When Interruption Becomes Innovation: How Integrated Behavioral Health in Primary Care Adapted During COVID-19.

BACKGROUND AND OBJECTIVES: Integrated behavioral health (IBH) delivered in primary care is critical to addressing the growing behavioral health crisis in the United States. COVID-19 prompted changes to the core components of IBH, causing the model to shift. The specifics of how IBH teams adapted and what these adaptations mean for the future of IBH teams in primary care are uncertain. METHODS: We conducted individual interviews with IBH team members using a semistructured interview guide. A purposive convenience sample consisted of primary care clinicians (N=20) from nine states. We used qualitative thematic analysis to code and generate themes. RESULTS: Four themes emerged: (a) permanent changes to the physical structure of the team; (b) increased reliance on technology for team communication; (c) shift in team collaboration, often occurring asynchronously; and (d) telehealth embraced for IBH. CONCLUSIONS: COVID-19 interrupted the originally designed IBH model of team-based care. Changes to the physical proximity of team members disrupted all other components of IBH, requiring adapted workflows, communication via digital channels, virtual team building, asynchronous care coordination, and remote service delivery. Long-term evaluation of these innovations is needed to examine whether shifts in core components impact model efficacy. Training family medicine, primary care, and behavioral health clinicians for these adapted models of IBH will be needed.

How would a certification in harm reduction impact service delivery and the harm reduction workforce? A qualitative study.

INTRODUCTION: Harm reduction utilizes evidence-based strategies to reduce the negative health and social impacts of substance use. As harm reduction services expand across the U.S. without the requirement of professional certification, variation in how the workforce is regarded and trained on harm reduction principles and practices persists. This study explores the harm reduction workforce's perspectives on how certification would impact service delivery and their profession. METHODS: The study employed purposive sampling to identify and survey administrators within a publicly available syringe services program directory (N = 168). This sub-study utilized thematic analysis to evaluate 152 respondents' answers to one dichotomous closed-ended question, "Would a certification in the harm reduction field be helpful?" followed by an open-ended response to the follow-up statement, "Based on your answer to the previous question about a certification to work in harm reduction, please explain why or why not." Approximately 45 % of the respondents (n = 68) answered no, while 55 % (n = 84) answered yes. RESULTS: Seven themes emerged in total. Among those against harm reduction certification, the four themes were: (1) certification is exclusionary and creates barriers, (2) lived experience is more important than certification, (3) certification does not equate to skills, and (4) no regulatory body exists to oversee the certification process. The study identified three themes from individuals who indicated harm reduction certification was helpful: (1) certification helps standardize training, (2) certification validates/legitimizes the harm reduction field, and (3) low barriers to receiving certificates. CONCLUSIONS: The study presents participants' perspectives for and against harm reduction certification emphasizing implications for service delivery and the workforce. Despite varying perceptions on how certification may advance or hinder the field, the sample was unified in their commitment to harm reduction practices and endorsement of its integral role in confronting the U.S. drug use epidemic. This study highlights how certification can impact state and federal harm reduction service delivery and promotes future research on ways to address the needs of harm reduction organizations and their workforce.