Psychological Services最新文献

First responders experience mental health conditions at a higher rate than the general population. To improve treatment and enhance quality of care, it is important to understand the needs of those who provide mental health treatment to this population. The purpose of this study was to explore the needs of mental health providers with experience working with first responders to better understand how first responders differ from community patients, and what training and supports providers need to enhance treatment. Semistructured qualitative interviews were conducted via videocalls with 12 mental health providers who provide mental health care to Australian first responders. The interviews were transcribed verbatim and interpretative phenomenological analysis was performed. The findings highlighted the importance of identity and culture among first responders, and the need for cultural awareness and understanding among mental health providers working with this population. Various training opportunities which could enhance treatment capacities were identified, including training in accurate assessment and differential diagnosis, evidence-based trauma-focused treatments, transdiagnostic treatments, and working with specific first responder treatment characteristics (e.g., emotional detachment, rigid cognitive styles, and preferences toward structure and order). Ways in which mental health providers can be supported included facilitating professional networks between providers and connection with first responder organizations. The insights gathered from this study provide a foundation from which to consider training and support development for mental health providers working with first responders. Service level implications and directions are outlined to assist future decision making on this topic. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Embedding a behavioral health consultant (BHC) into primary care settings is a common way to address the challenge of providing mental health services to primary care patients. Systematic research on the mechanisms of change that underlie the relationship between the active components of these integrated models of care delivery on patient outcomes is needed to help maximize effectiveness and, in turn, guide future implementation efforts. Using the existing primary care behavioral health (PCBH) literature, this article provides a conceptual framework using a common presenting problem, depression and identifies the active ingredients of PCBH and hypothesized mechanisms of patient change that result in decreased depressive symptoms and improved functioning within a patient. Eight hypothesized mechanisms (i.e., belief that PCBH services provided by BHC is a standard part of care within primary care; increased credibility of BHC and PCBH care provided; increased receptivity to the PCBH services offered; increased understanding of problem and options; realignment of patient expectations for care; increased readiness to change; decrease stigma; increase capacity to cope and manage symptoms) are proposed within this conceptual framework along with four potential mediators/moderators (i.e., team processes, PCBH factors, common factors, treatment engagement). The theoretical conceptualization included calls for future research to provide an evidence base to inform clinical practice. An increased understanding of the relationship between these active ingredients and the identified mechanisms of change is essential to maximize PCBH's effectiveness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Insomnia is a prevalent and negatively impactful disorder among veterans. The Department of Veterans Affairs (VA) has committed significant resources to the development and dissemination of training related to cognitive behavioral therapy for insomnia (CBT-I), the recommended first-line intervention for chronic insomnia disorder. It has been established that VA clinicians can be effectively trained to deliver high fidelity CBT-I and that treatment results in significant improvements in insomnia. However, there is a paucity of research examining rates and predictors of veterans' participation in CBT-I in routine VA clinical care. In this study, we conducted a secondary analysis of data from VA electronic health records (EHR) to determine individual predisposing, enabling, and need factors associated with CBT-I participation. The sample included veterans who had at least one CBT-I templated note from the VA mid-Atlantic region of the United States (VISN4) between 2015 and 2019 in their chart (N = 2,801). CBT-I participation was defined by number of CBT-I templated notes occurring within a 6-month period from the initial note. Findings indicated that veterans most often completed only one session of CBT-I and, on average, completed approximately three sessions. Results from multinomial logistic regression identified significant associations of race, the presence of comorbid mental health disorders, rurality, presence of insomnia diagnosis, and insomnia medication with CBT-I participation; associations varied depending on how CBT-I participation was defined. More work is needed to better understand factors contributing to participation and reasons for completion and noncompletion of CBT-I. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Veteran engagement in mental health treatment (MHT) remains low. Peer specialists (PS) are well positioned to implement interventions addressing barriers to MHT engagement, given their familiarity with the process. This study aimed to develop and assess the acceptability of a primary care-based, PS-delivered intervention to improve MHT initiation. Aim 1 utilized modified Delphi methods with a committee of 12 stakeholders (e.g., PS, psychologists, and veteran patients) who provided input on the proposed PS-delivered MHT engagement intervention. The proposed intervention components included questionnaires to identify barriers to engagement and targeted strategies for the barriers (e.g., motivational interviewing, cognitive restructuring). Aim 2 consisted of qualitative interviews with veterans entering MHT, focused on acceptability and feasibility, and gathered additional feedback for the intervention drafted in Aim 1. PS in primary care also reviewed the intervention and provided feedback. Results from Aim 1 demonstrated the acceptability of PS utilizing questionnaires in their work with Veterans, emphasized the importance of rapport building, and provided consensus on the identification of tailored treatment strategies. Veterans entering MHT (n = 9) reported that they were excited about the option of PS being involved in treatment engagement. PS (n = 18) also reported the overall acceptability of the intervention and provided feedback impacting the implementation of the intervention. Incorporating primary care PS into MHT engagement is acceptable. This study serves as the first step in developing a PS-delivered intervention to improve engagement in veteran MHT with input from a diverse group of stakeholders. Implications and future directions will be explored. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

COVID-19 led to a rapid increase in telemental health care via video or phone. It is important to examine contributors to the choice of video versus phone, as video may be more effective and preferred by patients. Medical mental health (MH) providers (e.g., psychiatrists) may conduct more phone and less video visits than nonmedical MH providers (e.g., psychologists). This study examined whether medical and nonmedical providers' perceptions of the quality and complexity of phone and video MH care may contribute to differences in use. A 32-item survey of 414 providers (79.5% response rate) assessed perceptions of care quality, factors contributing to modality choice, and telehealth challenges. The types of visits completed by providers in the months prior to the survey were extracted from administrative data. Medical and nonmedical providers generally viewed video care as higher quality and more preferred than phone, although to a lesser extent among medical providers. Nonmedical providers' decision making was more impacted by research regarding the modalities' relative effectiveness. Medical providers more frequently endorsed video challenges, including patient technical difficulties and lack of patient training. Administrative data demonstrated that medical providers conducted fewer video appointments than nonmedical providers. Medical providers may be less aware of research demonstrating that video care is effective and preferred by patients, and the complexity of video visits may be a barrier to use. Streamlining video processes, increasing technical support, and disseminating research that compares the quality of video and phone care may increase video use among medical providers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Community health workers (CHWs) have established pathways to implementing effective, sustainable, and cost-effective health programs among underserved populations. Despite the significant role of CHWs, there is limited literature describing the needs of CHWs, specifically in times of health emergencies and crises. Thus, we explored the challenges and sources of support among CHWs providing services to Latinx families. Participants were recruited from a Latinx community-based organization in metro Atlanta, working to strengthen family relationships using evidence-based programming. Fifteen semistructured interviews were conducted among CHWs. Interviews were conducted primarily in Spanish, recorded, transcribed, and translated into English for analysis. Following a thematic analysis, data were double-coded, and codes were described and compared for themes. Participants identified as Latinx (n = 15), were between the ages of 29 and 69 years, and had worked as CHWs between 1 month to 4 years. Two themes and seven subthemes were identified in the data. Theme 1 highlighted barriers and strategies employed by CHWs to address clients' preexisting and emerging needs, and Theme 2 focused on responding to client needs during the COVID-19 pandemic, which introduced new challenges and barriers that provoked adaptive organizational strategies to promote worker resilience. Addressing the needs of vulnerable communities in times of crisis to improve the working conditions for CHWs will require a multifaceted approach that prioritizes the removal of structural barriers. Barriers can be mitigated by prioritizing cultural assets, adopting flexible and equitable work policies, and enacting policies at the federal level that promote health justice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Complex interventions combining multiple evidence-based strategies have gained substantial traction in suicide prevention across the world. However, implementing these interventions in real-life settings is fraught with several challenges, significant resource demands, and evidence on the merits of implementing complex interventions remains a topic of debate. This study explores the real-world experiences of implementing complex interventions, including challenges, lessons learned, and the way forward. Sixteen participants (nine leaders, five implementors, and two lived experience advocates) from varied professional backgrounds and experiences were purposively recruited from six high-income countries and one low- and middle-income country. Participants were encouraged to reflect on their experiences of implementing complex suicide prevention interventions in their specific country contexts. Thematic analysis was conducted to identify, organize, and offer real-world insights into challenges, lessons learned, and what is needed as the way forward. Important themes related to challenges and lessons learned emerged: (a) stakeholder characteristics, engagement, and dynamics; (b) resources such as funding priorities and capacity; (c) contextual factors including larger sociocultural beliefs, policies, and legislation surrounding suicide and its prevention; (d) nature of lived experience engagement; (e) design and approach to interventions; (f) delivery of interventions; and (g) the scope of evaluation. The study yielded important insights into practice recommendations related to the implementation of complex suicide prevention interventions on the ground. Important pathways for designing interventions, collaboration, and stakeholder engagement for future implementation efforts were discussed. These real-life experiences and lessons learned from international experts are critical in understanding and bridging the know-do gap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Safety Planning Intervention (SPI) is an evidence-based therapeutic intervention designed to mitigate suicide risk by providing a suicidal individual with a written, personalized safety plan. The Department of Veterans Affairs (VA) has implemented safety planning, but research found variability in the quality of safety plans. To improve quality, the VA developed an Advanced Training in the Safety Planning Intervention (ASPI) that went beyond previous didactic training efforts by emphasizing experiential learning. The aim of this article is to describe the procedures and initial results of VA's competency-based ASPI Training Program. Before training, providers participating in this program uploaded a written, deidentified safety plan completed with a Veteran. Providers then completed four training components, including evaluation of fidelity of written safety plans and competency in SPI during live, standardized roleplays at the conclusion of training, and at a 3-month follow-up evaluation. Of the 409 providers who initiated training, 367 (90%) completed training, 26 (6%) dropped out of training, and 16 (4%) did not meet the competency requirements for training completion. Relative to pretraining, there was a medium to large increase in the effect size of the quality of written Safety Plans at the end of training that was maintained at the 3-month follow-up. Using a standardized, observational measure of SPI competency, 383 of 391 (98%) providers met competency criteria following the training, and 367 of 375 (98%) providers met competency at 3-month follow-up. Findings suggest that ASPI training is effective in helping providers achieve and maintain fidelity in safety planning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The present study sought to investigate whether gender moderates the relationship between military sexual trauma (MST) and posttraumatic stress disorder (PTSD) treatment utilization, among veterans with clinically significant PTSD symptoms. Participants were 2,664 veterans with probable PTSD from a nationwide, population-based survey. Participants reported sociodemographic information, history of MST (including military sexual harassment and military sexual assault), and lifetime receipt of PTSD psychotherapy and medication treatment. We found that gender significantly moderated relationships between (a) military sexual harassment and PTSD psychotherapy, (b) military sexual assault and PTSD psychotherapy, and (c) military sexual harassment and PTSD medication. For women, MST was associated with a greater likelihood of receiving treatment, but for men, MST was not associated with PTSD treatment. Future research is needed to better understand gender differences in how experiences of MST may affect engagement in PTSD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).