Literature Collection

Most youth do not experience a coordinated and planned transition out of child and youth mental health services, which often results in discontinuity in mental health care. This gap in care has led to the development and uptake of novel interventions, such as the transition navigation model, to facilitate mental health care transitions. The transition navigation model is a research-informed intervention that aims to assess and improve youth's transition readiness, identify their transition needs and goals, and support the transfer of care to adult or community mental health services. To evaluate the ongoing implementation of this model, we conducted a pre-post mixed-methods study involving youth participants accessing transition navigation services at two hospitals. Participants (n = 43) completed self-report measures on transition readiness, daily functioning, and mental health service use at baseline and 6-month follow-up. Twenty participants also completed qualitative interviews focused on understanding their experiences and satisfaction with the navigation service. Results indicate a significant increase in participants' mean transition readiness score and a decrease in the number of emergency department visits from baseline to the 6-month follow-up. However, there were no significant changes in mean functioning scores or self-reported mental health symptoms. The quantitative and qualitative findings converged, indicating overall high satisfaction with the navigation service, with the primary gap in the service being the lack of communication maintained with youth while in the program.

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.

Ketamine-Assisted Therapy (KAT) presents a promising alternative for addressing mental health challenges, particularly in treatment-resistant conditions, yet little exists in the literature guiding its implementation in an Indigenous context, for Indigenous participants, or describing culturally adapted delivery models. This paper presents insights and lessons learned from a collaborative pilot program between Siksika Health Services and ATMA CENA to design and deliver a culturally responsive KAT program within the Siksika First Nation in Alberta Canada. The initiative aimed to explore the feasibility and therapeutic impact of KAT in an Indigenous healthcare setting, while also being conscious of cultural relevance and opportunities for continued clinical and quality improvement of the program. The pilot followed a five-phase approach: collaboration, knowledge acquisition, lived experience, data collection, and follow-up. Recruitment resulted in 6 participants completing care (3 Indigenous and 3 non-Indigenous). Findings demonstrated notable improvements in symptoms of depression, anxiety, and PTSD, with participants reporting increased emotional regulation and stronger cultural connections. Cultural elements including shared meals, traditional decor and blankets, community orientation, and a mid-program break for cultural events, were central to participant reported safety, trust, and meaning making. Notably, the Indigenous and non-Indigenous participant groups, who were treated together, reported comparable gains in safety, trust, and mental, emotional, and spiritual well-being. These shared outcomes suggest the model may hold relevance for reducing inequities in group KAT delivery. Challenges and lessons learned included need to address stigma and systemic influences experienced by Indigenous participants, barriers affecting timely intention setting and integration therapy, and overcoming logistical barriers when working in rural First Nation environments. This pilot program implementation underscores the importance of culturally responsive mental health interventions and highlights key considerations for expanding psychedelic-assisted therapies in Indigenous communities.

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.