Literature Collection

The Safe Babies Safe Moms Women's and Infants' Services Perinatal Mental Health and Wellness Program offers screening, assessment, prevention, and treatment options, as well as referrals, for complex care needs using an integrated collaborative care framework. Group and individual therapy options are available, leveraging both office-based and telehealth options. The article details the program's framework for services, describes the care team and program workflow, and summarizes program activities. In calendar year 2024, 3383 screenings using the Edinburgh Postnatal Depression Scale were completed for 1914 unique patients. Perinatal social workers conducted 1328 care coordination visits and completed 148 perinatal mental health assessments for elevated screenings. Integrated therapeutic services reached 220 people, and 53 were referred to psychiatry for complex care needs. The strengths of this program stem from early initiation of screening, multiple screenings throughout the perinatal period, care coordination for social services interventions, and a shared-decision-making process centered around the patients' needs and goals for perinatal mental health care. This integrated mental health model establishes a distinct, well-defined, yet dynamic pathway to provide screening, care coordination, and interventions for both prevention and treatment to optimize perinatal mental health outcomes. Evaluation of program outcomes is ongoing.

The prevalence of opioid use among pregnant people has been increasing over the past few decades, with a parallel increase in the rate of neonatal abstinence syndrome. Opioid agonist treatment (OAT) including methadone and buprenorphine is the recommended management method for opioid use disorders during pregnancy. Methadone has been extensively studied during pregnancy; however, buprenorphine was introduced in the early 2000s with limited data on the use of different preparations during pregnancy. Buprenorphine-naloxone has been incorporated into routine practice; however, only a few studies have investigated the use of this medication during pregnancy. To determine the safety and efficacy of this medication, we conducted a systematic review of maternal and neonatal outcomes among buprenorphine-naloxone-exposed pregnancies. The primary outcomes of interest were birth parameters, congenital anomalies, and severity of neonatal abstinence syndrome. Secondary maternal outcomes included the OAT dose and substance use at delivery. Seven studies met the inclusion criteria. Buprenorphine-naloxone doses ranged between 8 and 20 mg, and there was an associated reduction of opioid use during pregnancy. There were no significant differences in gestational age at delivery, birth parameters, or prevalence of congenital anomalies between buprenorphine-naloxone-exposed neonates and those exposed to methadone, buprenorphine monotherapy, illicit opioids, or no opioids. In studies comparing buprenorphine-naloxone to methadone, there were reduced rates of neonatal abstinence syndrome requiring pharmacotherapy. These studies demonstrate that buprenorphine-naloxone is a safe and effective opioid agonist treatment for pregnant people with OUD. Further large-scale, prospective data collection is required to confirm these findings. Patients and clinicians may be reassured about the use of buprenorphine-naloxone during pregnancy.

INTRODUCTION: Chronic pain is a significant risk factor for suicide, especially among Veterans. The aim of this study is to evaluate the safety (i.e., the occurrence of suicidal behavior after treatment) and tolerability (i.e., treatment completion) of a Brief Cognitive-Behavioral Therapy for Chronic Pain (Brief CBT-CP) group in primary care among a sample of Veterans with chronic noncancer pain deemed to be at an increased risk for suicide. MATERIALS AND METHODS: Chart review was used to assess suicide history and treatment completion among Veterans who participated in a Brief CBT-CP group within a Primary Care-Mental Health Integration Clinic at a Veteran Affairs Medical Center. Suicide risk was stratified into 3 categories: Minimal (no current suicidal ideation or history of suicidal behavior), Elevated (current suicidal ideation or history of suicidal behavior), and High Risk (current suicidal ideation and history of suicidal behavior). Safety was assessed as the absence of suicidal behavior during and after Brief CBT-CP sessions. Tolerability was defined as completion of at least 4/6 sessions. RESULTS: Of the 261 Veterans who participated in a Brief CBT-CP group, 24.9% of Veterans were identified to be at Elevated Risk for suicide, and 1.5% of Veterans were identified to be at High Risk. Brief CBT-CP was identified as safe, as no deaths (by suicide or otherwise) or suicidal behaviors were observed while Veterans engaged in the treatment sessions. In fact, following completion of Brief CBT-CP, a 24.2% reduction in relative risk of suicidal behaviors was observed in the overall sample. Brief CBT-CP was also tolerable, with nearly 90% of Veterans completing at least 4 sessions (n = 229). CONCLUSIONS: Brief CBT-CP appears to be a safe and well-tolerated treatment for Veterans with chronic noncancer pain who are also at risk for suicide.

OBJECTIVE: To identify key barriers and facilitators to designing and implementing collaborative care (CC) for children with developmental disabilities (DD) in safety-net primary care. METHODS: This pre-implementation qualitative study involved semi-structured interviews with safety-net primary care leaders. Using purposive and respondent-driven sampling, interviews were conducted with 16 leaders across 9 safety-net organizations in Northern California between August 2024 and January 2025. Key Consolidated Framework for Implementation Research (CFIR) constructs guided data collection. Data were analyzed using the Rapid Assessment Process and validated through structured member checking. RESULTS: Leaders from 8 of 9 organizations reported existing integrated behavioral health programs staffed by mental health counselors and/or psychiatrists, but nearly all noted that these programs did not address the specific needs of children with DD. When asked about developing a CC intervention for this population, leaders identified implementation barriers and facilitators that mapped to CFIR inner and outer setting domains. Four themes were distilled: inner setting barriers (space and cost), inner setting facilitators (perceived clinical need among leadership), outer setting barriers (restrictive Medicaid reimbursement policies and limited performance measurement pressure), and outer setting facilitators (alternative financing mechanisms). CONCLUSION: Safety-net leaders indicate a clinical need for CC models specifically for children with DD, but implementation success will depend on addressing space, financing, and policy barriers through targeted implementation strategies.

IntroductionThe Veterans Health Administration (VHA) prioritizes use of connected care technologies to enhance access and outcomes. The context in which connected care is implemented is crucial, yet difficult to measure, due to its subjective and complex nature. This evaluation examined alignment among stakeholder perceptions of context related to connected care implementation across VHA.MethodsA national, cross-sectional survey assessed perceptions of 11 contextual factors relevant to connected care implementation as identified in published reviews within the implementation science literature. Across 142 VHA facilities and 18 regions, surveys were sent to four stakeholder groups: clinical team members, connected care coordinators, facility leadership, and regional leadership. Mean scores for each factor were compared between stakeholder groups using Welch's ANOVA and Bonferroni-corrected post-hoc comparisons.ResultsA total of 5541 respondents (36.1% response rate) participated. Organizational Culture and Climate was rated the most favorable contextual factor (mean = 3.9, SD = 0.7), while Financial Resources was perceived as least favorable (mean = 3.0, SD = 1.0). Significant differences emerged between the perceptions of frontline workers (clinical team members, connected care coordinators) and leadership (facility, regional). Clinical team members rated nearly all contextual factors less favorably than facility leadership. Coordinators similarly rated most factors less favorably than leadership.DiscussionFindings highlight a misalignment between leadership and frontline workers in their perceptions of organizational context for implementing connected care technologies. Leadership viewed key contextual factors (e.g. Organizational Readiness to Change, Leadership Support) more favorably than frontline workers. This misalignment may impact implementation success, suggesting a need for strategies to better align stakeholder perceptions.