Literature Collection

Texas is in urgent need of more well-trained and supported mental health professionals. The majority of the state's counties are characterized by a shortage of mental health professionals, with declines in supply in recent years most notably affecting rural areas. Both leaders of Texas state agencies and community healthcare organizations report extensive problems in recruitment and retention and insufficient training capacity. Existing supply gaps in mental health providers are likely to increase as an aging workforce begins to retire and job availability for mental health professions increases. Despite the number of Texas universities offering professional education in mental health fields, insufficient attempts are being made to research and promote organized and widespread recruitment and retention activities. People of color are underrepresented in mental health professions, and Texas appears to be lacking in effective racial and culturally diverse recruitment in the mental health professions. This snapshot of the current state of the Texas mental health workforce provides preliminary information to highlight issues that key stakeholders--professionals, employers, higher education, consumers of services, and licensing boards, among others--must address to assure the availability of a qualified mental health workforce.

BACKGROUND: In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use). METHODS: Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients' CM attendance and urine test results also were collected from the 94 implementation sites. RESULTS: The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%. CONCLUSION: The VA's CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.

The majority of research and policy directives targeting opioid use and overdose prevention are based in larger urban settings and not easily adaptable to smaller Canadian settings (i.e., small- to mid-sized cities and rural areas). We identify a variety of research and policy gaps in smaller settings, including limited access to supervised consumption services, safer supply and novel opioid agonist therapy programs, as well as housing-based services and supports. Additionally, we identify the need for novel strategies to improve healthcare access and health outcomes in a more equitable way for people who use drugs, including virtual opioid agonist therapy clinics, episodic overdose prevention services, and housing-based harm reduction programs that are better suited for smaller settings. These programs should be coupled with rigorous evaluation, in order to understand the unique factors that shape overdose risk, opioid use, and service uptake in smaller Canadian settings.