Literature Collection

BACKGROUND AND OBJECTIVES: The purpose of the study was to use a best practice quality improvement process to identify and eliminate barriers to Screening, Brief Intervention, and Referral to Treatment (SBIRT) integration in a Federally Qualified Health Center. SBIRT provides an initial method for addressing mental health and substance abuse concerns of patients. The method is very useful in integration of behavioral health screening in primary care. METHODS: A Process Improvement Team used 4 Plan-Do-Study-Act cycles during a 10-week time frame to (1) reduce the reported frequency of barriers to the SBIRT process, (2) reduce non-value-added activities in the SBIRT workflow, (3) reduce bottlenecks, and (4) increase patient receipt of SBIRT. A modified Referral Barriers Questionnaire, a swim lane diagram, non-value-added versus value-added analysis, and a Shewhart control chart (P-chart) were used to evaluate process and outcome measures. RESULTS: Nurses reported a 23.82% reduction in referral barrier frequency and a 21.12% increase in the helpfulness of SBIRT. Providers reported a 7.60% reduction in referral barrier frequency and a decrease in the helpfulness of SBIRT. The P-chart indicated that the process changes resulted in a positive shift in behaviors and an increase in patient receipt of SBIRT. CONCLUSION: The use of a best practice quality improvement process resulted in improvements in workflow related to SBIRT, greater communication about SBIRT, and identification of barriers that blocked successful receipt of SBIRT.

BACKGROUND: While the overdose crisis has impacted all ages, overdose-related deaths among adolescents have been increasing more rapidly than any other age group, doubling between 2019 and 2020. Identifying and treating substance use disorders (SUDs) among adolescents is critical to preventing adolescent overdose deaths. While evidence-based interventions for adolescents with SUDs exist, they remain underutilized. Implementing SUD interventions in primary care settings through integrated behavioral health (IBH) is one approach for increasing access to evidence-based SUD services for adolescents. METHODS: This is a Hybrid Type 2, cluster-randomized, stepped-wedge trial comparing SUD IBH to standard primary care treatment. In our open cohort stepped-wedge design, primary care clinics will be randomly designated to one of three cohorts. We will use a mixed-methods approach to evaluate both implementation and effectiveness outcomes, with a focus on assessing the impact of IBH on primary care provider behaviors around SUD interventions. All cohorts will complete baseline surveys during the control condition and then every 6 months. At each time point, we will also collect and analyze patient administrative data to assess patient engagement and outcomes. In addition, we will conduct qualitative interviews at pre-, mid-, and post-implementation during sustainment of the intervention. CONCLUSION: Addressing the overdose crisis is a national priority. IBH has the potential to reduce overdose rates by enhancing primary care provider willingness to deliver SUD services for adolescents.

The Australian stepped care model (SCM) in primary mental healthcare aims to provide a structured, accessible and flexible approach to addressing mental health issues. This study, a subset of a broader study, explores the perspectives of multidisciplinary mental health professionals on the implementation and effectiveness of the SCM. Using an exploratory descriptive qualitative methodology, the study collected data from nine participants: mental health nurses, an occupational therapist, a psychologist, a social worker, psychiatrists and a care coordinator, all involved in an SCM. Ethical approval was obtained from the Human Research Ethics Committee (de-identified for review), and measures were implemented to ensure the privacy and confidentiality of all participants. Data were collected through face-to-face interviews and analysed using reflective thematic analysis. Four main themes were developed from the reflexive thematic analysis: working together to deliver collaborative care, a flexible and personalised approach, complexities of navigating the model and stories of success: positive client outcomes. The multidisciplinary nature of the SCM facilitates a holistic approach to mental healthcare, ensuring comprehensive support for patients. However, workforce shortages and systemic issues present significant challenges. The study found that flexibility and personalisation allow the SCM to adapt to diverse patient needs, which enhances outcomes and satisfaction, though inconsistencies in service delivery remain. Navigating the SCM is complex, requiring better coordination and more precise guidelines to ensure smooth transitions between care levels. Despite these challenges, the SCM has demonstrated considerable success in improving patient outcomes. In conclusion, the SCM represents a promising primary mental healthcare approach, emphasising tailored, multidisciplinary care. The study highlights the need for continuous improvements which include addressing workforce shortages and enhancing coordination to maximise the SCM's impact and ensure sustainable mental health services in Australia. Future research with larger samples and quantitative data is recommended to evaluate further the SCM's effectiveness in Australia.

OBJECTIVE: This pilot open trial examined the feasibility, acceptability, and preliminary effectiveness of Written Exposure Therapy (WET), a 5-session evidence-based intervention for posttraumatic stress disorder (PTSD) during pregnancy. Participants were pregnant women with comorbid PTSD and substance use disorder (SUD) receiving prenatal care in a high risk obstetrics-addictions clinic. METHODS: A total of 18 participants with probable PTSD engaged in the intervention, and 10 completed the intervention and were included in outcome analyses. Wilcoxon's Signed-Rank analyses were used to evaluate PTSD and depression symptoms and craving at pre-intervention to post-intervention and pre-intervention to the 6-month postpartum follow-up. Engagement and retention in WET and therapist fidelity to the intervention manual were used to assess feasibility. Quantitative and qualitative measures of patient satisfaction were used to assess acceptability. RESULTS: PTSD symptoms significantly decreased from pre-intervention to post-intervention (S = 26.6, p = 0.006), which sustained at the 6-month postpartum follow-up (S = 10.5, p = 0.031). Participant satisfaction at post-intervention was high. Therapists demonstrated high adherence to the intervention and excellent competence. CONCLUSIONS: WET was a feasible and acceptable treatment for PTSD in this sample. Randomized clinical trial studies with a general group of pregnant women are needed to expand upon these findings and perform a full-scale test of effectiveness of this intervention.