Literature Collection

INTRODUCTION: Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program's impact on the knowledge and attitudes of NE OBAT ECHO participants. METHODS: We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control. RESULTS: Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points. CONCLUSIONS: NE OBAT ECHO may have improved participants' confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.

Depression and anxiety disorders are the most prevalent mental disorders in the world. The transdiagnostic approach to the study of these emotional disorders suggests that certain diagnostic categories, such as depression or anxiety disorders, share common underlying factors. This paper evaluated several models of common maladaptive cognitive factors in depressive and anxiety disorders (Study 1) and the predictive validity of these models (Study 2). In Study 1, 1703 primary care patients with suspected emotional disorder completed brief scales to assess the following cognitive factors: worry, rumination, attention to threat, and metacognitions. We found that the model with the best fit was the bifactor model, estimated through an exploratory structural equation model (ESEM). This bifactor model suggests that individual cognitive factors can be explained by a general factor plus four independent factors, evidencing the existence of a transdiagnostic cognitive factor (TD-C factor). In Study 2, a subgroup of 178 participants (from Study 1) were clinically diagnosed by semi-structured clinical interviews with major depressive disorder, generalized anxiety disorder, and/or panic disorder. The predictive validity of TD-C factor was acceptable (AUC > 0.80), but specific factors were not predictive (AUC < 0.70), indicating that TD-C factor was a significant predictor for each diagnosis. This study supports the claim that there is a transdiagnostic cognitive factor that can predict the diagnosis of various depressive and anxiety disorders, thus potentially representing a useful transdiagnostic assessment.