Psychological Services最新文献

Nationally, since 2018, over 1,400 first responders have died by suicide (Costa, 2025), with 153 deaths in 2024 and 71 deaths as of July 2025 (First Honor, Educate, Lead, and Prevention, 2025). Suicide disproportionately impacts first responders and emergency medical services workers compared to the general population (National Emergency Medical Services Management Association, 2016). Based on real-world experiences of first responders, this study aimed to identify the factors that cause mental health distress for first responders in Nebraska and explore their awareness of current strategies and mental health programs. A convenience sample of 15 first responders was recruited through email. In-depth qualitative semistructured interviews were conducted with active or retired Nebraska first responders to (a) identify the factors that influence their mental health and (b) examine the current formal policy(s), procedures, or regulations that address work-related mental illnesses. Data were analyzed using a thematic analysis. The interviews uncovered the following four themes that help explain higher first responder suicide rates: (a) horrific encounters tied to mental illness and suicide, (b) barriers to accessing mental health services, (c) low volunteerism tied to fatigue, and (d) recommendations for change. This study reveals that intricate mental health challenges are faced specifically by Nebraska first responders working in both urban and rural communities. These challenges are magnified because of severe workforce shortages and low volunteerism among workers. Though there were only 15 participants, the saturation and depth of information provided were adequate to suggest recommended changes for policy makers and organization leaders. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The objective of this work was to describe shared decision-making (SDM) domains within the context of a modular anxiety intervention provided in primary care behavioral health within a large organized care setting by (a) identifying patient and provider behaviors that exemplify each domain and (b) quantifying the frequency of these behaviors. Participants were 15 veterans (87% male) with anxiety symptoms randomized to the intervention. The intervention was designed as a brief, modular intervention specifically for primary care behavioral health and was delivered by using primary care behavioral health-trained study interventionists (N = 5). Using established SDM theory, deductive qualitative analysis identified and described SDM domains in audio recordings of initial intervention sessions. SDM-congruent behaviors occurred in all sessions with frequencies ranging from 13.3% to 100%. Common provider behaviors included the following: invites questions, validates, and asks the patient to share (recognition of areas of expertise); sets expectations, describes roles/treatments, provides psychoeducation, and links psychoeducation with the patient's specific symptoms (mutual sharing of information); asks about desired changes and preferred modules (discussion regarding treatment preferences); and agrees with the patient's choice (joint making of decision). Common patient behaviors included the following: readily responds and complies with instructions (recognition of areas of expertise), describes symptoms and gives examples (mutual sharing of information), lists goals (discussion regarding treatment preferences), and chooses an option (joint making of decision). A new domain, active listening (with behaviors such as uses listening sounds, uses reflection, and clarifies reports), was also identified. Findings enhance understanding of what SDM "looks like" in clinical practice by providing clear behavioral exemplars of SDM and may guide how to increase engagement in SDM during provision of patient-centered care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Posttraumatic stress disorder (PTSD) is prevalent among veterans and evidence-based treatments for PTSD are widely available in the Veterans Health Administration. However, rates of treatment seeking for PTSD remain low, due in part to knowledge gaps, perceived treatment readiness, shame/stigma, pride in self-reliance, and trauma-related avoidance (Zinzow et al., 2012). AboutFace is an online peer-based intervention that was developed to overcome many of these barriers to service seeking. The current clinical trial compared the efficacy of AboutFace to a psychoeducational brochure that addressed stigma and PTSD treatment engagement among veterans recommended for PTSD treatment. A total of N = 330 veterans who had presented for an intake at a PTSD specialty clinic were randomized to either AboutFace (n = 165) or a psychoeducational brochure condition (n = 165) and assessed across primary outcomes of treatment engagement and secondary measures of stigma/attitudes about treatment seeking and PTSD, depression, and quality of life at baseline and at 1, 3, and 6 months. In the intention-to-treat sample, there were no statistically significant group differences in outcomes. However, due to a large percentage of noncompliance in the AboutFace group, we considered "as treated" analysis to further quantify the effects of exposure to the intervention. These analyses revealed that participants who accessed AboutFace for at least 15 min were significantly more likely to initiate treatment, initiated treatment sooner, and completed more therapy sessions than those who did not. Study data support the potential benefit of AboutFace as a brief intervention for increasing PTSD treatment initiation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Peer specialists (PS) in the Veterans Health Administration are veteran employees with lived mental health experience supporting others in recovery. While PS worked in traditional mental health settings for many years and demonstrated benefits to veteran engagement and satisfaction with health care, little is known about the best strategies to support implementation in novel, complex settings like primary care (PC). Implementation facilitation, which combined external facilitation plus national resources, was chosen to promote uptake when the VA MISSION Act of 2018 required the Veterans Health Administration to implement PS into PC. Using a mixed-methods, formative program evaluation approach, we examined the effects of implementation facilitation across two cohorts of 15 sites. Due to startup timing, Cohort 1 received minimal implementation facilitation during preimplementation compared with Cohort 2. Outcome measures included qualitative evaluation of facilitator notes, time to attain implementation milestones, and PS productivity and program fidelity (percent of total PS encounters in PC). Results suggested that overall productivity was similar across cohorts, but Cohort 2 demonstrated high program fidelity in Month 1 of implementation, while Cohort 1 required 12 months to attain similar fidelity. Qualitative findings indicated implementation facilitation that fostered team cohesion, clarified roles, supported supervisor training, and encouraged sites to guard against competing demands smoothed transitions for PS into PC. During preimplementation, implementation facilitation that focused on these findings resulted in the rapid attainment of program fidelity. Policymakers should consider the value of investing in preimplementation support for speeding the attainment of high-fidelity implementation of novel and complex practices such as PS in PC. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Practical, Robust Implementation and Sustainability Model (PRISM) was utilized to develop an assessment for improving fit between implementation context, intervention, and implementation efforts. We present findings from the PRISM assessment used in seven military to Veterans Affairs clinics implementing eScreening to improve rate and time for the completion of mental health screenings for veterans and increasing referral to mental health treatment. Questions developed by Glasgow et al. (2020) were adapted to the study context covering the PRISM domains (six items) and reach, effectiveness, adoption, implementation, and maintenance (13 items) outcomes. Assessment results were summarized for each site graphically including comments and were presented in a discussion-based action-planning meeting. Group discussion involving implementation partners and research team members, including an external facilitator, focused on identifying ways to improve the implementation of eScreening. Participants across all sites identified areas of concern related to reach, adoption, and patient expectations. Survey data and comments on these concerns drove the team discussion and identification of implementation activities, which included (a) increasing communication of the value for veteran care, (b) standardizing minimum-effort workflows, and (c) increasing buy-in and collaboration with leadership and other facility services. In this study, the PRISM assessment was used as a one-time activity to enhance implementation across military to Veterans Affairs clinics. The assessment was feasible, and discussion yielded important data on alignment and potential adaptations of the implementation efforts within the dynamically changing local context. Recommendations are provided for those interested in applying the PRISM assessment in their studies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The U.S. Department of Veterans Affairs (VA) developed evidence-informed mental health mobile applications (MH apps) to supplement treatment and serve as self-care resources for veterans. However, lack of awareness and understanding of how to integrate MH apps into care pose barriers to uptake. The VA Mobile Mental Health Apps Project was conducted from 2019 to 2021 to train and support VA health care staff in integrating VA MH apps into practice using implementation facilitation. Interdisciplinary staff (N = 1,110) from 19 VA sites, led by local site champions, and supported by project Facilitators, participated. The training phase successfully equipped staff with key knowledge and skills for MH app integration (McGee-Vincent et al., 2023), but training is not sufficient for practice change (Schueller & Torous, 2020). The current article summarizes results from a mixed methods evaluation of the preimplementation planning and active implementation phases of the project. Survey data from 3-month posttraining (n = 362) and qualitative interview data (n = 27) assessed within the Consolidated Framework for Implementation Research (Damschroder et al., 2022b) were analyzed to highlight facilitators and barriers to implementation. Results showed positive perceptions, meaningful adoption, and expanded reach of MH apps for veterans by staff across VA. Given that the project was well-received and perceived to be sustainable, the adaptability of the innovation and implementation model, and the relatively limited number of perceived barriers, this project may serve as a model for other practice changes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Medication for opioid use disorder (MOUD) is an evidence-based treatment for opioid use disorder (OUD). However, only a small proportion of eligible patients receive MOUD, due in part to access barriers and the complex medical needs of this population. Provision of MOUD traditionally occurs in ambulatory opioid treatment programs that operate separately from other providers, making it difficult to address patient needs comprehensively during health care encounters. To alleviate these barriers to continuous care for individuals with OUD, The Ohio State Wexner Medical Center designed the System-Wide MOUD (SW-MOUD) program. The SW-MOUD program has two objectives, (a) expand access to MOUD across emergency, inpatient, and outpatient settings, and (b) coordinate care for patients across these settings using integrated program staff. This article describes the SW-MOUD program implementation in order to serve as a roadmap for the creation of similar care delivery mechanisms. In the program's first 4 years, there were a total of 4,908 MOUD initiations. The implementation tools presented in this article include a patient flow model with an overall program structure, a detailed multilevel implementation timeline, and a table of implementation strategies used across three broad phases: preparation, rollout, and sustainability. The transformation of evidence-based treatments into systematic delivery approaches offers the potential to improve patient outcomes. Our experience is informative not only for health systems seeking to increase access to MOUD in their communities but also for those looking to expand access to care for any treatment modality by coordinating care across existing system silos. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Progress toward ending the HIV epidemic has been slowed by suboptimal utilization of effective biomedical interventions (e.g., HIV testing, pre-exposure prophylaxis), especially for populations with the highest incidence. In 2021, the New York City Health Department initiated a multilevel implementation strategy, focused on promoting the GOALS Approach to Sexual History and Health-an antistigmatizing, client-centered strategy for sexual history taking-as a lever for increasing HIV intervention adoption, reach, and equity. Project Partnership to Increase Access, Client-Centered Care, and Equity in HIV Services is a community-academic implementation science partnership designed to investigate the impact of strategy enactment on implementation outcomes, including changes in intervention utilization (HIV testing, sexually transmitted infection testing, pre-exposure prophylaxis) in practice over time. This article presents preliminary implementation outcomes collected from the 19 programs (client N = 8,865) funded to adopt GOALS. Data indicate the successful enactment of systems-level strategies (infrastructure development, service mandates), program-level strategies (staff training, learning collaboratives), and provider-level strategies (utilization of the GOALS). By Quarter 5, the GOALS was being utilized in a median of 84% of visits across programs (interquartile range: 54%-97%), and GOALS utilization was positively associated with provider adoption of HIV prevention interventions in practice. Programs that struggled with implementation had less buy-in from leadership and lower commitment to provider training; programs with upward implementation trends had less experience delivering sexual health care and used a phased approach to foster support, focusing on the positive reaction to the GOALS among their clients. These data suggest that a multilevel implementation strategy focused on delivery of antistigma, client-centered sexual histories may be a potent implementation strategy for enhancing HIV prevention intervention adoption. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Often in implementation science efforts, an intervention originated by research funding does not continue in clinical practice after funding ends, or if it does, the process by which it was sustained remains known only to the implementation research or clinical teams. From 2018 to 2020, we implemented a complex telehealth interdisciplinary behavioral health program supported by research funding. The intervention was Primary Care Mental Health Integration (PCMHI) delivered via televideo from a large parent medical facility to rural satellite clinics (tele-PCMHI) within the Veterans Health Administration. Two implementation facilitators worked closely with clinical leaders and staff to plan, launch, and sustain tele-PCMHI across four sites. The intervention is still maintained by the clinical service and has spread to eight sites. Based on ethnographic and qualitative data collected weekly over 2 years, we categorized sustainment strategies across distinct time periods for this complex program, theoretically grounded in the Dynamic Sustainability Framework, emphasizing changes to adapt intervention fit to rapidly changing context. To contextualize, we identified barriers and strengths, such as difficulty training staff to use new equipment, restructuring clinic workflow, and determining suicide risk management remotely. New barriers arose, and, thus, new strategies were needed to continue implementing at the onset of the COVID-19 pandemic in 2020. Different strategies at different stages of implementation allowed sustainment to be a dynamic and evolving process. Plus, proactive and persistent planning for sustainment early in the effort, along with alignment with performance metrics and national policy, supported continued delivery in real-world organized care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

A primary goal of implementation science (IS) is to promote access to evidence-based practice; however, without careful attention to equity, IS may inadvertently reify inequities for priority populations who are most affected by access barriers and health inequities. Recently, there has been a push to integrate health equity concepts into IS frameworks. Yet, empirical examples are limited. This study sought to fill that gap by providing an example application of the RE-AIM framework extension for health equity in the evaluation of a family-based preventive intervention implemented in primary care for our priority population: Latinx, Black/African American, and Native American children. The Family Check-Up 4 Health (FCU4Health) is an individually tailored preventive intervention, adapted from the evidence-based Family Check-Up, for delivery in primary care settings. Data came from a Type 2 effectiveness-implementation hybrid study conducted with multiple primary care organizations in the Phoenix area, with 240 children (85% in the priority population) and their parents/caregivers. We present descriptive data guided by the RE-AIM framework's extension for health equity. Quantitative details about adoption and maintenance are supplemented with descriptions of implementation determinants, provided by partners at each site who coauthored this article. Concerning adoption, three of six organizations approached went on to implement the FCU4Health during the trial. Adoption appeared to be driven by perceived appropriateness, relative advantage, and research-related constraints. Reach: Across multiple stages from initial approach to initiation of services, reach was higher for our priority population, although differences were not statistically significant. Implementation: There were no significant differences in fidelity, active participation, and the completion or quality of home practice between our priority and nonpriority populations. Concerning dosage, coordinators spent more time working with families in our priority population on referrals to resources. Maintenance: None of the organizations continued to implement beyond the trial, which was primarily driven by feasibility. The results provide an exemplar of how the RE-AIM equity extension can be applied to assess the ability of preventive interventions to promote equitable implementation in routine primary care settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).