Psychological Services最新文献

Veterans' reluctance to engage in mental health treatment coupled with high attrition in such treatment should motivate practitioners and researchers to create innovative ways to treat veterans. Nature-based interventions show promise as a means for addressing veterans' mental health needs. The present study aimed to test the feasibility and acceptability of a manualized nature-based mindfulness intervention for veterans with mental illness. The authors hypothesized that veterans participating in the outdoor, nature-based intervention would report greater reductions in posttraumatic stress disorder symptoms and psychological distress compared to those participating in an indoor mindfulness intervention. Recruited from a Veterans Affairs health care center, 41 veterans with diagnosed mental illness were randomized to either a six-session outdoor group mindfulness intervention or a comparable six-session group mindfulness intervention delivered indoors at the Veterans Affairs. A t test and chi-square tests were used to examine treatment session attendance and treatment completer status. An intent-to-treat framework was used to assess between-group differences by fitting separate generalized linear mixed models with robust estimation for the outcomes of posttraumatic stress disorder symptoms, psychological distress, sense of restoration, and nature connectedness. Results showed that, while the average number of training sessions attended did not statistically differ by group, the number of treatment completers did; there were more treatment completers in the outdoor group. Additionally, linear mixed modeling with robust estimation revealed a significant Condition × Time interaction for posttraumatic stress disorder symptoms. The findings of this research demonstrate that nature-based interventions show promise as an approach to treating veteran mental illness while combating mental health care stigma and increasing treatment completion rates. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This study outlines the development and implementation of a law enforcement led, co-responder program that occurred in one Florida county from 2017 to 2021. The goal was to reduce involuntary commitment (i.e., Baker Act) examinations initiated by frontline officers. The program was embedded in the sheriff's office, designed for youth under the age of 18, and relied on licensed therapists to provide on-scene crisis de-escalation assistance to responding officers. First, we describe the strategic planning process which included a survey of sworn officers and dispatchers (n = 165), semistructured interviews with the chain of command (n = 30), and analysis of months of administrative records. Then, we report findings from 29 months of program implementation. Data describing 206 juvenile mobile crisis responses, youths' suicidal risk factors, and involuntary commitment decisions are presented, as well as monthly and yearly trends in recorded calls for service that involve a youth experiencing a mental health crisis and their dispositions (i.e., involuntary commitment or de-escalation). A reduction in the rate of involuntary commitment examinations made by frontline officers, timely on-scene arrival by a mental health professional, and clear alignment in suicide risk severity and response dispositions were some of the observed benefits of the program. We highlight the critical role that police mental health collaborations have in providing effective care for youth in crisis and emphasize the critical role that these initiatives will play in the future. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The goal of this study was to examine the cost-effectiveness of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), including prolonged exposure and cognitive processing therapy, by comparing four delivery modalities: home-based telehealth (patient in home), office-based telehealth (patient in one office, provider in another), in-home in-person, and in-office in-person. Pooled data from 268 veterans enrolled in two harmonized PTSD clinical trials were used to examine costs related to personnel, travel mileage, and office space. Cost-effectiveness was calculated using an incremental cost-effectiveness ratio that included unadjusted medians of cost differences between modalities and percent change in clinical outcomes. K-sample equality of medians tests were used to ascertain statistical significance in differences across treatment modalities for the total cohort, as well as for cohorts based on greater baseline PTSD severity (baseline Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, score ≥39 points), for the half of participants who did not respond as well to therapy, and for those who experienced reliable change in PTSD symptoms. The median incremental cost-effectiveness ratio was -$81 across all treatment modalities, -$92 for in-office in-person, -$92 for home-based telehealth, -$131 for office-based telehealth, and -$55 for in-home in-person. Sensitivity analyses examining baseline PTSD severity and responder status are also presented. Cost-effectiveness differed across treatment modalities, but only for those who were considered treatment responders. Shared decision making can help clinicians determine the best therapy delivery approach for each patient suffering from PTSD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Even after intensive trainings, human and health service professionals may not optimally take up new approaches, such as motivational interviewing (MI). To decrease this knowledge-action gap, scaffolding of learning MI has been proposed. We developed (a) a workbook that aimed to boost MI uptake from the perspective of practitioner behavior change using goal setting, planning, self-monitoring, and social support and (b) structured peer group sessions to support this scaffolded learning process. We examine participants' perceptions of and engagement with these components and whether the use of workbook and peer group meetings was associated with changes in participants' MI skills. Social workers (n = 33) participated in an MI training over 2 months and responded to a survey about engagement at midintervention. At baseline and postintervention, real or simulated conversations with service users were assessed using the social work and interviewing motivationally coding system to identify the use of MI skills. Survey responses were aggregated into an engagement index, and its relationship to mean social work and interviewing motivationally assessed skill change was explored, using visualization methods in R. Approximately half of the respondents found the workbook useful for learning MI, while the other half reported that the workbook was difficult to use. The use of the workbook and peer group support was positively but modestly associated with skill improvement. Structured program to support behavior change to take up MI can improve training results. Basing training materials on both behavior change science strategies and feedback from the trainees has the potential to overcome the knowledge-action gap in MI trainings and promote sustained, high-quality training results. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Transgender and gender diverse (TGD) people are at increased risk for suicide. Gender minority stress is associated with suicidal ideation (SI), and lack of social connection mediates this relationship. However, these associations have largely been studied in nonclinical samples and without also considering social connection as a resilience factor. The present study tested the relationships among minority stress, social connection, and SI among a sample of inpatient TGD adults. Fifty participants completed measures of proximal and distal gender minority stress, community connectedness, thwarted belongingness, perceived burdensomeness (PB), and SI. Structural equation modeling was employed to determine mediators of the relationship between gender minority stress and SI. Proximal, but not distal, minority stress was significantly correlated with SI. The proximal minority stress-SI relationship was partially mediated by PB but not thwarted belongingness. Community connectedness was also a mediator when explored in isolation; however, when community connectedness was included in the model along with thwarted belongingness and PB, only PB remained as a significant mediator. Proximal minority stress and PB are potential treatment mechanisms for reducing SI among inpatient TGD adults. Bolstering social connection with other TGD individuals may also lessen the negative impacts of proximal gender minority stress. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The Department of Veterans Affairs requires integrated mental health (MH) services across programs, including 132 facility nursing homes (community living centers, CLCs). As part of a national survey of CLC MH providers in the fall of 2022, which aimed to characterize CLC MH practice patterns and service integration, information was also shared regarding the impact of the COVID-19 pandemic in CLC. The aim of this article was to present qualitative feedback from CLC MH providers regarding MH service integration and interdisciplinary teamwork in the CLC during the pandemic. Response rate to the entire survey was 48%. Out of the 107 survey participants, 82 responded to open-ended survey questions; of these, 71 (87%) were psychologists, and 11 (13%) were psychiatric providers. This analysis focuses on presents two major themes: (a) impact of the COVID-19 pandemic on CLC MH providers, staff, and veterans and (b) importance of team morale and functioning. In their feedback, CLC MH providers emphasized the importance of broad stakeholder engagement, including MH providers, in addressing a public health crisis in ways that optimize person-centered care, strong interdisciplinary team functioning, and support from leaders. Findings highlight the importance of MH integration in the nursing home setting, especially during times of crisis such as the pandemic. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Individuals who decline transport to the hospital following an opioid overdose represent a vulnerable subgroup at increased risk for subsequent overdoses. This study describes a unique joint overdose response model implemented by an emergency medical service provider and a community-based organization to connect overdose survivors to medication for opioid use disorder and services. Qualitative interviews were conducted with emergency medical system employees (n = 7), community-based organization staff (n = 3), and program clients (n = 20). A qualitative descriptive method was applied for thematic analysis to understand participants' experiences with this coresponse model, particularly navigating clients to health and opioid treatment services. Thematic analysis identified three themes: (a) Outreach workers perceived as part of the community describes why clients trusted the community outreach workers and coresponse acceptability; (b) in coresponse team emphasized personal empowerment, clients described how the coresponse team provided postoverdose and follow-up services, which promoted their self-efficacy to address health and substance use priorities; (c) service uptake and challenges include difficulties with linking clients to evidence-based opioid use disorder treatment with medications for opioid use disorder and follow-up interactions with community outreach workers for wraparound services to facilitate linkage to opioid treatment services. This is among the first partnerships that allowed community responders to arrive at the scene of an overdose. This program attempts to connect trusted partners to people who recently survived an overdose and immediately begin support and service navigation. Clients were enthusiastic about the services provided by the community outreach workers to initiate and maintain their connection to essential social and treatment services. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Ending veteran homelessness remains a priority within the U.S. Department of Veteran Affairs (VA). Efforts over the past decade have led to encouraging declines in veteran homelessness but have required significant funds and resources. Analysis of clinical characteristics and utilization patterns of veterans accessing VA homeless programing can clarify the needs of and inform treatment for this subset of the veteran population. Veterans were categorized according to low, moderate, or high rates of VA homeless service use from 2005 to 2024 (N = 1,086,852) and compared based on demographic profiles, documented mental health diagnoses, and use of nonhomeless VA services, such as rehabilitation and mental health services, during the same time frame. Veterans with high (vs. moderate or low) VA homeless service utilization had significantly higher rates of documented psychiatric diagnosis, particularly severe mental illness, substance use disorders, and personality disorders, and had 2-3 times greater odds of utilizing services through Veterans Justice Programs, emergency services, primary care, and other VA programs and 46% greater odds of utilizing rehabilitation services. Despite these patterns, the frequency of nonhomeless VA service use was low across groups, suggesting potentially minimal sustained engagement with these services. Adapting interventions to meet the co-occurring needs of this population by prioritizing connection to and sustained engagement with nonhomeless VA programing may help homeless veterans benefit from the VA's comprehensive health care system. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Primary care (PC) represents a widely accessed health care service for youths and families in the United States. In recent years, there has been an increase in youth presenting to PC with suicidal thoughts and behaviors. This study aims to better understand current suicide prevention practices and provider perspectives regarding suicide prevention practices in PC with pediatric populations. Two studies (one using focus groups, the other using individual interviews) were conducted with 40 PC staff (including physicians and physician assistants, integrated behavioral health staff, nurses and nurse practitioners, and clinic leaders) from pediatric PC clinics in Washington State. Focus groups/interviews elicited feedback on current suicide care practices, staff and clinic needs, barriers, facilitators, and suggestions for improvement. Focus groups/interviews were recorded, transcribed, and analyzed using thematic analysis. Results were similar across clinics and highlight challenges and needs for pediatric PC including time limitations, lack of resources for parents, need for additional provider training in suicide prevention, need for team-based approaches, need for standardized and streamlined pathways for patients at different risk levels, and need for integrating screening and intervention components into existing workflows. Overall, results suggest that suicide care is difficult to implement within PC contexts. Understanding PC staff needs, barriers, and facilitators is imperative to adapt feasible suicide care pathways for PC. Results highlight important needs and key components for implementation strategies to target. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Gay and bisexual men experience disproportionate rates mental health challenges including for depression, suicidality and substance use disorders. At the same time, they may face unique barriers to seeking mental health care that is lesbian, gay, bisexual, transgender and queer+ (LGBTQ)-affirming. In this study, we describe and analyze gay and bisexual men's mental health care navigation, with a focus on identifying challenges that arose when seeking care. Between July and September of 2023, 24 individuals participated in in-depth interviews via video-conferencing software. Interviews were transcribed and analyzed using a reflexive thematic approach. Participants reported challenges navigating insurance networks, which often engendered frustration and emotional upset. Participants desired mental health providers that could provide affirming and culturally tailored care, with a preference for providers from the LGBTQ+ community and from their racial or ethnic background. Such needs were complicated by narrow provider networks, limited resources and provider directories replete with inaccuracies and unavailable providers. Participants also highlighted cost-related challenges, including high out-of-pocket costs associated with care and treatment limitations that restricted access to care. Finally, participants reported programing and resources that helped bridge the payment gap or made accessing care more convenient, including community and employer-offered mental health programming, primary care provider-delivered care and telehealth utilization. Our findings support that gay and bisexual men experience challenges when seeking mental health care that also affect the broader population, but may be magnified for this population, particularly for men of color seeking care from a smaller subset of providers prepared to deliver culturally tailored and affirming care to LGBTQ+ individuals. (PsycInfo Database Record (c) 2026 APA, all rights reserved).