Psychological Services最新文献

Posttraumatic stress disorder (PTSD) treatments delivered in a massed format (i.e., therapy sessions at least 3 days per week) can significantly reduce dropout rates and result in similar PTSD symptom reduction as standard delivery (i.e., once or twice a week). The VA Health Care System is the largest integrated delivery system in the United States and is uniquely positioned to provide mass treatment to veterans with PTSD. Understanding providers' and administrators' perceived barriers and facilitators to massed treatment can inform implementation. This study conducted semistructured interviews with VA PTSD Clinic providers (n = 17) from five sites and VA mental health administrators (n = 14) from seven VA sites of varying facility complexities and geographic regions. The consolidated framework for implementation research and social cognitive theory informed the interview guide and the thematic analysis. Providers and administrators identified barriers to implementation, including presumed negative veteran and provider attitudes to massed treatment, increased pressure on providers, lack of staff time and other resources, and limits created by current systems and performance metrics. Providers and administrators also identified implementation facilitators, including high expectations for effectiveness, engagement, and acceptability; increased resources, time, and flexibility over scheduling; access to knowledge and training; a heightened need for adjunctive and coordinated care; and thoughtful planning, communication, and support from leadership. Findings suggest that VA providers and administrators are largely supportive of massed treatment and believe it can improve retention rates. They also believe there would be several barriers to implementation, but that many may be overcome with strategic and purposeful planning. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Starting in 2008, the Veterans Health Administration required mental health (MH) provider integration in nursing homes, called Community Living Centers (CLCs), to promote access to quality MH services. This project aimed to understand MH practice patterns and service integration in the CLC and to identify facilitators and barriers to integrated MH services. CLC physician and nurse leaders, and MH providers, were invited to participate in national surveys in the fall of 2022. Survey questions were designed to assess MH provider staffing and workload, organizational alignment and resources, practice and services provided, training and resource needs, MH provider satisfaction and burnout, integration, and CLC team functioning and morale. Questions included structured and open-ended formats. A total of 107 CLC MH providers and 85 CLC leaders completed their respective surveys. Descriptive and bivariate analyses were performed with quantitative data, and conventional content analysis procedures were used to analyze open-ended text responses. Findings highlighted that CLC MH providers care for Veterans with complex presentations across a range of treating specialties requiring many specialized skills, and MH integration is important and valued by CLC leaders. Results support Veterans Administration MH integration efforts and highlight the need for and importance of MH services in the CLC. MH provider job satisfaction and burnout were significantly related to team functioning, morale, and support. Findings will inform ongoing development of CLC MH practice resources and serve as a baseline for further evaluation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Academic withdrawal from colleges and universities is a common occurrence, particularly among students with mental health concerns. Receiving a successful course of psychotherapy may reduce students' risk of academic withdrawal, but outcomes in university counseling centers (UCCs) could be hindered by strategies used to meet high service demands with limited resources, such as offering a low number or frequency of sessions. The present study examined associations among psychotherapy dose, clinical outcome, and academic withdrawal among students (N = 16,197) in short-term individual psychotherapy at 85 UCCs in the United States. Structural equation modeling results indicated that after controlling for baseline psychological distress, the number of psychotherapy sessions attended positively predicted, and the average number of days between sessions negatively predicted, clients' self-reported reductions in psychological distress. In turn, after controlling for pretreatment characteristics associated with academic withdrawal (prior psychiatric hospitalization, gender, academic distress) reductions in psychological distress negatively predicted therapists' report of clients voluntarily withdrawing from their academic institution during psychotherapy. This indicates that students who receive higher psychotherapy doses within a short-term context (i.e., 10 or fewer sessions) are less distressed by the end of treatment, which then predicts a lower likelihood of academic withdrawal during psychotherapy. UCC leadership and clinicians might enhance clinical and academic outcomes by providing flexibility in the number and frequency of psychotherapy sessions available to students. However, centers may need additional resources from their academic institutions to provide this flexibility. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Telehealth can facilitate continuity of behavioral health treatment for opioid use disorder (OUD). Use of telehealth significantly changed during COVID-19, but it is unknown how implementation differed across payors nationally. Adults with OUD and a behavioral health treatment claim for OUD between January 2019 and February 2020, separated by commercial (N = 23,048), Medicaid (N = 87,303), or Veterans Health Administration (N = 84,597), were included. We performed descriptive analysis using longitudinal claims and electronic health record data from 2019 to 2021 and logistic regressions to evaluate associations between patient characteristics and utilization of telehealth visits in the pandemic period. Prior to the pandemic, 0.26%, 1.16%, and 2.67% of adults covered by commercial, Medicaid, or Veterans Health Administration had a telebehavioral health visit each month, respectively. Between April 2020 and March 2021, these averages increased to 12.7%, 18.8%, and 15.8%, respectively. Rates of in-person treatment dropped at pandemic onset but remained the primary modality. Age, sex, health plan type, co-occurring conditions, and comorbidity were all associated with telehealth use, and these variables differed between payors. Although in-person care for OUD decreased dramatically postpandemic onset, it remained the primary modality for adults with OUD. Despite swift increases in the rate of telehealth care, it was not widely adopted for OUD treatment and uptake differed significantly across payors and patient demographics (e.g., older individuals and veterans). Telehealth was used less for medication management overall, despite regulatory exceptions expanding on this option, also with notable differences across payors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

FLOW (not an acronym) is a program that aims to improve mental health (MH) access using an algorithm that extracts electronic medical record data to identify recovered or stabilized MH patients who may be eligible to transition to primary care. The purpose of this case study was to describe and understand the factors that contributed to success or struggles in implementing FLOW. We conducted a posthoc evaluation of four health care sites implementing FLOW, using a mixed-method formal case study analysis. Qualitative data included written process notes, teleconference minutes, and interviews with internal facilitators (IF), MH providers, and patients who were transitioned. The external facilitation team also examined the degree to which IF characteristics matched suggested criteria. Quantitative data included discharge percentages and the percentage of providers who transitioned ≥ three patients during implementation. Sites were considered successful if they: (a) discharged ≥ 3% of their unique MH patients and (b) had a preponderance of patients who were satisfied with their MH to primary care transition. This article discusses two successful and two struggling FLOW sites based on these and other criteria and the factors that contributed to these outcomes. These case study findings increased understanding of how to successfully implement FLOW. The importance of shared decision making, selection of the IF, role definition, as well as leadership and organizational support are key elements in fostering appropriate transitions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The Intensive Community Mental Health Recovery (ICMHR) services have been established by the Veterans Health Administration to provide veterans with high-quality mental health care. This study, for the first time, evaluates the association between ICMHR service initiation and change in psychiatric symptoms among veterans, to assess the effectiveness of these services. This retrospective observational study includes veterans who enrolled in ICMHR services during October 2018-September 2021, and had a Brief Psychiatric Rating Scale (BPRS) assessment at the time of ICMHR service enrollment (baseline), and at sixth and/or 12th month after enrollment. Multivariable random-effects linear regression was used to examine the change in BPRS scores over time during the first year after ICMHR service enrollment. Changes in the five clinically relevant BPRS domains were also examined. The study found a statistically significant decrease in BPRS scores during the sixth (adjusted change = -1.6; 95% CI [-2.2, -1.0]) and 12th month (adjusted change = -2.4; 95% CI [-3.0, -1.7]) follow-up after ICMHR service enrollment, as compared with the baseline score. The study also found that ICMHR service initiation was associated with considerable improvement in BPRS domains representing affect, activation, and negative and positive symptoms, but was not associated with changes to the domain representing resistance. These results suggest that ICMHR services were potentially effective in improving psychiatric symptoms, as measured by the BPRS scores, in veterans enrolled in these services. The services were not associated with improvement in all psychiatric symptoms, potentially indicating that additional services might be needed to manage symptoms that do not improve. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Although there is an active screening program for posttraumatic stress disorder (PTSD) in Veterans Health Administration (VHA) primary care clinics and empirically supported treatments for PTSD are available, many patients who are identified through screening and receive a new PTSD diagnosis do not engage in cognitive processing therapy (CPT) or prolonged exposure therapy (PE). CPT and PE are both widely promoted and recommended first-line treatments in the VHA that were the focus of the VHA's initial implementation of evidence-based psychotherapy for PTSD. We examined the mental health care patients received following a new positive PTSD screen in VHA primary care clinics and whether health system factors were associated with engaging in CPT or PE. A national cohort of VHA primary care patients who screened positive for PTSD in 2018 were followed for 1 year from the date of screening. Overall, 20,853 patients screened positive for PTSD; of these, 76% received a diagnostic clinical evaluation, and 86% of these patients evaluated received a confirmatory PTSD diagnosis within 1 year of screening. Ten percent (n = 1,372) of patients who received a confirmatory PTSD diagnosis engaged in CPT or PE. Confirmatory evaluation location (in a PTSD specialty clinic) and timing (within 3 months of screening) were each associated with increased likelihood of engaging in CPT or PE. Most patients who screen positive for PTSD in VHA primary care clinics are connected to follow-up clinical evaluations and receive confirmatory PTSD diagnoses. However, only one-in-ten patients who screen positive and receive a confirmatory PTSD diagnosis go on to receive CPT or PE. Screening appears to more effectively lead to patients with PTSD engaging in CPT or PE when the confirmatory evaluation occurs quickly and in a setting prepared to deliver evidence-based treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Interventions for substance use disorders (SUDs) are typically delivered face-to-face or remotely via telehealth. In recent years, there has been a rapid rise in the number of SUD services delivered using telehealth. However, the literature on which mode of service delivery SUD patients and providers prefer is still emerging, particularly with respect to family-based interventions in Opioid Treatment Programs (OTPs). This study sought to identify/explain preferences for delivering family-based programs among OTP patients and providers. Data collection from a total of 40 participants (20 patients and 20 providers) was conducted from August 2022 to October 2022 at two OTPs in Florida. An online survey was used to collect demographic data, while individual qualitative interviews were conducted to explore preferences for delivering family-based programs. Audiotapes of interviews were transcribed, coded, and thematically analyzed. Analyses revealed that patients and providers had similar preferences, with the most salient being (a) concerns about keeping children engaged during telehealth sessions, (b) concerns about communication barriers when using telehealth, (c) preference for telehealth using live video (as opposed to prerecorded content), and (d) preference for telehealth over face-to-face due to greater convenience for patients. These findings show that preferences for delivering family-based services are varied and may differ somewhat from preferences for delivering traditional individual therapy services. The data presented here can be used to develop and further refine protocols for adapting and delivering family-based interventions in OTP settings, and are especially timely as legislative discussions are currently occurring about expanding telehealth services in these facilities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Cognitive remediation (CR) for schizophrenia has been extensively studied and has proven effective in improving both cognition and functioning. Yet, implementation into mental health services is poor, with implementation and engagement barriers and facilitators not understood. The present study aimed to assess expert opinions on CR barriers and facilitators that pertain to staff, mental health services, and consumers. Thirty-seven international CR experts (clinicians/researchers) responded to Likert-scale questions on implementation and engagement facilitators, essential CR components, barriers in mental health facilities, barriers for clinicians, and barriers for consumer access and engagement across three rounds of a Delphi survey. The main barriers to CR implementation were (a) lack of staff training, (b) lack of perceived relevance/lack of knowledge about cognitive deficits in schizophrenia and CR usefulness in both clinicians and consumers, as well as (c) lack of staff employed in cognitive rehabilitation roles. The presence of defeatist beliefs and difficulty in accessing the place of delivery were both barriers to consumer engagement and access. The most important facilitators for CR were a good therapeutic alliance, CR delivered as part of integrated rehabilitation services, psychoeducation provided to families and stakeholders, and CR focusing on generalization of learning to everyday life. This study highlights the barriers to CR implementation from experts. A multitude of factors were identified that need attention. It is also apparent that CR cost-effectiveness studies are needed to facilitate organizational change and national guideline recommendations for improving mental health services policy around serious mental illness/schizophrenia health care provisions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

We examined beliefs and practices regarding firearm assessment and lethal means safety counseling (LMSC) among U.S. Air Force (USAF) mental health providers (MHPs) and behavioral health technicians (BHTs). Data were collected from 204 USAF MHPs (74.0%; n = 151) and BHTs (26.0%; n = 53) via an anonymous, voluntary survey. A modest proportion indicated they strongly/extremely believe that firearm ownership (42.2%) and storage practices (58.3%) are related to suicide risk. A minority indicated they "strongly"/"extremely" believe that LMSC will yield changes in storage practices (30.9%) and decreases in suicide risk (29.9%). Across patient scenarios, most indicated that "most of the time"/"always" they assess for firearm access (74.5%-99.5%) and provide LMSC (57.8%-95.6%). About half (52.5%) reported having distributed cable locks. Most (59.3%) indicated they are somewhat interested/very interested in receiving additional training on LMSC. MHPs, compared with BHTs, were significantly more likely to report believing a link between firearm ownership and storage practices and suicide risk, believing LMSC is effective at reducing suicide risk, providing LMSC to female patients and patients with current suicidal ideation, and having distributed cable locks. Findings suggest that there is not widespread agreement among USAF MHPs and BHTs that personal firearm ownership and nonsecure storage practices are associated with elevated suicide risk, and there were low levels of confidence in the effectiveness of LMSC. Yet, most USAF MHPs and BHTs reported they integrate firearm access assessment and LMSC as part of their routine clinical care, particularly for patients with identified suicide risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).