Literature Collection

OBJECTIVE: Child psychiatry access programs (CPAPs) address the mental health treatment access gap by providing training, consultation, and referral support to primary care providers (PCPs). Research has documented provider use of and satisfaction with CPAPs, but less work has examined how usage relates to provider practice change. This qualitative study examines PCPs' perceptions about the use of CPAP services (ie, consultations, referral support, training) and resulting changes in their practice behaviors. METHODS: The population of CPAP users was purposively sampled based on variation in geography and frequency of use: frequent (N=16), moderate (N=10), and infrequent (N=11) users. Semistructured interviews were conducted with 37 providers. PCPs were asked about their use of CPAP services, and if/how these services influenced patient care and practice change. Interviews were recorded, transcribed, and analyzed using content analysis. RESULTS: Regardless of frequency of CPAP use, all providers indicated medication management and need for patient referrals as primary reasons for calling the CPAP. All providers described practice change behaviors, with increased confidence/comfort in providing mental health care and medication management identified predominantly by frequent users. Providers consistently reported a positive attitude toward CPAP consultations. CONCLUSIONS: Providers perceive CPAP services as helpful and related to improvements in their ability to address patient mental health needs. Providers reported making changes to their practice behaviors, regardless of their level of CPAP use. This study provides preliminary support that participation in CPAP services contributes to improved PCP practice in addressing child mental health concerns.

PURPOSE: The juncture of integrated care and professional identity is an under-researched yet critical intersection. This study aims to support the development of integration by gaining further understanding about the professional identity of integrated care team members. DESIGN/METHODOLOGY/APPROACH: Qualitative case study methodology using observations, semi-structured interviews and focus groups was used to explore professional identity in three UK newly integrated, community teams. The cases were nursing (n = 17), therapy (n = 13) and mental health nursing (n = 3) professions. FINDINGS: All professions identified with their own professional group. Some new identification with the integrated teams was evident, although individual professional group identity was always salient. Key themes were professional role, perceived lack of understanding, defensiveness and security. Participants employed tactics to prove their worth, strengthen their professional identity and counteract perceived threats against their profession. PRACTICAL IMPLICATIONS: Profession specific identities should be recognised and nurtured to reduce defensiveness and counteract threat. Differences between professions should be acknowledged and space given to improve understanding between professions. When individual professional identity is supported, team members can start to form a new, additional identity within their integrated team. ORIGINALITY/VALUE: Identification with professional in-groups was based on security, not discrimination against other professions. Professional groups didn't feel understood by other professional groups but still maintained respect and recognition for their expertise. Tactics employed to counteract professional identity threat included proving how busy they were.

Suicide is a leading cause of death among active-duty military personnel. Although specialty mental health services are readily available, primary care clinics represent the most frequently accessed clinical setting immediately preceding suicide deaths and suicide attempts among service members. Primary care clinics offer a critical and unique opportunity to implement interventions targeting suicide prevention. Effective engagement and response to servicemembers with elevated suicide risk requires scalable alternatives to traditional mental health care. The central focus of this study is to test the efficacy of Aviva, a scalable, digital adaptation of Brief Cognitive Behavioral Therapy for Suicide Prevention in three primary care clinics with active-duty military servicemembers in comparison to treatment as usual. This paper describes the design, methodology, and protocol of an active randomized controlled trial comparing Aviva to treatment as usual. The impact on subsequent suicidal ideation and behaviors during a year-long follow-up period will be evaluated. Clinical Trial Registration: NCT06318962.

The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to postimplementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multiclinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.