Literature Collection

Objective: To examine providers' perceptions of integrated care prior to the merger of a university's student health center and counseling services. Participants: Seventeen providers across student health services (n = 9) and counseling (n = 8) agreed to participate in the qualitative study. Method: Semi-structured individual interviews that focused on the perceived benefits and challenges of the merger were conducted in December 2019. Following the interviews, a thematic analysis was completed. Results: The perceived benefits noted by providers centered on the ability of an interdisciplinary team to improve the coordination of, access to, and quality of care delivered to students. However, more anticipated challenges were reported by providers (e.g., differences in training and care protocols, losing one's autonomy as a provider). Conclusions: This qualitative study provides a more in-depth analysis of providers' perceptions of integrated care prior to implementation in a university setting and may have implications for model adoption.

Introduction: The U.S. Department of Veterans Affairs (VA), in partnership with the Opioid Overdose Education and Naloxone Distribution (OEND) Program, implemented the National Academic Detailing Service to deliver naloxone education to providers with patients at-risk for opioid-related overdose. Methods: We administered a 26-item online survey to VA providers to explore their perceptions about prescribing naloxone for opioid overdose emergencies and their experience with academic detailing between August 2017 and April 2018. Responses were analyzed using descriptive statistics to (1) explore their current perceptions of naloxone prescribing and their experience with academic detailing, (2) identify differences across provider types [primary care providers (PCP), specialists, and others], and (3) assess perceived naloxone prescribing behavior change after an academic detailing visit. Results: Providers (N = 137) indicated that they were practicing at a level that was consistent with VA goals to promote take-home naloxone to reverse opioid-related overdose events. Average domain scores were similar across PCP, specialist, and other provider types. Specialists reported a higher average attitude domain score (+.56, P = .011) and perceived barriers domain score (+.82, P = .009) than PCPs. Most providers agreed that they prescribed naloxone more frequently due to academic detailing (53%) and indicated that they synthesized information from the academic detailer to change their naloxone prescribing practice (60%). Discussion: VA providers' perceptions of take-home naloxone were aligned with current evidence-based practice. Moreover, providers reported increasing their naloxone prescribing and synthesizing OEND-related information after an academic detailing interaction. Understanding providers' perceptions can be used to improve and enhance the academic detailing program's effectiveness.

This cross-sectional study examined the relationship between social variables, recovery orientation, and recovery capital among a sample of n = 30 women actively seeking substance use disorder treatment at a community-based facility in the Midwest United States. Results indicated a positive association between social connectedness, abstinence recovery orientation (p = .048) and social isolation (p = .010). Social isolation was positively associated with abstinence recovery orientation (p = .004) and negatively related to recovery capital (p = .003). Social support was positively correlated with positive expectancy (p = .030) and recovery capital (p = .033). Further, moderate/high alcohol use was related to lower normal living scores (t(28) = 3.10, p = .004), lower recovery capital scores (t(28) = 4.15, p < .000), and higher social isolation scores (t(28) = -2.53, p = .017). Screening at moderate/high risk for cannabis use was related to lower normal living scores (t(28) = 3.01, p = .005), and lower positive expectancy scores (t(28) = 3.03, p = .005). Finally, screening for moderate/high risk for polysubstance use was related to lower normal living orientation (t(28) = 2.52, p = .018) and recovery capital scores (t(28) = 2.79, p = .009). Current findings may inform strategies for examining social connectedness and social isolation variables in future clinical practice, policy, and scholarship.

PURPOSE: As primary care (PC) clinics seek to integrate behavioral health (BH) services into patient care, it is crucial to understand the experiences of the clinic team and the impact on workflow and well-being. This study was designed to identify perspectives and experiences of nurse practitioner-led PC teams as they implemented a behavioral health integration (BHI) model into their Federally Qualified Health Center PC practices. METHODS: We conducted in-depth qualitative interviews with staff members at three clinic sites that implemented BHI. Interviewees were asked questions about the benefits and challenges encountered in the new BHI workflow, the dynamics of the warm hand-off, the tools and resources they used and desired, and the changes they would like to see to promote efficient workflows. RESULTS: We interviewed 21 staff members during May and June of 2020. An analysis of the qualitative data showed the most frequently reported experiences and attitudes focused on (a) the availability of behavioral health consultants (BHC); (b) procedural uses of the warm hand-off; (c) the organization's productivity goals; and (d) desired tools and resources that are generally unavailable to the clinicians but could make a difference to patient care. CONCLUSION: Our results can assist FQHCs and similar organizations to achieve both BHI and the Quintuple aim. Integrating BH services into PC clinics is valuable and may mitigate clinician-staff burnout. However, PC organizations desiring to integrate new sustainable care models should consider involving staff in every phase of the transitional process phase to increase staff buy-in and staff rapport.

BackgroundThe pressures on community Children and Young People's Mental Health Service (CYPMHS) clinicians to manage and maintain caseloads can be immense, therefore discharging young people from CYPMHS in a safe and timely way is often discussed as a priority. However, there is limited research into how discharge can be done well, especially for discharge occurring prior to children and young people (CYP) reaching the upper age limit of CYPMHS. Thus, this study aimed to gain a better understanding of the barriers and facilitators discharging CYP from community CYPMHS, by exploring clinicians experiences of discharging CYP from their service.MethodSemi-structured interviews of 30-40 minutes were conducted with 12 clinicians working at different CYPMHS in England and analysed using codebook thematic analysis.ResultsSix themes were identified. These included, "perfectionistic approach towards treatment outcomes", "reducing dependence on CYPMHS through empowerment", "a lack of flexibility in the wider system", "lack of collaborative care", "an increasing pressure on the service" and "keeping the focus on discharge".ConclusionClinicians face multiple barriers when discharging CYP which should be addressed, alongside enhancing the use of reported facilitators to ensure timely, safe and well-managed discharges.; Little research has been conducted on the discharge pathway at child and adolescent mental health services (CYMPHS) despite it being the way in which many young people will leave the service. Additionally, the few studies which are present, indicate that discharge is poorly managed and can be delayed. They have also mainly focused on young people who were around 16–18 years old. Thus, this study aimed to gain a better understanding of the discharge pathway, specifically the barriers and facilitators of discharging children and young people across all ages from CYMPHS. The researchers interviewed twelve clinicians from CYMPHS across the UK. We found that multiple barriers affected the ability of clinicians to carry out a timely, and well-planned discharge such as families becoming too attached, a disjointed and inflexible mental health care system, lengthy waiting times, high staff turnover and a lack of focus on discharge planning from the outset. However, there were also some facilitators, which included helping families become self-confident, regular communication with all relevant parties, and using supervision to keep the focus on discharge. The findings of this study can be used to improve the current discharge pathway at CYMPHS, and to hopefully bring attention to this topic which has been so far fairly neglected.; eng

Integration of medication-assisted treatment (MAT) for opioid use disorder in primary care settings is an emerging health care delivery model that supports increased access to specialized care but requires primary care provider engagement. Examining the characteristics of providers who provide this service is key to informing targeted recruitment. Using administrative and supplemental data collected during license renewal, this study aimed to identify the characteristics of primary care physicians and nurse practitioners (NPs) associated with greater odds of providing MAT in their practice. A retrospective observational study was conducted using a descriptive correlational design. The analysis included 5259 physicians and 3486 NPs who renewed their licenses electronically in 2021 and specialized in primary care or psychiatry. Chi-square and logistic regression analyses were conducted to identify the demographic and clinical characteristics of physicians and NPs associated with MAT participation in their practice. Physicians had a higher odds ratio (OR) of providing MAT if they were younger than 35 years (OR = 1.334; P = .0443), practiced in a federally qualified health center (OR = 3.101, P < .0001), and offered a sliding fee scale in their practice (OR = 2.046; P < .0001). Likewise, NPs had higher odds of providing MAT if they practiced in a public or community health center (OR = 3.866; P < .0001). The results of this study highlight the personal and professional characteristics of physicians and NPs associated with higher odds of providing MAT. These findings may have implications for the recruitment and sustainability of MAT integration in primary care.

Integration of medication-assisted treatment (MAT) for opioid use disorder in primary care settings is an emerging health care delivery model that supports increased access to specialized care but requires primary care provider engagement. Examining the characteristics of providers who provide this service is key to informing targeted recruitment. Using administrative and supplemental data collected during license renewal, this study aimed to identify the characteristics of primary care physicians and nurse practitioners (NPs) associated with greater odds of providing MAT in their practice. A retrospective observational study was conducted using a descriptive correlational design. The analysis included 5259 physicians and 3486 NPs who renewed their licenses electronically in 2021 and specialized in primary care or psychiatry. Chi-square and logistic regression analyses were conducted to identify the demographic and clinical characteristics of physicians and NPs associated with MAT participation in their practice. Physicians had a higher odds ratio (OR) of providing MAT if they were younger than 35 years (OR = 1.334; P = .0443), practiced in a federally qualified health center (OR = 3.101, P < .0001), and offered a sliding fee scale in their practice (OR = 2.046; P < .0001). Likewise, NPs had higher odds of providing MAT if they practiced in a public or community health center (OR = 3.866; P < .0001). The results of this study highlight the personal and professional characteristics of physicians and NPs associated with higher odds of providing MAT. These findings may have implications for the recruitment and sustainability of MAT integration in primary care.