Literature Collection

BACKGROUND: Substance use is common among U.S. military veterans and veterans are at high risk for negative consequences associated with substance use, such as injection-related infections and overdose. Although harm reduction services (HRS) are highly evidence-based, implementation in traditional healthcare settings has been limited. This formative, qualitative study sought to identify barriers and facilitators to the integration of HRS and identify appropriate implementation strategies to support the optimized integration of a comprehensive bundle of HRS in the Veterans Health Administration (VHA). METHODS: Semi-structured interviews explored how harm reduction is currently understood by VHA providers and elicited input on perceived facilitators and barriers to implementation. Data were analyzed using a directed content analysis and the Practical, Robust Implementation and Sustainability Model (PRISM) implementation framework was used to organize findings. Results were then mapped to relevant implementation strategies using the Consolidated Framework for Implementation Research - Expert Recommendations for Implementing Change (CFIR - ERIC) tool. RESULTS: 15 interviews with VHA providers were conducted across 5 sites. Respondents reported that current HRS are fragmented and dependent on the knowledge, time, and comfort level of individual providers. Stigma around substance use at the patient, provider, and institutional levels was noted to be a key barrier to HRS adoption. Based on identified barriers and facilitators, strategies that may be effective for increasing adoption of HRS include engagement of champions, communication and educational strategies, and adaptation of existing infrastructure. CONCLUSIONS: Many of the barriers identified in this formative study may be addressed using evidence-based implementation strategies. Additional research is needed to identify implementation strategies that are effective for addressing stigma, which is perceived to be a persistent challenge to the provision of integrated harm reduction services.

There are established evidence-based interventions for children with various medical and psychological conditions. In addition, there is evidence supporting biofeedback to treat some of these conditions. However, there remains a gap in the literature in addressing how the practicing clinical psychologist or therapist can apply principles of psychotherapy to enhance biofeedback, as well as how components of biofeedback can enhance the application of evidence-based psychotherapies for children. This article utilizes a case-based approach to highlight some notable pathways for appropriate integration between psychotherapy techniques and biofeedback. It concludes with a summary of the current gaps and opportunities for research to address, as well as opportunities for clinicians and researchers to collaborate to better understand the real-world applications of successful integration of biofeedback with psychotherapy when treating children.