Literature Collection

IMPORTANCE: An increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized. OBJECTIVE: To explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022. MAIN OUTCOMES AND MEASURES: Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation. RESULTS: A total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced. CONCLUSIONS AND RELEVANCE: In this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.

INTRODUCTION: The perinatal period is widely recognized as a time of profound transition and heightened vulnerability, particularly for women with substance use disorders (SUD). Adopting a strengths-based perspective, this qualitative study aims to explore how professionals across healthcare, child welfare, substance use, and child protection services in Belgium perceive this period as a window of opportunity for change in women with SUD. METHOD: Semi-structured interviews were conducted with 43 professionals, and thematic analysis identified key themes related to barriers, opportunities, and facilitators to achieve change. RESULTS: Barriers include disconnected bodily awareness, mutual avoidance between women and professionals, limited insight and (self-) reflection on SUD and motherhood, and insufficient support across interpersonal, socioeconomic, and systemic levels. However, professionals also identified several areas that could be reinforced to unlock the period's transformative potential, reflecting a gradual shift from a deficit-oriented view toward a more strengths-based understanding of perinatal SUD. Empowerment was seen as crucial through open conversations on family planning, psychoeducation on fertility and contraception, access to appropriate contraceptives, and trauma-sensitive, body-oriented approaches that foster connection to pregnancy and the unborn child, as well as the integration of the infant mental health perspective. The perinatal period itself was considered a naturally occurring window of opportunity for change, driven by processes of identity transformation and growing maternal motivation. Professionals emphasized the importance of enhancing professional capacity, particularly in healthcare, and improving screening and referral by midwives and gynecologists. At the care system level, increased and more consistent contact with healthcare services during pregnancy was described as a contextual opportunity for timely support; however, intersectoral collaboration and integrated care were considered essential, alongside a legal prenatal framework that enables early, non-punitive interventions to support both mother and (unborn) child. DISCUSSION: These findings underscore the need to move beyond hegemonic discourses that frame strength and deficit, mothering and substance use, or vulnerability and opportunity as binary opposites. Recognizing the ways these dimensions coexist and intersect is vital for developing responsive, relational, and ethically grounded models of perinatal care.

The world's displaced population has reached a record high. Immigration is under the global lens and part of the public debate more than ever. The existing data on mental health disorders among displaced youth are alarming, and children and adolescents are disproportionately impacted by forces outside their control. In the United States, the recent border crisis has exponentially increased the needs for accessible mental health services for immigrant children, adolescents, and their families. As a result, implementation of integrated solutions for primary and behavioral health care has grown. In this article, we explore the application of an integrated model, the Primary Care Behavioral Health Consultation Model (PCBH) with Hispanic and Latino immigrant children and adolescents and their families in a Federally Qualified Health Center in Houston, Texas. PCBH holds great promise for increasing access to mental health services for immigrant and refugee populations.