Literature Collection

INTRODUCTION: Academic detailing, an educational outreach that promotes evidence-based practices to improve the quality of care for patients, has primarily been delivered using one-on-one in-person interactions. In 2018, the U.S. Department of Veterans Affairs (VA) Pharmacy Benefits Management implemented a pilot virtual academic detailing program to increase naloxone prescribing among veterans at risk for opioid overdose or death. The aim of this evaluation was to compare virtual and in-person academic detailing on naloxone prescribing rates at VA. METHODS: A retrospective quasi-experimental pretest-posttest non-equivalent groups design was used to compare virtual academic detailing and in-person academic detailing on naloxone prescribing rates 12 months before and after providers received a naloxone-specific encounter at three VA regional networks between January 1, 2018 to May 31, 2020. Subgroup analysis was performed on rural providers. Generalized estimating equation models were constructed to compare the difference in naloxone prescribing rates before and after receiving virtual or in-person academic detailing controlling for provider-level characteristics. RESULTS: Providers who received virtual (N = 67) or in-person (N = 186) academic detailing had significant increases in naloxone prescribing, but the differences in the naloxone rates between the groups were not statistically significant (difference in changes in naloxone rates=+0.63; 95% CI: -2.23, 3.48). Similar findings were reported for rural providers. DISCUSSION: Providers who received naloxone-related in-person or virtual academic detailing had increased naloxone prescribing rates; however, there were no differences between the two types of modalities. Virtual academic detailing is a viable alternative for delivering academic detailing and allows academic detailers to expand their reach to rural providers.

PURPOSE: This study aimed to develop and validate a competency framework for a bachelor-level social worker, or related degree type, to work in integrated behavioral healthcare settings under clinical supervision. In Washington state, a new bachelor-level certification called a Behavioral Health Support Specialist or BHSS includes social work, psychology, and related degree programs. METHODS: Focus group interviews with stakeholders from across Washington State (n = 49) were conducted in addition to a confidential survey. A thematic analysis of data and validity check preceded interpretation of results. RESULTS: Qualitative data generated salient recommendations to shape a competency framework tailored to integrated care, and other behavioral health settings. Survey data helped gauge the degree of endorsement for a new mental health provider for integrated care in Washington State. DISCUSSION: Participants recommended specific action steps related to scope of practice, differentiation from other non-specialists, work setting expansion, supervisor qualifications, and ethics to align the competency framework with real-world practice. CONCLUSION: A BHSS competency framework supports the development of a new professional role to prepare a bachelor level social worker to deliver evidence-informed psychosocial interventions under supervision within integrated care settings.

Background Complex Mental Health Difficulties (CMHD) describes long-term difficulties with emotional regulation and relationships, including personality disorders, complex trauma and dysthymia. People with CMHD often experience episodic and crisis-related care. Aim To understand how general practices can better recognise people with CMHDs and provide the best care. Design and Setting A concurrent mixed-methods study was conducted with three components: two qualitative studies and a database study. Methods PPIE People with lived experience of CMHD were consulted throughout the study. Qualitative interviews with GPs and people with CMHD were conducted and transcripts analysed using thematic analysis. Database study A retrospective case-control analysis was conducted using the Connected Bradford database. Integration of results was conducted using 'following the thread' and triangulation methods. Results GP interviews: Four overarching themes were identified: (1) The challenges of CMHD; (2) Role expectations; (3) Fragmented communication, fragmented care; (4) Treatment in the primary care context. Lived experience interviews: Four main themes were identified: (1) "How I got here"; (2) Varied care experiences; (3) Traversing mental health services; (4) "Being Seen". Database study: Approximately 3,040 (0.3% of the database population) records met our criteria for CMHD, suggesting significant under-coding. The most informative feature was the count of unique psychiatric diagnoses. Triangulation: Five meta-themes were identified (i) Complexity of mental health difficulties; (ii) Experience of trauma; (iii) Diagnosis; (iv) Specialist services; and (v) GP services. Conclusion The current organisation of care and lack of an acceptable language for CMHD means that patients' needs continue to go unrecognised and "unseen".