Literature Collection

Youth internalizing symptoms (i.e., depression and anxiety), suicide ideation and attempts have been rising in recent years, including among Hispanics. Disparities in mental healthcare are concerning and require intervention, ideally prevention or early intervention. Familias Unidas is a culturally-syntonic, family-centered intervention effective in reducing youth drug use and sexual risk, with evidence of unanticipated effects on internalizing symptoms. This paper describes the systematic process used to adapt the eHealth version of the Familias Unidas intervention to more directly address internalizing symptoms and suicide risk in preparation for an effectiveness-implementation hybrid trial for youth with elevated internalizing symptoms, a history of suicide ideation/attempts, or poor parent-youth communication. The resulting eHealth Familias Unidas Mental Health intervention is described. Guided by a 4-phase framework, the steps in the adaptation process involved: assessment of the community and intervention delivery setting (pediatric primary care clinics); integration of previous intervention research, including intervention mechanisms of action; and expert and community consultation via focus groups. Focus group analyses showed that youth and parents perceived that the intervention was helpful. Their feedback was categorized into themes that were used to directly target mental health by addressing technology use, parent mental health, and social support. Effective and scalable preventive interventions are needed to address mental health disparities. The systematic adaptation process described in this paper is an efficient approach to expanding interventions while maintaining known, empirical and theoretical mechanisms of action. Findings from the ongoing effectiveness-implementation trial will be critical.; Mental health symptoms and suicide ideation and attempts have been increasing for several years. Disparities in quality and access to mental healthcare indicate that Hispanic and socioeconomically disadvantaged youth need accessible and targeted interventions, ideally preventive and early interventions. Our team adapted an existing, evidence-based prevention program for Hispanic families to specifically and directly address youth mental health to be delivered in primary healthcare settings. This paper describes the adaptation framework and steps taken to adapt the original program that was developed and tested for drug use and sexual risk behaviors, with the purpose of additionally addressing depression, anxiety, and suicide ideation and attempts. We subsequently describe the adapted program- eHealth Familias Unidas Mental Health- and discuss how it is currently being implemented and evaluated in primary healthcare settings. The paper provides information and an example of how other research teams can systematically adapt an intervention using insights from the peer-reviewed literature, participants, primary care clinic staff, and experts in youth mental health.; eng

Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP.Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy.Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]).Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care.KEY MESSAGESThe Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program setting. Using telehealth was associated with increased three-month buprenorphine retention. Baseline stimulant use was negatively associated with three-month buprenorphine retention.

OBJECTIVE: To examine the feasibility, acceptability, and potential health effects of computerized cognitive behavioral therapy-enhanced collaborative care (cCBT-CC) versus usual primary care (UC). BACKGROUND: Internet-based cCBT can effectively treat depression but is not widely used, including in the Veterans Health Administration where it was freely available for veterans. We adapted pre-existing depression collaborative care models using implementation and user-centered design strategies to facilitate cCBT implementation. METHODS: This pilot randomized controlled trial (RCT) included 57 VA primary care patients to cCBT-CC or UC. Participants had Patient Health Questionnaire (PHQ-9) scores of 10+. Those with serious mental illness (e.g., bipolar depression, schizophrenia) and active suicidality were excluded. Intervention patients received tailored Vets Prevail cCBT accompanied by collaborative care manager support, overseen by psychiatry and primary care. UC offered collaborative care services and digital mental health tools at baseline. Feasibility (patient reach, provider adoption, intervention implementation), acceptability (CSQ-8), and potential effectiveness (PHQ-9) data was collected at baseline and 3-months by a blinded study team member. RESULTS: Participants (cCBT-CC n = 29, UC n = 28) were 50 years old (mean); 70 % men; 32 % White, 32 % Hispanic, 25 % Black; 21 % homeless-experienced. Mean baseline PHQ-9 scores were 15.1 (SD = 5.0); 39 % reported suicidal thoughts/behaviors. 72 % of 94 primary care providers, from 6 out of the 8 participating clinics, helped support their patients' participation. cCBT-CC participants received 4 care manager check-ins over 33 days totaling 113 min (64 % clinical; 36 % technical), on average. They completed mean 6.7 out of 11 cCBT lessons. Participants in the cCBT-CC arm experienced a statistically (not clinically) significant decline in the primary outcome of depression (Δ = -2.5; p = 0.02) symptoms from pretreatment to posttreatment. There was a greater, albeit non-significant, decrease in PHQ-9 scores among cCBT-CC participants over 3-months, compared to UC participants (Δ = -2.8; 95 % CI = -5.6, -0.01; p = 0.05). CONCLUSIONS: cCBT-enhanced collaborative care appeared feasible, acceptable, and possibly effective in treating primary care patients with depression.

Utilization of telehealth modalities to provide cognitive and behavioral therapies is rapidly increasing. Limitations to access to care can prohibit individuals from getting the care they need, especially evidence-based treatments. In the U.S., Veterans are a population in great need of accessible and high-quality evidence-based psychotherapy for insomnia, as it often co-occurs with other common syndromes such as depression and PTSD. Cognitive Behavioral Therapy for Insomnia (CBT-I) offers effective treatment for insomnia and can be delivered via telehealth and in a group format to greatly increase availability and accessibility. To date, however, few programs exist offering telehealth-to-home CBT-I, fewer still are offered in a primary care setting, and none to our knowledge are offered in group format. We examine the feasibility and efficacy of a fully telehealth-to-home (TTH) group CBT-I pilot program in primary care and compare primary outcomes to those seen in a face-to-face (F2F) format as well as meta-analytic studies of group CBT-I. Primary endpoints, as typically defined such as sleep efficiency (SE) and scores on the insomnia severity index (ISI) appear comparable to those seen in F2F groups in our clinic, and to outcomes seen in the literature. We discuss challenges and strategies for successful implementation of such a program in integrated primary care to increase access and availability of this evidence-based treatment.