103, USA
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Reis G, Bromage B, Rowe M, Restrepo-Toro ME, Bellamy C, Costa M, Davidson L. Citizenship, Social Justice and Collective Empowerment: Living Outside Mental Illness. Psychiatr Q 2022; 93:537-546. [PMID: 35048313 PMCID: PMC8769788 DOI: 10.1007/s11126-021-09968-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/04/2021] [Accepted: 12/12/2021] [Indexed: 01/20/2023]
Abstract
Citizenship is emerging as one of the world's leading models to shift mental health care from artificial psychiatric settings into more natural community settings by incorporating human rights. This paper describes a four-session roundtable series entitled Citizenship, Social Justice, and Collective Empowerment: Living Outside Mental Illness. These roundtables were part of the New England Mental Health Technology Transfer Center Network (MHTTC). They were built on the conviction that people who have lived experiences of mental health challenges and engaged in making community connections should be at the center of teaching about those experiences. Presenters shared their experiences about how they navigated stigma and discrimination on their way to community inclusion, belonging, and empowerment. The common theme across the series was the citizenship framework. The citizenship framework has inspired people to become involved in an individual and collective dynamic experience that connects them with the 5R's of rights, responsibilities, roles, resources, relationships, and a sense of belonging in society. The outcomes from the discussion on the webinars demonstrated that peer support could be a promising intervention to increase the sense of belonging in the community.
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Affiliation(s)
- Graziela Reis
- Department of Psychiatry, Yale Program for Recovery and Community Health (PRCH), Yale School of Medicine, New Haven, CT United States
| | - Billy Bromage
- Department of Psychiatry, Yale Program for Recovery and Community Health (PRCH), Yale School of Medicine, New Haven, CT United States
| | - Michael Rowe
- Department of Psychiatry, Yale Program for Recovery and Community Health (PRCH), Yale School of Medicine, New Haven, CT United States
| | - Maria E. Restrepo-Toro
- Department of Psychiatry, Yale Program for Recovery and Community Health (PRCH), Yale School of Medicine, New Haven, CT United States
| | - Chyrell Bellamy
- Department of Psychiatry, Yale Program for Recovery and Community Health (PRCH), Yale School of Medicine, New Haven, CT United States
| | - Mark Costa
- Department of Psychiatry, Yale Program for Recovery and Community Health (PRCH), Yale School of Medicine, New Haven, CT United States
| | - Larry Davidson
- Department of Psychiatry, Yale Program for Recovery and Community Health (PRCH), Yale School of Medicine, New Haven, CT United States
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Claborn KR, Creech S, Whittfield Q, Parra-Cardona R, Daugherty A, Benzer J. Ethical by Design: Engaging the Community to Co-design a Digital Health Ecosystem to Improve Overdose Prevention Efforts Among Highly Vulnerable People Who Use Drugs. Front Digit Health 2022; 4:880849. [PMID: 35712228 PMCID: PMC9192346 DOI: 10.3389/fdgth.2022.880849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The COVID-19 pandemic highlighted significant structural barriers that exacerbated health inequities among people at-risk for overdose. Digital health technologies have the potential to overcome some of these barriers; however, development of these technologies often fails to include people who use drugs and community key stakeholders in the development and dissemination process. Consequently, this may exacerbate health inequities and the digital divide among underserved, highly vulnerable people who use drugs. Methods The current study employed community-engaged research methods to develop and implement a digital platform to improve overdose surveillance among harm reductionists in Texas. We used a co-design process with four community advisory boards (CABs) and conducted qualitative interviews among N = 74 key stakeholders (n = 24 people who use drugs; n = 20 first responders, n = 20 harm reductionists, n = 10 overdose prevention and response experts) to inform initial design and development. Results Several key themes emerged through the qualitative data pertaining to technical features and human factors applications. In regards to technical features, participants highlighted the importance of developing a unified system of overdose reporting and data sharing among community organizations within a county or region to better inform overdose surveillance and community outreach efforts. This system should include flexible data entry methods, have offline usage capability, be user friendly, and allow for tracking of overdose-related supply distribution. Key human factor themes included the need to use person-centered language, to preserve the established trust of the community organizations among people who use drugs, to be tailored to specific target user groups (e.g., harm reduction workers, people who use drugs, first responders), and maintain transparency of data usage. Further, participants noted the importance of developing a platform that will facilitate client conversations about overdose when doing outreach in the field. These themes were reviewed by our CABs, academic, and industry partners to design an overdose digital platform uniquely tailored to community-based organizations providing harm reduction and overdose response efforts. Discussion Community engagement throughout the development process is critical toward developing digital health tools for underserved people who use drugs. Dismantling the power structure among academic and industry partners is critical toward creating equity in engagement of community-based partners, particularly among persons with lived experience in addiction, a history of incarceration, or financial challenges. Our study highlights a multisectoral co-design process across community-academic-industry partners to develop a digital health tool tailored to the unique needs of community-based harm reduction organizations serving highly vulnerable people who use drugs. These partnerships are essential toward creating impact and reducing health disparities among highly vulnerable people who use drugs.
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Affiliation(s)
- Kasey R. Claborn
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Addiction Research Institute, The University of Texas at Austin, Austin, TX, United States
- *Correspondence: Kasey R. Claborn
| | - Suzannah Creech
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Quanisha Whittfield
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
| | - Ruben Parra-Cardona
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
| | - Andrea Daugherty
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Justin Benzer
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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Lister JJ, Lee G, Ellis JD, Pasman E, Agius E, Resko SM. Comorbid Affective and Substance Use Disorders of Medicaid/Medicare Beneficiaries at an Opioid Treatment Program Serving Small Urban and Rural Communities. Front Psychiatry 2022; 13:881821. [PMID: 35586409 PMCID: PMC9108361 DOI: 10.3389/fpsyt.2022.881821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Identify rates and correlates of comorbid affective and substance use disorders among an understudied population, Medicaid/Medicare beneficiaries receiving care at an opioid treatment program serving patients from small urban and rural areas. Examine whether past-year non-medical opioid use status differentiates comorbidity status. Methods A cross-sectional, venue-based design was used to recruit a convenience sample of patients treated with methadone for opioid use disorder. Measures were assessed across three domains: (1) demographic characteristics, (2) opioid use characteristics, and (3) comorbid disorders. Brief validated screeners categorized probable comorbid disorders. Bivariate analyses examined correlates of comorbid disorders and determined variable selection for multivariable analyses. Results In this sample (N = 210; mean age = 38.5 years; female = 62.2%; Non-Hispanic White race/ethnicity = 86.1%), comorbid disorders were common. Rates were as follows: current anxiety (48.1%), depression (41.1%), and PTSD (33.7%), and past-year stimulant (27.6%), marijuana (19.0%), alcohol (14.9%), and sedative (7.6%). In bivariate analyses, past-year non-medical opioid use and a greater accumulation of opioid use consequences were associated with most disorders. When including demographic and opioid use characteristics in multivariable analyses, past-year non-medical opioid use was associated with anxiety, PTSD, stimulant use disorder, and sedative use disorder. Conclusions Few studies have investigated comorbid disorders among this understudied population. This analysis highlights a high burden, especially for affective disorders. Our findings demonstrate that routine, ongoing assessment of non-medical opioid use may be a promising and feasible strategy to detect patients needing integrated care. Future research should investigate whether changes to assessment protocols at opioid treatment programs in small urban and rural settings facilitate care coordination.
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Affiliation(s)
- Jamey J. Lister
- Rutgers University School of Social Work, New Brunswick, NJ, United States
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Guijin Lee
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Jennifer D. Ellis
- Wayne State University School of Social Work, Detroit, MI, United States
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States
| | - Emily Pasman
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Elizabeth Agius
- Wayne State University School of Social Work, Detroit, MI, United States
| | - Stella M. Resko
- Wayne State University School of Social Work, Detroit, MI, United States
- Wayne State University Merrill Palmer Skillman Institute, Detroit, MI, United States
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McCabe K, Hotton A, Loyd AB, Floyd B, Donenberg G, Fletcher FE. The process of adapting a sexual health intervention for Black early adolescents: a stakeholder engagement approach. Health Educ Res 2022; 37:7-22. [PMID: 34865042 PMCID: PMC9092122 DOI: 10.1093/her/cyab041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 11/16/2021] [Indexed: 06/13/2023]
Abstract
Young Black women are disproportionately affected by sexually transmitted infections (STIs) and HIV. Notably, few sexual health interventions for Black girls have documented the process of utilizing stakeholder input from the Black community to culturally tailor content. We conducted formative work in Chicago to adapt a mother-daughter HIV/STI prevention intervention originally designed for Black adolescent girls aged 14-18 years to meet the needs of early adolescent girls aged 11-13 years. Our iterative process involved three phases: (i) soliciting feedback from an expert panel and community advisory board; (ii) conducting focus groups with experienced research participants; and (iii) theater testing a new curriculum in the target population. Key findings of this process indicate the importance of sophisticated community engagement strategies to shape research design and program implementation. Findings may be used to inform processes for future adaptation work, especially in sexual health programs for young Black girls and their mothers.
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Affiliation(s)
- K McCabe
- Sinai Urban Health Institute, Sinai Chicago, 1500 S. Fairfield, Chicago, IL 60608, USA
| | - A Hotton
- Department of Medicine, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - A B Loyd
- Department of Psychology, University of California, 900 University Ave, Riverside, CA 92521, USA
| | - B Floyd
- Department of Community Health Sciences, University of Illinois at Chicago, 1603 W. Taylor St, 654 SPHPI, Chicago, IL 60612, USA
| | - G Donenberg
- Center for Dissemination and Implementation Science, University of Illinois at Chicago, 818 S. Wolcott Ave, SRH 6th Floor, Chicago, IL 60612, USA
| | - F E Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310DK, Houston, TX 77030, USA
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Haliwa I, Layman H, Coffman J, Snodgrass A, Santer P, Barlett B, Long K, Mason A, Pfost G, Harden J, Dino G, Jarrett T. Perceptions and Expectations of School-Based Professionals Surrounding School-Based Mindfulness Training in Appalachia During the COVID-19 Pandemic: A Qualitative Study. Front Public Health 2022; 10:816494. [PMID: 35186847 PMCID: PMC8854180 DOI: 10.3389/fpubh.2022.816494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background School-based professionals often report high burnout, particularly in geographic areas like Appalachia, where school-aged children are exposed to high levels of adverse childhood experiences, which may be exacerbated by the COVID-19 pandemic. While school-based mindfulness trainings can reduce burnout, their efficacy is influenced by the expectations of intervention personnel ahead of implementation. The present study assessed expectations and perceptions of a school-based mindfulness training among school personnel in 21 Appalachian schools during the COVID-19 pandemic. Methods Upon enrollment in the training, staff (N = 191) responded to open ended survey questions regarding perceived impacts of COVID-19 on students, expected benefits and barriers to school-based mindfulness, and perceived community acceptance of mindfulness. Results School personnel identified social isolation and lack of structure as negative impacts of COVID-19 on students. Expected benefits of classroom mindfulness included improved coping skills, focus, and emotion regulation, whereas barriers included lack of time and student ability level (e.g., age, attention). While most respondents indicated that their community was accepting of mindfulness practices, some noted resistance to and misperceptions of mindfulness, which may illustrate the influence of local cultural norms and values on the acceptability of mental health interventions. Conclusions Overall, these findings suggest positive expectations and relative perceived support for mindfulness practices within these Appalachian communities, including in response to negative impacts of the COVID-19 pandemic on students. Adapting practices and language to accommodate barriers such as time, student ability, and cultural misconceptions of mindfulness may increase the feasibility and efficacy of these interventions.
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Affiliation(s)
- Ilana Haliwa
- Department of Psychology, West Virginia University, Morgantown, WV, United States
- *Correspondence: Ilana Haliwa
| | - Hannah Layman
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
| | - Jessica Coffman
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
| | - Amy Snodgrass
- Department of Rural Health, West Virginia University, Morgantown, WV, United States
| | - Pamela Santer
- Wellness Center, WVU Parkersburg, Parkersburg, WV, United States
| | | | - Kate Long
- Try This West Virginia, Charleston, WV, United States
| | - Ashley Mason
- School of Physical Therapy, Marshall University, Huntington, WV, United States
| | - Gretchen Pfost
- School of Physical Therapy, Marshall University, Huntington, WV, United States
| | - Jenny Harden
- Greenbrier County Schools, Rupert, WV, United States
| | - Geri Dino
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
| | - Traci Jarrett
- WVU School of Public Health, West Virginia Prevention Research Center, Morgantown, WV, United States
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Abdul-Adil J, Suárez LM. The Urban Youth Trauma Center: A Trauma-Informed Continuum for Addressing Community Violence Among Youth. Community Ment Health J 2022; 58:334-342. [PMID: 33870469 PMCID: PMC8053560 DOI: 10.1007/s10597-021-00827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
Contemporary community violence has escalated into a national public health crisis with urban youth, particularly ethnic minorities, suffering disproportionate negative impacts. The Urban Youth Trauma Center (UYTC) promotes a trauma-informed continuum of prevention-to-intervention services that combines community-based and clinic-based manualized protocols designed to reduce and prevent community violence for youth and families. Based on a socio-ecological model, UYTC has the main goals of addressing community violence and related traumatic stress as well as co-occurring conditions of substance abuse and disruptive behavior problems in urban youth by: (1) raising public awareness; (2) disseminating specialized trauma-informed training; and (3) mobilizing service system coalitions. UYTC employs this evidence-based yet flexible structure for disseminating, implementing, and evaluating trauma-informed training as a means of contributing to the reduction and prevention of community violence for low-income urban minority youth and families who bear the biggest burden of this current crisis.
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Affiliation(s)
- Jaleel Abdul-Adil
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, 1747 West Roosevelt Road, Mail Code 747, Chicago, IL, 60608, USA.
| | - Liza M Suárez
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, 1747 West Roosevelt Road, Mail Code 747, Chicago, IL, 60608, USA
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Nayak SS, Tobias C, Wolfe J, Roper K, Méndez-Peñate L, Moulin C, Arty M, Scoglio AAJ, Kelleher A, Rue J, Brigham M, Bradshaw T, Byars N, Camacho A, Douglas S, Molnar BE. Engaging and Supporting Young Children and their Families in Early Childhood Mental Health Services: The Role of the Family Partner. Community Ment Health J 2022; 58:87-98. [PMID: 33641064 PMCID: PMC8732897 DOI: 10.1007/s10597-021-00796-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
This study explores the role of family partners, peer professionals with lived experiences of raising a child with behavioral health needs, and their value in primary and community-care based mental health services for young children aged 0-8 years. Interviews and focus groups were conducted with staff, leadership, and caregiver participants (n = 38) from two early childhood mental health programs and analyzed using thematic analysis. Five interdependent themes emerged: (1) the centrality of lived experience to the family partner role; (2) the importance of the family partner in family engagement and relationship building; (3) the value added by the family partner in navigating systems; (4) the ability of the family partner to build skills and empower caregivers; (5) the role of the family partner in alleviating caregiver stress and other mental health concerns. Adapting and expanding the role of family partners will improve effective mental health care for children and their caregivers.
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Affiliation(s)
- Sameera S Nayak
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Carol Tobias
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Jessica Wolfe
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Kate Roper
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Christy Moulin
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Malika Arty
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Arielle A J Scoglio
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Amy Kelleher
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | | | | | - Tarsha Bradshaw
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | | | - Angelina Camacho
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Sade Douglas
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Beth E Molnar
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA.
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Frank HE, Last BS, AlRabiah R, Fishman J, Rudd BN, Kratz HE, Harker C, Fernandez-Marcote S, Jackson K, Comeau C, Shoyinka S, Beidas RS. Understanding therapists' perceived determinants of trauma narrative use. Implement Sci Commun 2021; 2:131. [PMID: 34852850 PMCID: PMC8638192 DOI: 10.1186/s43058-021-00231-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists' use of TNs. METHODS Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR. RESULTS While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. CONCLUSIONS These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.
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Affiliation(s)
- Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA.
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | - Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Reem AlRabiah
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N Rudd
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Hilary E Kratz
- Department of Psychology, La Salle University, Philadelphia, PA, USA
| | - Colleen Harker
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Kamilah Jackson
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
- PerformCare New Jersey, Robbinsville, NJ, USA
| | | | - Sosunmolu Shoyinka
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA
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Goode RW, Watson HJ, Masa R, Bulik CM. Prevalence and contributing factors to recurrent binge eating and obesity among black adults with food insufficiency: findings from a cross-sectional study from a nationally-representative sample. J Eat Disord 2021; 9:154. [PMID: 34823600 PMCID: PMC8620158 DOI: 10.1186/s40337-021-00509-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Living in a food-insecure or food insufficient household may increase risk for binge eating and obesity. Because racial disparities in food access, obesity, and access to treatment for disordered eating exist, it is important to examine these relationships in Black populations. METHODS We conducted a secondary analysis of data from the National Survey of American Life (N = 4553), a nationally-representative sample of Black Americans, including African Americans and Afro-Caribbeans. Logistic regression was used to explore the association of food insufficiency with obesity and binge eating. RESULTS In the total sample of Black Americans, the prevalence of food insufficiency was 10.9% (95% CI 10.0-11.8%). Food insufficiency was not significantly associated with obesity in Black Americans, but when associations were explored in analyses stratified by ethnicity and sex, food insufficiency significantly predicted an increased odds of obesity in Afro-Caribbeans (odds ratio [OR] = 1.47, 95% CI 1.01, 2.13). Individuals experiencing food insufficiency were more likely to report recurrent binge eating in the last 12 months (3% v 2%, P = 0.02) and a lifetime history of binge eating (6% v 3%, P = 0.004) compared to those who were food sufficient. After adjusting for socio-demographic factors, food insufficiency was not significantly associated with recurrent binge eating in Black Americans or in sex- and ethnicity-stratified analyses. CONCLUSION The present study reveals a more complex relation between food insufficiency and binge eating than previously thought-although an association existed, it was attenuated by an array of sociodemographic factors. Our results also underscore the importance of considering ethnicity as different patterns emerged between African American and Afro-Caribbean participants.
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Affiliation(s)
- Rachel W Goode
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599, USA.
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hunna J Watson
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Rainier Masa
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB #3550, Chapel Hill, NC, 27599, USA
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Davis SH, Winer JP, Gillespie SC, Mulder LA. The Refugee and Immigrant Core Stressors Toolkit (RICST): Understanding the Multifaceted Needs of Refugee and Immigrant Youth and Families Through a Four Core Stressors Framework. ACTA ACUST UNITED AC 2021; 6:620-630. [PMID: 34258385 PMCID: PMC8267510 DOI: 10.1007/s41347-021-00218-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Abstract
Research indicates that refugee and immigrant youth commonly face four core stressors during resettlement in a new country and culture: trauma, acculturative stress, resettlement stress, and isolation. This Four Core Stressors framework can be used to educate providers about these populations’ unique needs and support assessment of relevant socioecological factors influencing health. To facilitate education, training, and dissemination of this framework and complement existing provider resources, we developed the Refugee & Immigrant Core Stressors Toolkit (RICST), a free, web-based toolkit that provides an overview of the Four Core Stressors framework, assessment questions across the four domains, scaffolding to identify needs and points of triage, and recommended interventions. Public hosting of the RICST via REDCap began in March 2018. In addition to the toolkit, users are prompted to provide location of service delivery, intended purpose of use, and interface feedback. Between March 2018 and October 2020, the RICST was used over 2300 times across 6 continents. Most providers used the toolkit to learn more about the needs of refugee and immigrant youth in general, and several noted that it is a valuable educational tool for staff unfamiliar with these populations. Open-ended qualitative feedback indicated high usability. Amidst historically high levels of forced displacement, tools to support provider effectiveness in working with these populations are increasingly needed. The RICST shows promise as an educational, assessment, and treatment-planning tool for providers working with refugee and immigrant families globally. Future directions include location-specific resource mapping and culture-specific intervention strategies.
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Affiliation(s)
- Seetha H. Davis
- Trauma and Community Resilience Center, Boston Children’s Hospital, Boston, MA USA
| | - Jeffrey P. Winer
- Trauma and Community Resilience Center, Boston Children’s Hospital, Boston, MA USA
| | - Sarah C. Gillespie
- Institute of Child Development, University of Minnesota, Minneapolis, MN USA
| | - Luna A. Mulder
- Trauma and Community Resilience Center, Boston Children’s Hospital, Boston, MA USA
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Bruns EJ, Benjamin PH, Shepler RN, Kellogg M, Pluckebaum H, Woolston JL, English K, Zabel MD. Manuscript: Defining Quality Standards for Intensive Home Based Treatment Programs for Youth with Serious Emotional Disorders. Adm Policy Ment Health 2021; 48:1065-1088. [PMID: 34241737 PMCID: PMC8267760 DOI: 10.1007/s10488-021-01116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Intensive Home Based Treatment (IHBT) is a critical component of the continuum of community-based behavioral healthcare for youth with serious emotional disorder (SED) and their families. Yet despite being used nationwide at costs of over $100 million annually in some states, a well-vetted, research-based set of quality standards for IHBT has yet to be developed. The current project aimed to define program and practice standards for IHBT, drawing upon literature review, expert interviews, and a systematic Delphi process engaging over 80 participants, including IHBT developers, experts in evidence-based youth mental health, youth and family advocates, IHBT providers, and state policymakers. After two rounds of quantitative and qualitative input, adequate consensus was achieved on 32 IHBT Program Standards and 43 IHBT Practice Standards. These standards hold potential for informing efforts such as development of state regulations, provider contracts, memoranda of agreement, and training and workforce development initiatives. Translation of the quality standards into measurement strategies holds potential for providing a method of continuous quality improvement across multiple levels as well as use in research on IBHT.
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Affiliation(s)
- Eric J Bruns
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA.
| | - Philip H Benjamin
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Richard N Shepler
- Center for Innovative Practices, Case Western Reserve University, 11402 Bellflower Road, Cleveland, OH, 44106, USA
| | - Marianne Kellogg
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Hunter Pluckebaum
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Joseph L Woolston
- Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT, 06519-1124, USA
| | - Kelly English
- Children's Behavioral Health Knowledge Center, Massachusetts Department of Mental Health, 25 Staniford Street, Boston, MA, 02114, USA
| | - Michelle D Zabel
- School of Social Work, University of Maryland, 306 W. Redwood Street, 2nd Floor, Baltimore, MD, 21202, USA
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Rogers BG, Paradis-Burnett A, Nagel K, Yolken A, Strong SH, Arnold T, Napoleon SC, Maynard M, Sosnowy C, Murphy M, Daley Ndoye C, Holcomb R, Schierberl Scherr A, Pinkston M, Chan PA. Sex Workers and Syndemics: A Population Vulnerable to HIV and COVID-19. Arch Sex Behav 2021; 50:2007-2016. [PMID: 33759058 PMCID: PMC7987117 DOI: 10.1007/s10508-021-01940-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 05/02/2023]
Abstract
COVID-19 has disproportionately affected vulnerable populations across the U.S. Street-based sex workers are one vulnerable population whose health and impact of COVID-19 have been understudied to date. The goal of this study was to evaluate findings from a community needs assessment with street-based sex workers on impact of COVID-19 on health behaviors and social circumstances. A brief survey was developed at a community-based harm reduction and recovery services organization. Surveys were administered by peer specialists to street-based sex workers during street outreach in April and May 2020. A total of 46 surveys were analyzed. Many individuals reported continuing to do sex work and use substances during the COVID pandemic. Slightly more than a quarter of individuals (n = 13; 28.3%) indicated using personal protective equipment while doing sex work and described challenges to using precautions when working with clients. Individuals had used marijuana (n = 32, 71.1%), cocaine (n = 17, 39.5%), prescription stimulants (n = 9, 21.4%), methamphetamines (n = 5, 11.9%), prescription opioids (n = 12, 27.3%), street opioids (n = 12, 27.3%), sedatives (n = 11, 25.0%), hallucinogens (n = 3, 6.8%), inhalants (n = 3, 7.0%), or some other substance (n = 4, 8.7%) in the past 30 days. About half (48.8%) reported that COVID-19 had a major impact on their lives. This study is among the first to characterize the impact of COVID-19 on street-based sex workers. From a public health standpoint, this group also represents a high-priority population given their vulnerability and close contact with others, which increases the potential for community spread.
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Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Infectious Diseases, The Miriam Hospital, 11 Fourth St., Providence, RI, 02906, USA.
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Annaka Paradis-Burnett
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Katherine Nagel
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Sabrina H Strong
- Department of Medicine, Infectious Diseases, The Miriam Hospital, 11 Fourth St., Providence, RI, 02906, USA
| | - Trisha Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Siena C Napoleon
- Department of Medicine, Infectious Diseases, The Miriam Hospital, 11 Fourth St., Providence, RI, 02906, USA
| | - Michaela Maynard
- Department of Medicine, Infectious Diseases, The Miriam Hospital, 11 Fourth St., Providence, RI, 02906, USA
| | - Collette Sosnowy
- Department of Medicine, Infectious Diseases, The Miriam Hospital, 11 Fourth St., Providence, RI, 02906, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew Murphy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Anna Schierberl Scherr
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychology, University of Massachusetts, Dartmouth, MA, USA
| | - Megan Pinkston
- Department of Medicine, Infectious Diseases, The Miriam Hospital, 11 Fourth St., Providence, RI, 02906, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Infectious Diseases, The Miriam Hospital, 11 Fourth St., Providence, RI, 02906, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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43
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Arnold T, Rogers BG, Schierberl Scherr A, Pinkston M, Chan PA. Clinical Adjustments During COVID-19 for Outpatient Substance Use Treatment in a Sample of Men Who Have Sex With Men. Public Health Rep 2021; 136:387-390. [PMID: 33765394 PMCID: PMC8203036 DOI: 10.1177/00333549211006984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Trisha Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Brooke G. Rogers
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Medicine, Miriam Hospital, Providence, RI, USA
| | - Anna Schierberl Scherr
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Psychology, University of Massachusetts, Dartmouth, MA, USA
- Lifespan Psychiatry and Behavioral Health, Lifespan Physician Group, Providence, RI, USA
| | - Megan Pinkston
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Lifespan Psychiatry and Behavioral Health, Lifespan Physician Group, Providence, RI, USA
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Medicine, Miriam Hospital, Providence, RI, USA
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Han HR, Miller HN, Nkimbeng M, Budhathoki C, Mikhael T, Rivers E, Gray J, Trimble K, Chow S, Wilson P. Trauma informed interventions: A systematic review. PLoS One 2021; 16:e0252747. [PMID: 34157025 PMCID: PMC8219147 DOI: 10.1371/journal.pone.0252747] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. METHODS We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. RESULTS More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). CONCLUSIONS There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.
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Affiliation(s)
- Hae-Ra Han
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hailey N. Miller
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Manka Nkimbeng
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Chakra Budhathoki
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tanya Mikhael
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emerald Rivers
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ja’Lynn Gray
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kristen Trimble
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Sotera Chow
- Medstar Good Samaritan Hospital, Baltimore, Maryland, United States of America
| | - Patty Wilson
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
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45
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Londoño T, Klodnick VV, Emerson KR, Stevens L, Cohen DA. Creative Technology-Based Strategies for Engaging Young People with Serious Mental Health Conditions in Longitudinal Mental Health Services Research. Child Adolesc Social Work J 2021; 40:313-324. [PMID: 34155420 PMCID: PMC8210497 DOI: 10.1007/s10560-021-00778-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 05/24/2023]
Abstract
A better understanding of the transition from child to adult community mental health services is important given the high rates of service drop-out. Conducting longitudinal research is challenging during a major service provider change. Developmentally-typical transition-to-adulthood instability can deter study engagement. This study examines the efficacy of creative technology-based strategies to recruit and engage adolescents and young adults (AYA) with serious mental health diagnoses in a qualitative study during their transition from child to adult services. Participants were recruited from one agency to complete three in-depth qualitative interviews and monthly surveys exploring mental health service experiences over 12-months. Participants received a smartphone and data plan for 6-months at initial interview, $50 at 6-month interview and $55 at 12-month interview. Four research assistants used a shared Google Voice account to text monthly online surveys and to communicate with participants. 19 participants enrolled; 74% remained enrolled across the 12-months. Smartphones and data plans were not effective in recruiting nor sustaining study engagement for most participants. Participants preferred a mix of texting and phone calls to prompt study engagement; 60% of online surveys were completed. Unanticipated participant-researcher communication outside of research scope suggests that the formation of strong relationships and additional support during this transitional time is critical for sustained study engagement. Study findings have practical implications for social work longitudinal research design and effective study implementation. Future social work research is warranted on innovative strategies to boost study and service engagement among AYA with serious co-occurring mental health and developmental instability.
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Affiliation(s)
- Tatiana Londoño
- Steve Hicks School of Social Work, The University of Texas, 1924 San Jacinto Blvd. D3500, Austin, TX 78712 USA
| | | | - Kaleigh R. Emerson
- Steve Hicks School of Social Work, The University of Texas, 1924 San Jacinto Blvd. D3500, Austin, TX 78712 USA
| | - Laura Stevens
- Steve Hicks School of Social Work, The University of Texas, 1924 San Jacinto Blvd. D3500, Austin, TX 78712 USA
| | - Deborah A. Cohen
- Steve Hicks School of Social Work, The University of Texas, 1924 San Jacinto Blvd. D3500, Austin, TX 78712 USA
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46
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Lynch AC, Weber AN, Hedden S, Sabbagh S, Arndt S, Acion L. Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA. Subst Abuse Treat Prev Policy 2021; 16:8. [PMID: 33435993 PMCID: PMC7801772 DOI: 10.1186/s13011-021-00342-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD), a chronic disease, is a major public health problem. Despite availability of effective treatment, too few people receive it and treatment retention is low. Understanding barriers and facilitators of treatment access and retention is needed to improve outcomes for people with OUD. OBJECTIVES To assess 3-month outcomes pilot data from a patient-centered OUD treatment program in Iowa, USA, that utilized flexible treatment requirements and prioritized engagement over compliance. METHODS Forty patients (62.5% female: mean age was 35.7 years, SD 9.5) receiving medication, either buprenorphine or naltrexone, to treat OUD were enrolled in an observational study. Patients could select or decline case management, counseling, and peer recovery groups. Substance use, risk and protective factors, and recovery capital were measured at intake and 3 months. RESULTS Most participants reported increased recovery capital. The median Assessment of Recovery Capital (ARC) score went from 37 at enrollment to 43 (p < 0.01). Illegal drug use decreased, with the median days using illegal drugs in the past month dropping from 10 to 0 (p < 0.001). Cravings improved: 29.2% reported no cravings at intake and 58.3% reported no cravings at 3 months (p < 0.001). Retention rate was 92.5% at 3 months. Retention rate for participants who were not on probation/parole was higher (96.9%) than for those on probation/parole (62.5%, p = 0.021). CONCLUSION This study shows preliminary evidence that a care model based on easy and flexible access and strategies to improve treatment retention improves recovery capital, reduces illegal drug use and cravings, and retains people in treatment.
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Affiliation(s)
- Alison C Lynch
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA.
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA.
| | - Andrea N Weber
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Suzy Hedden
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Sayeh Sabbagh
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Laura Acion
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Instituto de Cálculo, Universidad de Buenos Aires - CONICET, Buenos Aires, Argentina
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47
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Last BS, Schriger SH, Timon CE, Frank HE, Buttenheim AM, Rudd BN, Fernandez-Marcote S, Comeau C, Shoyinka S, Beidas RS. Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making. Implement Sci Commun 2021; 2:6. [PMID: 33431032 PMCID: PMC7802291 DOI: 10.1186/s43058-020-00105-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians' use of TNs. The behavioral insights literature-an interdisciplinary field studying judgment and decision-making-offers theoretical and empirical tools to conceptualize what drives complex human behaviors and decisions. Drawing from the behavioral insights literature, the present study seeks to understand what determines clinician use of TNs and to generate strategies that target these determinants. METHODS Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (N = 17) to understand their decisions to use TNs with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the "Easy Attractive Social Timely" framework, a behavioral insights design approach. RESULTS We generated and validated three broad themes about what determines clinician implementation of TNs: decision complexity, clinician affective experience, and agency norms. We hypothesized behavioral insights that underlie these implementation determinants and designed a list of nine corresponding behavioral insights strategies that may facilitate TN implementation. CONCLUSIONS Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.
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Affiliation(s)
- Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carter E Timon
- College of Liberal and Professional Studies, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N Rudd
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Carrie Comeau
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Sosunmolu Shoyinka
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Rinad S Beidas
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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48
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Olson JR, Lucy M, Kellogg MA, Schmitz K, Berntson T, Stuber J, Bruns EJ. What Happens When Training Goes Virtual? Adapting Training and Technical Assistance for the School Mental Health Workforce in Response to COVID-19. School Ment Health 2021; 13:160-173. [PMID: 33425042 PMCID: PMC7781169 DOI: 10.1007/s12310-020-09401-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/19/2022]
Abstract
The Northwest Mental Health Technology Transfer Center (MHTTC) provides workforce training and technical assistance (TA) to support evidence-based school mental health practices. Historically, this support targeted school professionals through in-person and online trainings, workshops, and coaching. However, in response to COVID-19 restrictions, all support moved to online formats, and the Center introduced trainings for families and caregivers. The purpose of this article is to present preliminary process and outcome data that compare the reach and impact of support before and following COVID-19-related restrictions. Results suggest that transition to online support resulted in a wider reach and a more diverse audience, with no decrease in trainee satisfaction and perceived impact. Furthermore, families and caregivers reported positive gains in knowledge and behaviors following participation in a virtual youth suicide prevention training. Together, these findings suggest that online training and TA can provide tangible benefits to professionals and family members who support student mental health.
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Affiliation(s)
- Jonathan R. Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Megan Lucy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Marianne A. Kellogg
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Kelcey Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Taylor Berntson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Jennifer Stuber
- Forefront Suicide Prevention, University of Washington School of Social Work, Seattle, WA USA
| | - Eric J. Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
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49
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Winograd RP, Phillips S, Wood CA, Green L, Costerison B, Goulka J, Beletsky L. Training to reduce emergency responders' perceived overdose risk from contact with fentanyl: early evidence of success. Harm Reduct J 2020; 17:58. [PMID: 32831088 PMCID: PMC7443848 DOI: 10.1186/s12954-020-00402-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA.
| | - Sarah Phillips
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | - Lauren Green
- Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA
| | | | | | - Leo Beletsky
- Northeastern University, Boston, Massachusetts, USA
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50
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Lowder EM, Amlung J, Ray BR. Individual and county-level variation in outcomes following non-fatal opioid-involved overdose. J Epidemiol Community Health 2020; 74:369-376. [PMID: 31919146 PMCID: PMC7079264 DOI: 10.1136/jech-2019-212915] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/26/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A lack of large-scale, individually linked data often has impeded efforts to disentangle individual-level variability in outcomes from area-level variability in studies of many diseases and conditions. This study investigated individual and county-level variability in outcomes following non-fatal overdose in a state-wide cohort of opioid overdose patients. METHODS Participants were 24 031 patients treated by emergency medical services or an emergency department for opioid-involved overdose in Indiana between 2014 and 2017. Outcomes included repeat non-fatal overdose, fatal overdose and death. County-level predictors included sociodemographic, socioeconomic and treatment availability indicators. Individual-level predictors included age, race, sex and repeat non-fatal opioid-involved overdose. Multilevel models examined outcomes following non-fatal overdose as a function of patient and county characteristics. RESULTS 10.9% (n=2612) of patients had a repeat non-fatal overdose, 2.4% (n=580) died of drug overdose and 9.2% (n=2217) died overall. Patients with a repeat overdose were over three times more likely to die of drug-related causes (OR=3.68, 99.9% CI 2.62 to 5.17, p<0.001). County-level effects were limited primarily to treatment availability indicators. Higher rates of buprenorphine treatment providers were associated with lower rates of mortality (OR=0.82, 95% CI 0.68 to 0.97, p=0.024), but the opposite trend was found for naltrexone treatment providers (OR=1.20, 95% CI 1.03 to 1.39, p=0.021). Cross-level interactions showed higher rates of Black deaths relative to White deaths in counties with high rates of naltrexone providers (OR=1.73, 95% CI 1.09 to 2.73, p=0.019). CONCLUSION Although patient-level differences account for most variability in opioid-related outcomes, treatment availability may contribute to county-level differences, necessitating multifaceted approaches for the treatment and prevention of opioid abuse.
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Affiliation(s)
- Evan Marie Lowder
- Criminology, Law and Society, George Mason University, Fairfax, Virginia, USA
| | | | - Bradley R Ray
- School of Social Work, Wayne State University, Detroit, Michigan, USA
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