Helping families heal in substance use treatment: A qualitative study about the role of peer support specialists with client families.

INTRODUCTION: Peer support specialists (PSS) are people with previous psychiatric illness or substance use disorders who use their experience to support those facing similar hardships. PSS offer a range of beneficial outcomes to both the PSS and clients. The most immediate social connections to those seeking treatment are often their families, yet no PSS studies are inclusive of family involvement. Strong theoretical and empirical support exists for family involvement in addiction treatment, but no studies to date on families in substance use treatment include PSS. This study offers a first look at PSS's experiences with client families. We aimed to describe experiences and attitudes of PSS in working with families of those seeking substance use treatment. METHODS: This qualitative study included 25 adult PSS with at least 1 year of work experience in substance use treatment and state credentialing board certification. Participants had one interview either in a focus group format or individually. The recruitment and data collection phase lasted from November 2020 to June 2021. The semi-structured interview protocol included six main questions and interviews lasted 60 to 75 min. Upon completion of each interview, the recordings were transcribed and inductively coded. Thematic analysis of the codes identified overarching themes and their implications were described with associated quotes. RESULTS: Thematic analysis generated three interrelated themes. First, participants described the various ways they often work with the families of their clients, which seemed to be dependent on the age of the client. Second, participants identified the negative aspects of working with families such as family drama, stress, and co-dependency issues. Last, the third theme identified the ways in which PSS assist families in healing from the effects of addiction. The themes identify a complicated and conflicting approach to work with families. Overall, it seemed PSS were operating on their own experiences or suggestions given by supervisors to guide them with no training on how to approach families. CONCLUSIONS: This study highlights a deficit in PSS training on their role with families, family intervention, and the impact of family on substance use treatment for adults and youth. More research needs to establish the PSS role with families and with clients from marginalized backgrounds. Credentialing and national associations that support PSS should develop additional training and education opportunities related to working with families for PSS, supervisors, and organizational leadership who employ PSS for substance use treatment.

Missouri's Fentanyl Problem: The China Connection.

Recently, Missouri has followed an overall upward trend in opioid overdose deaths. In 2018, Missouri was the state with the largest absolute and percentage increase in opioid-related overdose fatality rates per capita over the previous year (18.3% and 3.1/100,000). This increase occurred despite an overall decrease in U.S. opioid-related death rates in the same period. This report identifies illicitly manufactured fentanyl (IMF) (and analogues) as the drug most responsible for this rise in opioid deaths in Missouri, with stimulant overdoses (primarily from methamphetamine) in second place. Within Missouri, we find the areas where opioid deaths are highest: St. Louis and the city's fringe areas, following the national trend for high rates in fringe areas. Based on reports from CDC Wonder data, county medical examiners, law enforcement agencies, and drug addiction prevention agencies, we conclude that IMF and related synthetic opioids arriving from China are primarily responsible for fatal narcotic overdoses in Missouri. Despite the COVID-19 disruption of fentanyl manufacturing and distribution centers in and around Wuhan, China early in the pandemic, preliminary 2020 data from medical examiners' offices show an upswing in opioid deaths, an indicator that Chinese fentanyl producers have restored the supply chain.

Care of Incarcerated Patients.

The United States has the highest incarceration rate of any nation in the world. Approximately 870 of every 100,000 U.S. citizens are currently in jails or prisons. U.S. inmates are disproportionately young males, racial and ethnic minorities, and persons of low socioeconomic status. Incarcerated persons have high rates of psychiatric conditions, communicable diseases, substance use disorders, and chronic diseases. The U.S. Preventive Services Task Force recommends that all inmates be screened for human immunodeficiency virus infection, hepatitis C, syphilis, and latent tuberculosis infection, and that sexually active female inmates be screened for gonorrhea and chlamydia. Inmates should also be screened for psychiatric conditions and substance use disorders. Therapy should be continued for all chronic conditions when indicated. Inmates should be referred to community organizations for follow-up medical care and treatment of substance use disorders before they are released from detention facilities. A systematic approach to urgent, routine, and preventive care for persons in jails and prisons creates a healthier correctional environment and a healthier community after release.

Do Patient-Centered Medical Homes Improve Health Behaviors, Outcomes, and Experiences of Low-Income Patients? A Systematic Review and Meta-Analysis.

OBJECTIVES: To examine: (1) what elements of patient-centered medical homes (PCMHs) are typically provided to low-income populations, (2) whether PCMHs improve health behaviors, experiences, and outcomes for low-income groups. DATA SOURCES/STUDY SETTING: Existing literature on PCMH utilization among health care organizations serving low-income populations. STUDY DESIGN: Systematic review and meta-analysis. DATA COLLECTION/EXTRACTION METHODS: We obtained papers through existing systematic and literature reviews and via PubMed, Web of Science, and the TRIP databases, which examined PCMHs serving low-income populations. A total of 434 studies were reviewed. Thirty-three articles met eligibility criteria. PRINCIPAL FINDINGS: Patient-centered medical home interventions usually were composed of five of the six recommended components. Overall positive effect of PCMH interventions was d = 0.247 (range -0.965 to 1.42). PCMH patients had better clinical outcomes (d = 0.395), higher adherence (0.392), and lower utilization of emergency rooms (d = -0.248), but there were apparent limitations in study quality. CONCLUSIONS: Evidence shows that the PCMH model can increase health outcomes among low-income populations. However, limitations to quality include no assessment for confounding variables. Implications are discussed.

Science Reinforcing Mission. How Can Our Communities Move Ahead After Ferguson?

During Jesus' healing ministry, he addressed the diseases of his day, particularly the conditions that ostracized people, such as demon possession, paralysis, hemorrhage and blindness. This healing ministry is much of our focus in Catholic health care, as it should be. But Jesus addressed the deeper stories that surrounded the people he healed. He challenged his listeners to recognize the role they played in creating their own narrative of disease and their communities' norms in responding to illness. He did not shy away from separating the afflicted person's illness from moral failings or character weakness. He was clear about calling out institutional practices that marginalized people. In short, Jesus called out injustice when he saw it, and his healing was tied up in these social statements.

Assessment of hepatitis C risk factors and infection prevalence in a jail population.

OBJECTIVES: We sought to validate previous reports of HCV prevalence in jails, identify HCV risk factors prevalence, and identify risk factors associated with HCV infection in this population. METHODS: Inmates at the Buzz Westfall Justice Center (BWJC) in St. Louis, Missouri, were offered risk factor screening for HCV and anti-HCV antibody testing from December 2012 through May 2013. Demographic and risk factor information were assessed for significant associations with positive HCV antibody results. Risk factors that were significantly associated in univariate analysis were assessed using binary logistic regression to model the relationship between positive HCV results and the risk factors and demographics. RESULTS: Fifty of 304 inmates were positive for HCV, with a prevalence of 16.4%. The risk factors significantly associated with increased risk for positive HCV antibody were age (odds ratio [OR] = 1.09; 95% confidence interval [CI] = 1.04, 1.15 for each year), injection drug use (OR = 53.87; 95% CI = 17.78, 163.21), sex with HCV-positive partner (OR = 7.35; 95% CI = 1.41, 38.20), and tattoos by a nonlicensed provider (OR = 2.62; 95% CI = 1.09, 6.33). Prevalence for women was 3 times that of men (38% vs 12%). CONCLUSIONS: Prevalence of HCV at BWJC was similar to previous jail studies, which is lower than reported prison rates and higher than the general population.

Exploring interprofessional education in the family medicine clerkship: a CERA study.

BACKGROUND AND OBJECTIVES: The need for interprofessional education (IPE) to improve teamwork skills has been recognized by several national organizations. The purpose of this study was to investigate IPE integration in family medicine clerkships and factors associated with IPE's success. METHODS: A survey of clerkship directors at US allopathic medical schools was conducted through the Council of Academic Famiily Medicine Educational Research Alliance (CERA). Respondents were asked (1) whether IPE was part of the curriculum, (2) the educational methods used, (3) which health professions students and faculty participated in IPE, (4) what outcomes were measured, (5) the types of faculty development provided, and (6) the barriers encountered when implementing IPE. RESULTS: The response rate was 66% (88/134), and 38% reported incorporating IPE into the clerkship with most offering IPE in clinical activities. A wide variety of health professions students and faculty participated in clerkship IPE activities. One third of the respondents offered faculty development. Most agreed that third party funding (85%), IPE team training (94%), clearly defined roles (94%), and dedicated time during clinical care for team meetings (93%) were vital for IPE to succeed. Many programs did not measure IPE-specific outcomes (49%). Eighty percent reported at least one barrier to implementing IPE. The most common barriers were scheduling conflicts (46%) and lack of IPE experience (40%). No one reported a lack of institutional support for IPE. CONCLUSIONS: Few clerkships offered IPE. However, family medicine is in a unique position to highlight the value of interprofessional teamwork for students and should recognize and promote IPE opportunities.