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D'Aunno T, Neighbors CJ. Innovation in the Delivery of Behavioral Health Services. Annu Rev Public Health 2024; 45:507-525. [PMID: 37871139 DOI: 10.1146/annurev-publhealth-071521-024027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Several factors motivate the need for innovation to improve the delivery of behavioral health services, including increased rates of mental health and substance use disorders, limited access to services, inconsistent use of evidence-based practices, and persistent racial and ethnic disparities. This narrative review identifies promising innovations that address these challenges, assesses empirical evidence for the effectiveness of these innovations and the extent to which they have been adopted and implemented, and suggests next steps for research. We review five categories of innovations: organizational models, including a range of novel locations for providing services and new ways of organizing services within and across sites; information and communication technologies; workforce; treatment technologies; and policy and regulatory changes. We conclude by discussing the need to strengthen and accelerate the contributions of implementation science to close the gap between the launch of innovative behavioral health services and their widespread use.
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Affiliation(s)
- Thomas D'Aunno
- Wagner Graduate School of Public Service, New York University, New York, NY, USA;
| | - Charles J Neighbors
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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Zuccarini MM, Stiller C. The Effect of Peer Support on Treatment Engagement for Opioid Use Disorder. J Am Psychiatr Nurses Assoc 2024; 30:709-715. [PMID: 36254384 DOI: 10.1177/10783903221128062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Opioid misuse has been a growing problem in the United States that has escalated into a national public health emergency. Despite substance abuse programs that offer assistance in the treatment of opioid use disorder (OUD), keeping clients engaged in recovery treatment can be very challenging. Relapse prevention is a priority concern due to the higher risk of overdose following a period of sobriety. AIMS This research compares two different approaches to treatment of OUD to assess relative treatment adherence. The purpose of this research is to establish whether a peer support-based treatment methodology, combined with increased medication-assisted treatment, provided by an outpatient facility is more effective than treatment-as-usual in improving client engagement in recovery treatment. METHODS The research analyzed data collected over a 6-month period by a facility. The retrospective review of data compared a total of 1,570 clients enrolled in a certified recovery services (CRSs) program versus individuals engaged in treatment-as-usual program. Inclusion criteria consisted of clients with at least one diagnoses of OUD who met level of care requirements. RESULTS Statistical t-test analysis revealed greater engagement in recovery services among those enrolled in the CRS program. CONCLUSIONS The findings support the benefits of a peer support program as a treatment methodology for clients with OUD. This research will be of value in the design and development of future program policy and treatment guidelines.
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Affiliation(s)
- Michelle M Zuccarini
- Michelle M. Zuccarini, MSN, RN, PMHNP-BC, Clarion University of Pennsylvania, Clarion, PA, USA
| | - Cate Stiller
- Cate Stiller, PhD, RN, CNE, Clarion University of Pennsylvania, Clarion, PA, USA
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Kirk MR, Dawkins AD, Wei X, Ajumobi O, Lee LC, Oman R, Woodard S, Wagner KD. What makes a peer? Characteristics of certified peer recovery support specialists in an emergency department-based intervention. PLoS One 2023; 18:e0289920. [PMID: 38060503 PMCID: PMC10703250 DOI: 10.1371/journal.pone.0289920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/28/2023] [Indexed: 12/18/2023] Open
Abstract
Providing brief interventions by certified peer recovery support specialists (CPRSS) in the emergency department (ED) following a drug related visit is a promising method of service engagement and has garnered national attention. This study examines CPRSS's perceptions of the qualities that enable them to deliver interventions in the ED. We conducted qualitative interviews with 14 CPRSSs working in EDs. Interview topics included how the participants became involved with CPRSS work, experiences working in the ED, how the ED differs from other settings, and what interactions with patients look like. Interviews were digitally recorded, transcribed, and analyzed for emerging categories. Three categories were identified relating to CPRSS work: (1) how they approach peer work, (2) inherent qualities required to do the work, regardless of the setting, and (3) context-specific skills required to do the work in the ED. When describing their approach to this work, participants talked about CPRSS work as their life calling and their passion. Participants also identified certain qualities that all CPRSS workers possess, regardless of the setting, including the ability to build rapport, strong listening skills, and a shared lived experience. Lastly, participants identified how specific hard and soft skills help them to navigate organizational and structural challenges in the ED. The unique conditions of the ED and the required qualities of a CPRSS should be considered when implementing an ED-based intervention.
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Affiliation(s)
- Mia R. Kirk
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Ashley D. Dawkins
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Xing Wei
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Olufemi Ajumobi
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Lisa C. Lee
- Roots to Wings Consulting, LLC, Reno, Nevada, United States of America
| | - Roy Oman
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Stephanie Woodard
- Division of Public and Behavioral Health, Bureau of Behavioral Health, Wellness and Prevention, State of Nevada, Carson City, Nevada, United States of America
| | - Karla D. Wagner
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
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Barber CM, Terplan M. Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective. Front Pediatr 2023; 11:1045745. [PMID: 37292372 PMCID: PMC10246753 DOI: 10.3389/fped.2023.1045745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
Substance use in pregnant and parenting persons is common, yet still underdiagnosed. Substance use disorder (SUD) is one of the most stigmatized and undertreated chronic medical conditions, and this is exacerbated in the perinatal period. Many providers are not sufficiently trained in screening or treatment for substance use, so gaps in care for this population persist. Punitive policies towards substance use in pregnancy have proliferated, lead to decreased prenatal care, do not improve birth outcomes, and disproportionately impact Black, Indigenous, and other families of color. We discuss the importance of understanding the unique barriers of pregnancy-capable persons and drug overdose as one of the leading causes of maternal death in the United States. We highlight the principles of care from the obstetrician-gynecologist perspective including care for the dyad, person-centered language, and current medical terminology. We then review treatment of the most common substances, discuss SUD during the birthing hospitalization, and highlight the high risk of mortality in the postpartum period.
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Affiliation(s)
- Cecily May Barber
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States
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Jack HE, Denisiuk ED, Collins BA, Stephens D, Blalock KL, Klein JW, Bhatraju EP, Merrill JO, Hallgren KA, Tsui JI. Peer providers and linkage with buprenorphine care after hospitalization: A retrospective cohort study. Subst Abus 2022; 43:1308-1316. [PMID: 35896006 PMCID: PMC9586121 DOI: 10.1080/08897077.2022.2095078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Background: People with opioid use disorder (OUD) are increasingly started on buprenorphine in the hospital, yet many patients do not attend outpatient buprenorphine care after discharge. Peer providers, people in recovery themselves, are a growing part of addiction care. We examine whether patients who received a low-intensity, peer-delivered intervention during hospitalization had a greater rate of linking with outpatient buprenorphine care relative to those not seen by a peer. Methods: This was a retrospective cohort study of adults with OUD who were started on buprenorphine during hospitalization. The primary outcome was receipt of a buprenorphine prescription within 30 days of discharge. Secondary outcomes included attendance at a follow-up visit with a buprenorphine provider within 30 days and hospital readmission within 90 days. Modified Poisson regression analyses tested for differences in the rate ratios (RR) of each binary outcome for patients who were versus were not seen by a peer provider. Peer notes in the electronic health record were reviewed to characterize peer activities. Results: 111 patients met the study inclusion criteria, 31.5% of whom saw a peer provider. 55.0% received a buprenorphine prescription within 30 days of hospital discharge. Patients with versus without peer provider encounters did not significantly differ in the rates of receiving a buprenorphine prescription (RR = 1.06, 95% CI: 0.74-1.51), hospital readmission (RR = 1.45, 95% CI: 0.80-2.64), or attendance at a buprenorphine follow-up visit (RR = 1.03, 95% CI: 0.68-1.57). Peers most often listened to or shared experiences with patients (68.6% of encounters) and helped facilitate medical care (60.0% of encounters). Conclusions: There were no differences in multiple measures of buprenorphine follow-up between patients who received this low-intensity peer intervention and those who did not. There is need to investigate what elements of peer provider programs contribute to patient outcomes and what outcomes should be assessed when evaluating peer programs.
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Affiliation(s)
- Helen E. Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Eric D. Denisiuk
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Brett A. Collins
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Dan Stephens
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kendra L. Blalock
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jared W. Klein
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Elenore P. Bhatraju
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joseph O. Merrill
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Judith I. Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
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Bosse JD, Hoffman K, Wiest K, Todd Korthuis P, Petluri R, Pertl K, Martin SA. Patient evaluation of a smartphone application for telehealth care of opioid use disorder. Addict Sci Clin Pract 2022; 17:50. [PMID: 36085078 PMCID: PMC9462609 DOI: 10.1186/s13722-022-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background People with opioid use disorder (OUD) face barriers to entering and remaining in life-saving treatment (e.g., stigma, detrimental interactions with health care, and privacy concerns). Telehealth and related technology can reduce barriers to entering and staying in care. Patient feedback is critical to the development of these newer treatment approaches to ensure they are usable and do not inadvertently recreate treatment barriers. Purpose Evaluate the perceived usability of existing and planned features of a mobile application (app) that facilitates delivery of OUD treatment via telehealth. Methods People with current or prior experience with OUD treatment were eligible for the study. Participants (n = 31; 55% women) provided feedback on an interactive prototype demonstration via individual qualitative interviews and completed a quantitative survey on the app’s perceived usability. Descriptive statistics summarized the usability survey. We analyzed qualitative interview transcripts to elicit common themes. Results Participants were primarily white (77%) with a mean age of 42.2 years (range 22–69). Participants rated the six major features of the current app as helpful (median response 5 out of 5) and appreciated the flexibility of conducting a visit from a place of their choosing. Participants regarded the five proposed components of the app, such as daily affirmations and medication treatment-related reminders (e.g., pick up medication at pharmacy, medication schedule), as useful features with medians 5 out of 5, and reported they would recommend the app to others for OUD care. Participant qualitative interviews provided additional information on perceived usability of existing and proposed app features. Conclusion Our study suggests that an appealing, easy-to-use app—with tools and features that effectively support care—could circumvent existing barriers and foster sustained recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00331-4.
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Watson DP, Staton MD, Grella CE, Scott CK, Dennis ML. Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic. Subst Abuse Treat Prev Policy 2022; 17:22. [PMID: 35303913 PMCID: PMC8931576 DOI: 10.1186/s13011-022-00449-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.
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Affiliation(s)
- Dennis P. Watson
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Monte D. Staton
- grid.185648.60000 0001 2175 0319Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 818 S Wolcott Ave, Chicago, IL 60613 USA
| | - Christine E. Grella
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Christy K. Scott
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 221 W. Walton St, Chicago, IL 60610 USA
| | - Michael L. Dennis
- grid.413870.90000 0004 0418 6295Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761 USA
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What Obstetrician–Gynecologists Should Know About Substance Use Disorders in the Perinatal Period. Obstet Gynecol 2022; 139:317-337. [DOI: 10.1097/aog.0000000000004657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
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Brady LA, Wozniak ML, Brimmer MJ, Terranova E, Moore C, Kahn L, Vest BM, Thomas M. Coping Strategies and Workplace Supports for Peers with Substance Use Disorders. Subst Use Misuse 2022; 57:1772-1778. [PMID: 36017896 DOI: 10.1080/10826084.2022.2112228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Introduction: Substance use disorder (SUD) peers provide support and navigation through a fragmented treatment system for people who use drugs (PWUD) and those in recovery. While barriers to peers' work are well established, from role ambiguity to stigma surrounding substance use, little research has focused on factors that facilitate peers' work. Methods: We conducted in-depth semi-structured interviews (N=20) with peers as part of an evaluation of a larger project related to the opioid crisis in Western New York. Participants were recruited from a regional peer network via flyers, emails, and a brief presentation. Interviews were conducted in person or by phone, audio recorded, and transcribed. Transcripts were analyzed using thematic content analysis. Results: Peers emphasized two factors: healthy personal coping strategies and strong workplace supports. Coping strategies included a sense of community, setting appropriate boundaries, and self-care routines. At the workplace, peers valued mental and emotional support, as well as professional relationships and organizational policies that made their work easier and supported self-care. For a few peers, professional relationships included advocating on behalf of PWUD by sharing personal experiences of SUD. Conclusions: Peers valued peer colleagues and peer-led organizations, noting how shared experiences of substance use and recovery enabled a unique support system. For peers who lack such support at work, the authors suggest peer networks as an alternative. We also recommend organizational policies and practices to facilitate peers' work, such as promoting peer input and feedback, but further research is needed to measure effects on peer retention and job satisfaction.
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Affiliation(s)
- Laura A Brady
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M L Wozniak
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M J Brimmer
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - E Terranova
- Erie County Department of Health, Buffalo, NY, USA
| | - C Moore
- Erie County Department of Health, Buffalo, NY, USA
| | - L Kahn
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - B M Vest
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
| | - M Thomas
- Department of Family Medicine, SUNY University at Buffalo, Buffalo, NY, USA
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Hubach RD, O'Neil AM, Ernst C, Stowe M, Hickey M, Remondino M, Giano Z. Client perspectives on the accessibility and quality of substance use treatment during the COVID-19 pandemic. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 1:100002. [PMID: 35156104 PMCID: PMC8606257 DOI: 10.1016/j.dadr.2021.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND People who use drugs have been particularly vulnerable during the COVID-19 pandemic because of their unique social, harm reduction, and treatment needs. These unique needs and challenges have significant influence on the severity of their substance use, mental health symptomatology, willingness to engage in treatment, and adherence to treatment options. This has included immense challenges related to the dissemination of COVID-19 messaging and the need for harm reduction and treatment service entities to adopt new formats to continue operation. METHODS In-depth interview data were collected people who use drugs (N=24) residing in Oklahoma from November 2020 through February 2021 to assess perspectives on (1) their access to harm reduction, substance use prevention, and treatment programs during the COVID-19 pandemic, (2) the perceived quality of such services and programs during this time, and (3) the perceived availability of tailored COVID-19 information. RESULTS Several factors emerged related to accessing and quality of substance use services during COVID-19, including poor accessibility (e.g., internet access), diminished quality (i.e., lack of social support), and lack of tailored COVID-19 prevention and treatment messaging. CONCLUSIONS Upticks in COVID-19 cases and deaths are expected to continue as new SARS-CoV-2 variants are introduced. The present findings highlight the need for tailored COVID-19 messaging (e.g., minimizing the sharing of substance use supplies that can spread COVID-19, mask wearing, COVID-19 vaccination), which is responsive to unique needs of substance using populations. Similarly, as prevention and treatment programs are delivered online, efforts are necessary to ensure equitable access and enhanced quality of services.
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Affiliation(s)
- Randolph D. Hubach
- Department of Public Health, Purdue University, West Lafayette, IN, USA,Corresponding Author: Randolph D. Hubach, Department of Public Health, Purdue University, 219 A Matthews Hall, West Lafayette, IN 47907
| | - Andrew M. O'Neil
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Campbell Ernst
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Mollie Stowe
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Mark Hickey
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Molly Remondino
- Center for Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Zachary Giano
- Center for Innovating Design and Analysis, University of Colorado-Anschutz, Denver, CO USA
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Banks DE, Carpenter RW, Wood CA, Winograd RP. Commentary on Furr-Holden et al. : As opioid overdose deaths accelerate among Black Americans, COVID-19 widens inequities-a critical need to invest in community-based approaches. Addiction 2021; 116:686-687. [PMID: 33417278 PMCID: PMC7878302 DOI: 10.1111/add.15362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has exacerbated racial inequities in fatal opioid overdoses affecting Black Americans. To reduce overdose rates among Black Americans, funding and policy efforts should prioritize local strategies that build community trust, such as grassroots organizations already engaged in outreach, advocacy, and harm reduction services.
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Affiliation(s)
- Devin E Banks
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri St Louis, St Louis, MO, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, MO, USA
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