Journal of Behavioral Health Services & Research最新文献

Substance use disorder (SUD) is increasing among primary Spanish-speaking populations, and treatment use is disproportionately low. Patient-provider Spanish language concordance is associated with SUD treatment initiation and better outcomes. Recent geographic shifts within primary Spanish-speaking populations are important considerations in identifying gaps in SUD service delivery in Spanish. This national epidemiologic study used the Mental Health and Addiction Treatment Tracking Repository (2022; N = 9336 facilities) and US census data to pinpoint the location of SUD treatment facilities that offer services in Spanish, and used multilevel models to determine whether access to Spanish services is keeping up with the influx of primary Spanish-speaking populations in new areas that have not historically had a large Spanish language presence. Twenty-two percent of SUD treatment facilities provided services in Spanish. For every 10% increase in the percentage of a census tract speaking Spanish, the odds of SUD treatment facilities offering services in Spanish increased by 30% (aOR = 1.03, 95% CI = 1.02-1.04, p < 0.0001), indicating that Spanish language services were more common in places where people who speak Spanish already live. In contrast, the study team identified no association between the availability of Spanish services and increases in community-level Spanish between 2010 and 2022 (aOR = 1.00, 95% CI = 0.99-1.01, p = 0.87), indicating that access to services is not keeping up with demand as populations move and the Spanish language grows in new areas. SUD treatment services are lagging behind as the location of where primary Spanish-speaking families choose to live changes. Local health policies and ambitious interventions are needed that target the unique needs of SUD treatment clients who speak Spanish.

The Institute of Medicine (2001) describes quality health care as safe, effective, patient-centered, efficient, equitable, and timely. Although this definition highlights the necessity of continuous program evaluation to ensure that these goals are being addressed, there is a notable lack of industry-wide standards and benchmarks, and many clinical programs lack the ability to continually and rigorously evaluate their own performance with data. This might be particularly true in the case of ensuring service members and veterans with posttraumatic stress disorder (PTSD) obtain treatment, as several systemic barriers exist, such as long wait times and lack of equitable treatment for individuals with minoritized identities. The current study examines the impact of a clinic-wide intake redesign for a massed PTSD treatment program to shift the intake process to a small, dedicated team rather than a responsibility shared across all clinicians. The redesign led to significantly shorter wait times for treatment and reduced some types of pre-treatment dropout. On average, patients received an acceptance/rejection decision 1 week sooner, attended the program almost 2 months sooner, and saw a roughly 60% reduction in the odds of dropout at the point of receiving an acceptance/rejection decision. Some disparities in wait times for those who were not partnered, women, and individuals who financially supported more family members remained after the redesign. Results are discussed in light of the importance of continuous program evaluation to address IOM's holistic definition of quality health care.

Growing mental health treatment access disparities elevate the urgency for identifying and implementing innovative approaches for delivering evidence-supported interventions. Work-related cognitive behavioral therapy (WCBT), a technology-assisted CBT (t-CBT) designed to address social anxiety and employment outcomes among job seekers at vocational service centers and for delivery by vocational service professionals, offers a promising way to increase access to needed mental health care. This qualitative study, guided by the Organizational Transformation Model (OTM), explored factors related to WCBT's implementation at two Jewish Vocational Services (JVS) Human Service sites in Detroit, MI and Los Angeles County, CA. Twenty-seven staff-stakeholders across the two JVS sites completed in-depth, semi-structured interviews focused on their experiences with WCBT over the four-year study period. Thematic analysis identified five core codes that most broadly captured participants' perceptions of WCBT implementation and the factors influencing implementation, including: (1) Need, (2) Buy-in and engagement, (3) Communication, (4) Sustainability concerns, and (5) Implementation facilitators. Core codes aligned with OTM factors related to impetus to transform, improvement initiatives, integration across boundaries, alignment from top to bottom, and leadership. Findings identify implementation strategies likely to optimize uptake and sustainability of WCBT within JVS sites that can be tested in a larger, multi-site implementation trial.

In February 2023, two catastrophic earthquakes in Turkey resulted in over 50,000 fatalities and over 300,000 injuries. This study investigated the psychological effects on firefighters who engage in rescue operations following these earthquakes, focusing on trauma-related symptoms, depression, anxiety, stress, and resilience. The research employed validated psychometric instruments, including the Post-earthquake Trauma Level Determination Scale (PETLDS); Depression, Anxiety, Stress Scale-21 (DASS-21); PTSD Checklist for DSM-5 (PCL-5); and Brief Resilience Scale (BRS), to assess the psychological states of firefighters. The primary goal of this study was to evaluate the psychological impact of earthquakes on firefighters. Specific objectives include quantifying trauma levels; identifying the prevalence of post-traumatic stress disorder (PTSD), depression, anxiety, and stress among firefighters; and investigating the role of psychological resilience in mitigating the effects of disaster-related psychological trauma. This study is also aimed at providing empirical evidence to inform the development of psychological support and intervention strategies for firefighters in the aftermath of these earthquakes. In this study of 223 primarily male firefighters, significant psychological impacts from earthquake trauma were observed. The PETLDS scores indicated high trauma levels in 28 participants and modest levels in 195. Subscales revealed affective responses and cognitive structure were most affected. DASS-21 scores showed higher depression, anxiety, and stress in the high trauma group. PCL-5 and BRS analyses confirmed higher PTSD symptoms and lower resilience in high-trauma individuals. Correlation analysis highlighted strong associations between trauma, psychological distress, and decreased resilience. These findings highlight the necessity for targeted mental health interventions and support mechanisms for firefighters, contribute to the establishment of training programs to enhance psychological resilience among firefighters, and add valuable insights to the field of disaster psychology.

The behavioral health workforce has been experiencing deepening problems with recruitment and retention, particularly in publicly funded settings serving individuals with serious mental illnesses. This quality improvement project gathered Assertive Community Treatment (ACT) participant (service user) and provider perspectives on workforce challenges. The authors conducted 8 interviews with ACT participants and 9 focus groups with ACT current staff, team leaders, and former staff. Interviewees discussed barriers to recruitment and retention, including inadequate compensation, work becoming more task-oriented during periods of short staffing, a lack of understanding of what ACT work entails, and elements of the team-based model of care; and facilitators of recruitment and retention, including other aspects of the team-based model of care, connections with colleagues and ACT participants, and flexibility. ACT participants had variable experiences regarding availability of their teams. Recommendations from focus groups and interviews include increasing flexibility, improving awareness of ACT work, optimizing team functioning, addressing staff wellness, and attending to risk. Findings include key insights that may help address the critical workforce shortages in public behavioral health settings.

The Institute of Medicine (2001) describes quality healthcare as safe, effective, patient-centered, efficient, equitable, and timely. Although this definition highlights the necessity of continuous program evaluation to ensure that these goals are being addressed, there is a notable lack of industry-wide standards and benchmarks, and many clinical programs lack the ability to continually and rigorously evaluate their own performance with data. This might be particularly true in the case of ensuring service members and veterans with posttraumatic stress disorder (PTSD) obtain treatment, as several systemic barriers exist, such as long wait times and lack of equitable treatment for individuals with minoritized identities. The current study examines the impact of a clinic-wide intake redesign for a massed PTSD treatment program to shift the intake process to a small, dedicated team rather than a responsibility shared across all clinicians. The redesign led to significantly shorter wait times for treatment and reduced some types of pre-treatment dropout. On average, patients received an acceptance/rejection decision 1 week sooner, attended the program almost 2 months sooner, and saw a roughly 60% reduction in the odds of drop out at the point of receiving an acceptance/rejection decision. Some disparities in wait times for those who were not partnered, women, and individuals who financially supported more family members remained after the redesign. Results are discussed in light of the importance of continuous program evaluation to address IOM's holistic definition of quality healthcare.

Collaborative Care, an evidence-based model, has proven effective in treating depression and anxiety in healthcare settings. However, limited attention has been paid to exploring treatment outcome differences by clinical variables and diagnosis within this model. While previous research suggests that early and frequent contacts and swift treatment access lead to positive outcomes for depression and anxiety, these aspects have not been comprehensively examined in Collaborative Care. This study investigates the impact of clinical variables on treatment completion in patients primarily diagnosed with anxiety or depression who received collaborative care treatment as a treatment program. Analysis was completed as an observational study of patients (n =2018) with behavioral health diagnoses spanning from 2016 to 2023. Classification analysis offers insights into optimal practices for implementing Collaborative Care across diverse healthcare populations from pediatric to geriatric. Identifying clinical characteristics associated with successful treatment in Collaborative Care has far-reaching implications for model adoption and enhancing patient outcomes. Across all results, patients who received more clinical support and had shorter enrollment durations showed a strong association with successful treatment completion.

In the United States, the opioid crisis remains a nationwide public health emergency. Narcan laws have increased medical collaboration between emergency medical services (EMS) paramedics and law enforcement officers (LEOs), yet research on joint opioid-response efforts with these first responders remains underexplored. Using a phenomenological approach, this study explores EMS paramedics and LEOs' experiences with joint-response efforts on suspected opioid overdose calls amidst the ongoing opioid crisis. Researchers conducted semi-structured interviews with 14 first responders (n = 8 EMS paramedics; n = 6 LEOs) from a large Central Florida emergency services district covering urban, suburban, and rural areas. Four major themes emerged: (1) facilitators to joint-response efforts; (2) barriers to joint-response efforts; (3) concerns for patient co-occurring behavioral health conditions; and (4) perceived solutions. Overall, participants described mutual respect, reliance, and communication as key facilitators, while barriers included conflicting on-scene priorities and differences in Narcan protocols. Concerns for co-occurring behavioral health (i.e., addiction and mental health) conditions among overdose patients included difficulties in assessing mental health and the availability of wraparound services, yet these concerns remained secondary to medical treatment during an opioid-related emergency. Key solutions included enhanced Narcan training for LEOs and increased availability of behavioral health services for long-term patient care. This research contributes to existing literature on opioid overdose response by specifically examining joint-response efforts between EMS paramedics and LEOs. These findings may be applicable to other partnering agencies such as mental health crisis teams and should be explored across behavioral health collaborations.

To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (n = 13 primary care providers; n = 6 behavioral health providers; n = 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.