Literature Collection

BACKGROUND: Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization. OBJECTIVE: The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics. METHODS: A qualitative design using a semistructured interview assessed the perceived impact, barriers, and facilitators of an MLP, among clinicians, clinic and MLP staff, and clinic patients. Open AI software (otter.ai) was used to transcribe interviews, and NVivo was used to code the data. Braun & Clarke's framework was used to identify themes and subthemes. RESULTS: Sixteen (n = 16) participants were included in this study. Most respondents were women (81%) and white (56%). Four respondents were clinic staff, and 4 were MLP staff while 8 were clinic patients. Several primary themes emerged including: Patients experienced legal issues that were pernicious, pervasive, and complex; through trusting relationships, the MLP was able to improve health and resolve legal issues, for some; mistrust, communication gaps, and inconsistent staffing limited the impact of the MLP; and, the MLP identified coordination and communication strategies to enhance trust and amplify its impact. CONCLUSION: HHLNs can have a significant, negative impact on the physical and mental health of patients. Respondents perceived that MLPs improved health and resolved these needs, for some. Despite perceived successes, integration between the clinical and legal organizations was elusive.

BACKGROUND: The opioid overdose crisis in the USA has called for expanding access to evidence-based substance use treatment programs, yet many barriers limit the ability of people who inject drugs (PWID) to engage in these programs. Predominantly rural states have been disproportionately affected by the opioid overdose crisis while simultaneously facing diminished access to drug treatment services. The purpose of this study is to explore barriers and facilitators to engagement in drug treatment among PWID residing in a rural county in West Virginia. METHODS: From June to July 2018, in-depth interviews (n = 21) that explored drug treatment experiences among PWID were conducted in Cabell County, West Virginia. Participants were recruited from locations frequented by PWID such as local service providers and public parks. An iterative, modified constant comparison approach was used to code and synthesize interview data. RESULTS: Participants reported experiencing a variety of barriers to engaging in drug treatment, including low thresholds for dismissal, a lack of comprehensive support services, financial barriers, and inadequate management of withdrawal symptoms. However, participants also described several facilitators of treatment engagement and sustained recovery. These included the use of medications for opioid use disorder and supportive health care workers/program staff. CONCLUSIONS: Our findings suggest that a range of barriers exist that may limit the abilities of rural PWID to successfully access and remain engaged in drug treatment in West Virginia. Improving the public health of rural PWID populations will require expanding access to evidence-based drug treatment programs that are tailored to participants' individual needs.

BACKGROUND: Recently here has been interest in the patient's voice within community mental health settings as a catalyst of service development. There remains a lack of literature documenting the lived experience of inpatient mental health care in Older People's Mental Health (OPMH) inpatient settings. There is a drive within the National Health Service (NHS) to transition care to community settings and improve the discharge process. AIMS: To gain insight into older people's experiences of being discharged from OPMH inpatient settings. METHODS: Semi-structured interviews were conducted with seven people discharged from OPMH inpatient wards. They were asked to share their experiences of preparing for discharge, the support during this process, the transition to home, and what should be learned from their experiences. The interviews were analysed using reflexive thematic analysis. RESULTS: Six main themes were identified. 1) Discharge as a gradual process, 2) Feeling involved in discharge planning; feeling empowered, 3) Communication; contrast between positive and negative experiences, 4) Social support; a sense that there was a causal link between support and successful outcome, 5) Importance of nurse support; the benefits of having support, 6) The importance of readiness for discharge; the relationship between how the patient felt before and after discharge. CONCLUSIONS: This is one of the first studies to explore older people's experiences of being discharged from mental health hospitals. It provides insight of the factors that patients believe are important for a positive experience of discharge. Suggestions for service improvements and recommendations on how patients are supported appropriately in the process are discussed.

BACKGROUND: Despite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI. METHODS: Eighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation. RESULTS: Important facilitators to implementation included: lived experience of CHWs, as well as NYC HJN's voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication. CONCLUSIONS: Findings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners.