Literature Collection

Mental health concerns (e.g., psychiatric disorders, traumatic experiences, suicidal ideation) are common among those with opioid use disorder (OUD) and are associated with an increased risk of overdose. Yet, few people with OUD receive integrated treatment for psychiatric disorders or other concerns, underscoring the need to reduce barriers to integrated care, such as a lack of knowledge about mental health conditions among frontline workers and providers. In this Community Case Study, we describe an effort at a single site (Massachusetts) of the HEALing Communities Study (HCS) to address barriers to integrated care through Learning Collaboratives (LCs), a method for large-scale dissemination of evidence-based practices. The HCS was a parallel-group, community-engaged, cluster-randomized trial conducted across four states/sites from January 2020 to December 2023 to reduce fatal opioid-related overdoses. LC sessions were offered to partners in HCS communities (e.g., frontline workers and providers, such as peer recovery coaches, social workers, psychiatrists) to support overdose reduction strategies. The HCS Massachusetts site implemented an LC series focused on mental health and OUD, including didactic presentations emphasizing concrete take-home messages and intervention strategies, case presentations, and interactive discussions. Provider participants from various professional backgrounds rated the LC sessions as helpful and useful, highlighting the feasibility of this method for disseminating information on evidence-based practices to address OUD and co-occurring mental health concerns. We also discuss challenges and lessons learned by the planning team to inform future LCs that address integrated care for OUD and mental health concerns.

Background: Substance use disorder (SUD) treatment centers serve a population of clients who have diverse needs, and may desire or require access to varied treatments while seeking care for their SUDs. While pharmacotherapies have increased in popularity for the treatment of SUDs, adoption rates do remain quite low. But a wider array of pharmacotherapies has become available in recent years which may shift the trend. This article helps shed light on how variations in SUD treatment centers develop and persist with regard to the adoption and delivery of off-label medications. Methods: We use a nationally representative and longitudinal sample of SUD treatment centers in the US (N = 196). We use a logistic regression to analyze the relationship between organizational characteristics and offering any medications, off-label. We also use a negative binomial regression to analyze the relationship between organizational characteristics and the number of medications that were used off-label. Results: Our findings reveal that older centers, accredited centers, and centers that offer mental health screenings are all positively associated with the provision of off-label medication in SUD treatment. We also find a positive relationship between private funding and offering a greater number of off-label medications. Conclusions: Our results suggest that SUD clients who seek treatment from centers that offer medications off-label, may have access to a greater number of medication-assisted treatment options.

BACKGROUND: The increasing number of older adults with complex care needs underscores the urgent need for improved coordination between health and social services, emphasizing the importance of integrated care models. The Social Return on Investment (SROI) framework is a valuable tool for evaluating the social, economic, and environmental impact of healthcare interventions, including integrated long-term care (LTC) solutions. However, a gap remains in reviews specifically analyzing its application to integrated LTC interventions. OBJECTIVE: To examine how SROI has been used to evaluate integrated LTC interventions, particularly for older adults. METHODS: A scoping review of peer-reviewed and grey literature was conducted, covering January 2012 to June 2024, through MEDLINE, CINAHL, Google Scholar, and citation searches. Three independent reviewers assessed study eligibility, following PRISMA guidelines. Data were extracted using PICOS terms and organized into summary tables detailing study characteristics and SROI findings. RESULTS: Out of 556 screened papers, only 11 studies met the inclusion criteria, with most conducted in the UK. SROI evaluations focused on Personal and Community Resources, such as improved physical and mental health and social connections, while Public Resource benefits, including reduced healthcare workloads, were noted in seven studies. Financial proxies came from sources like HACT Social Value Bank and Global Value Exchange. All studies reported positive SROI ratios, though methodological limitations affect interpretation. CONCLUSIONS: The application of SROI to integrated LTC remains limited, primarily UK-based and reliant on context-specific methodologies. Expanding its use requires standardized methods, broader geographic representation, and localized proxies for more accurate evaluations.