Addressing the Spectrum of Opioid Misuse Prevention, Treatment, and Recovery in Rural Washington State Communities: Provider Identified Barriers and Needs.

The opioid overdose epidemic has significantly impacted rural communities. Rural settings present unique challenges to addressing opioid misuse. The purpose of the current study was to understand the similarities and differences between rural and urban-based providers serving rural communities. Washington state-based opioid-related service providers who serve rural communities (N = 75) completed an online survey between July and September 2020. Chi-square tests of association were used to examine significant differences in proportions between rural providers and rural-serving urban providers across opioid prevention, treatment, and recovery training topics. Rural providers reported receiving significantly less opioid treatment and recovery training on the criminal legal system, workplace-based education on treatment and recovery, and co-occurring disorder treatment; and significantly higher prior opioid prevention training on the prevention programs for youth and accessing prevention funding. Differences between rural and rural-serving urban providers demonstrate ways in which rural-urban partnerships can be strengthened to enhance public health.

Public space as a potential resource during reentry for formerly incarcerated people with serious mental illnesses.

BACKGROUND: Formerly incarcerated people with serious mental illnesses (SMI) are overrepresented in the criminal legal system. Professional-brokered "connecting" interventions are the predominant means for supporting community reentry, but they are vulnerable to the paucity of formalized services in areas of concentrated disadvantage. Public spaces offer unique opportunities for developing naturally occurring relationships and connecting to diverse forms of capital and resources. METHODS: This qualitative study explored how 36 formerly incarcerated people with SMI navigated risks in public spaces, as they met the practical challenges of reentry while also examining the supportive resources and relationships they derive from spaces often perceived as risky. RESULTS: Our findings indicated participants had dynamic and complex relationships to public spaces, including parks, coffee shops, and libraries and they used these spaces to create opportunities for solitude, socialization and resource acquisition. Spaces identified often featured: 1) activities and routines; 2) strong social infrastructure; and 3) opportunities for solitude and reflection. IMPLICATIONS: These findings can inform future interventions that use dynamic public space features as resources during reentry from criminal legal settings for people with MI.

Reorienting the focus from an individual to a community-level lens to improve the pathways through care for early psychosis in the United States.

The implementation of coordinated specialty care in the U.S. over the past decade has led to the improvements of clinical and functional outcomes among individuals in the early stages of psychosis. While there have been advancements in the delivery of early intervention services for psychosis, it has almost exclusively focused on short-term change at the individual level. In light of these advancements, research has identified gaps in access to care and delivery of services that are driven by different levels of determinants and have the biggest impact on historically excluded groups (e.g., ethnoracial minoritized communities). Interventions or efforts that place an emphasis on community level (structural or sociocultural) factors and how they may influence pathways to care and through care, specifically for those who have been historically excluded, have largely been missing from the design, dissemination and implementation of early psychosis services. The present paper uses a structural violence framework to review current evidence related to pathways to care for early psychosis and the physical/built environment and conditions (e.g., urbanicity, residential instability) and formal and informal community resources. Suggestions on future directions are also provided, that focus on enriching communities and creating sustainable change that spans from pathways leading to care to 'recovery.' In all, this lays the groundwork for a proposed paradigm shift in research and practice that encompasses the need for an emphasis on structural competency and community-driven approaches.

Community-based family peer navigator programme to facilitate linkage to coordinated specialty care for early psychosis among Black families in the USA: A protocol for a hybrid type I feasibility study.

BACKGROUND: Approximately 70% of Black/African American family members report no contact with mental health providers prior to initial diagnosis and the receipt of services for early psychosis. Black families often encounter barriers and experience delays on the pathway to coordinated specialty care programmes for early psychosis. METHODS AND ANALYSIS: This mixed-methods study will (1) develop and refine a family peer navigator (FPN) for Black families designed to increase access and engagement in coordinated specialty care and (2) pilot-test FPN for Black families with 40 family members with loved ones at risk for psychosis in a randomised trial to assess the acceptability and feasibility. Families will be randomised to FPN (n=20) or a low-intensive care coordination (n=20). Other outcomes include proposed treatment targets (eg, knowledge, social connectedness), preliminary impact outcomes (time to coordinated specialty care programmes, initial family engagement), and implementation outcomes (acceptability, feasibility, appropriateness). ETHICS AND DISSEMINATION: Ethics approval has been obtained from Washington State University Institutional Review Board and informed consent will be obtained from all participants. This study will establish an innovative culturally responsive FPN programme and implementation strategy, and generate preliminary data to support a larger hybrid effectiveness-implementation trial. Study findings will be presented at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05284721.

Mixed-methods trial of a phosphatidylethanol-based contingency management intervention to initiate and maintain alcohol abstinence in formerly homeless adults with alcohol use disorders.

BACKGROUND: Contingency management (CM) is an intervention where incentives are provided in exchange for biochemically confirmed alcohol abstinence. CM is effective at initiating alcohol abstinence, but it is less effective at maintaining long-term abstinence. Phosphatidylethanol (PEth), collected via a finger-stick, can detect alcohol use for 14-28 days. PEth allows for the development of a CM model that includes increasingly less frequent monitoring of abstinence to assist high risk groups, such as formerly homeless individuals, maintain long-term abstinence. AIMS: Investigate whether PEth-based CM intervention targeting alcohol abstinence in formerly homeless, currently housed individuals with alcohol use disorders is: (1) acceptable and feasible for housing program tenants and personnel; and is associated with increased (2) alcohol abstinence and (3) housing tenure. METHODS: Acceptability and feasibility will be assessed using a QUAL+quant mixed-methods design using qualitative interviews and quantitative measures of satisfaction and attrition. Effectiveness will be evaluated through a randomized pilot trial of 50 study participants who will receive 6 months of either treatment as usual (TAU) including incentives (e.g., gift cards) for providing blood samples (Control Condition) or TAU and incentives for negative PEth results (PEth-CM Condition). Outcomes will be assessed during the intervention and at a three-month follow-up visit. The trial will be conducted via telehealth as a result of COVID-19. DISCUSSION: This protocol seeks to utilize a novel alcohol biomarker to evaluate the acceptability, feasibility, and initial effectiveness of a CM model that encourages long-term abstinence in a high-risk group.

Racial and ethnic differences in alcohol-, opioid-, and co-use-related deaths in Washington State from 2011 to 2017.

BACKGROUND: Few studies exist examining alcohol and opioid co-use mortality rates among racially and ethnically diverse communities, presenting a critical gap in understanding the contribution of alcohol on opioid-related deaths and strategies for prevention. The purpose of the study was to assess whether alcohol and opioid-related deaths differ by race/ethnicity subgroups and if there has been an increase in alcohol and opioid-related deaths between 2011 and 2017. DESIGN: Secondary data analysis of publicly available alcohol and opioid mortality data among non-Hispanic Whites, Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native individuals in Washington State. MEASUREMENTS: The primary outcomes were alcohol-only, opioid-only, and alcohol-opioid co-use mortality, 2011-2017. Alcohol and/or opioid-related deaths were assigned an International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for the underlying or multiple cause of death. FINDINGS: Between 2011 and 2017, alcohol-only mortality rates increased among non-Hispanic White (P = 0.003) and Hispanic individuals (P = 0.008). Opioid-only mortality rates increased among American Indian/Alaska Native (P = 0.004) and Hispanic individuals (P = <0.001). American Indian/Alaska Native individuals had the highest alcohol-only, opioid-only, and co-use-related mortality rates when looking at between-group incidence rates. CONCLUSIONS: Although the opioid epidemic has been characterized as a public health crisis that predominantly impacts non-Hispanic White individuals, racial and ethnic minorities are increasingly impacted by fatal and non-fatal overdose related to co-occurring substance use. Our findings using data from Washington State, align with existing data and signal a dire need to address alcohol and opioid misuse through targeted interventions to prevent overdose and poisoning, with special considerations for American Indian/Alaska Native communities.

Neighbors as distal support for individuals with serious mental illnesses.

Social networks are regarded as an asset to community integration. While family and friends provide important sources of support, familiar strangers like neighbors can facilitate support through anonymous, but meaningful interactions. Among individuals with serious mental illnesses (SMI), these interactions can help to compensate for increased social isolation and smaller networks of peers. This study explores whether neighbors can play a unique role in decreasing loneliness and bolstering a sense of community for individuals with SMI. Participants in this study were drawn from 2 samples: (a) 232 individuals with SMI receiving services at outpatient community mental health centers throughout the United States; and (b) 300 adults recruited from the Truven Health Analytics' PULSE survey. Independent-samples t tests were performed to compare neighbor relationships between individuals with and without SMI. Multiple regression analyses were conducted to examine associations between neighbor relationships, sense of community, and loneliness. As hypothesized, individuals with SMI reported weaker relationships with their neighbors, as well as higher levels of loneliness and lower levels of community connectedness compared to individuals without SMI. For participants in both groups, the quality of neighbor relationships was significantly associated with their loneliness and sense of community regardless of how many neighbors they reported feeling close to. Participants with SMI indicated their sense of community and experiences of loneliness were associated with their relationships with their neighbors, no matter the quantity. Providers might capitalize on the utility of neighbors by expanding social and support networks of clients with SMI. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Stranger support: How former prisoners with mental illnesses navigate the public landscape of reentry.

BACKGROUND: Prisoners with mental illnesses (MI) are released from prison into environments where they are under-treated and under-supported by our criminal justice, social service, and health systems. Public space and interactions within those spaces have been shown to have positive effects in similar populations, including individuals with MI. This qualitative study explored the role different interactions play during the course of reentry. The study aimed to understand the more everyday relational dynamics that former prisoners with MI experience in public and private spaces. METHODS: Semi-structured interviews on both experiences of public spaces and interactions within were conducted with 36 former prisoners with MI. Go-along interviews were conducted as a follow-up to these interviews with a subsample of 11 participants in order to identify and describe public spaces and interactions within those spaces. Phenomenological analysis was used to analyze data collected. RESULTS: Participants described an array of supportive relationships with familiar strangers fostered in public spaces. Participants also described receiving stranger support from relationships typically associated with conventional and institutional supports. This form of "stranger support" was juxtaposed against the burdens and risks of reciprocal intimate relationships. IMPLICATIONS: Public space and public space interactions can provide support streams to counterbalance the more complex support of intimate relationships. Providers might consider the utility of familiar strangers in helping clients to navigate these sometimes risky, but potentially fruitful spaces.

Facilitating community connections among people with mental illnesses: Perspectives from grassroots community leaders.

We conducted focus groups comprising 20 grassroots community leaders to identify social and structural elements that affect community engagement among people with serious mental illnesses. Community leaders not affiliated with mental health systems have been mostly left out of the discussions about inclusion and engagement, even though they possess unique information about the places where they live and can be essential partners in making community connections. The findings from the focus groups point to elements that both facilitate and inhibit connections, as well as roles community mental health practitioners may take on, to engage with community leaders and people with mental illness to minimize barriers and foster connections in community settings. Additionally, the focus groups elucidated the interplay between the right to be a member of one's community and a community's responsibility to create a welcoming environment. The current study garnered information regarding the broader needs and implications of community connections, as well as some specific suggestions to enhance community engagement among people with serious mental illness. Hesitation and stigma around engaging individuals with mental illnesses were identified as barriers to inclusion. Further study about how community leaders and groups may be involved in facilitating meaningful community connections is recommended.

Implementation and Outcomes of Forensic Housing First Programs.

This mixed-method study used administrative data from 68 supportive housing programs and evaluative and qualitative site visit data from a subset of four forensic programs to (a) compare fidelity to the Housing First model and residential client outcomes between forensic and nonforensic programs and (b) investigate whether and how providers working in forensic programs can navigate competing Housing First principles and criminal justice mandates. Quantitative findings suggested that forensic programs were less likely to follow a harm reduction approach to substance use and clients in those programs were more likely to live in congregate settings. Qualitative findings suggested that an interplay of court involvement, limited resources, and risk environments influenced staff decisions regarding housing and treatment. Existing mental health and criminal justice collaborations necessitate adaptation to the Housing First model to accommodate client needs.

Role of Context, Resources, and Target Population in the Fidelity of Critical Time Intervention.

OBJECTIVE: The goal of this study was to understand departures from a model program, critical time intervention (CTI), when used with a population of men with mental illness who were leaving prison, a new population for the intervention. METHODS: A fidelity study was conducted with the CTI Fidelity Scale Manual, and six program staff participated in semistructured interviews. Thematic analysis of interviews supplemented information on departures from the model. RESULTS: The overall fidelity score indicated a well-implemented program, but low scores on early engagement, early linking with community resources, monitoring the transfer of services from CTI to community services, and nine-month follow-up were related to the context of the prison setting, the population of men leaving prison, and environmental resources. CONCLUSIONS: The setting in which evidence-based practices are applied, the environmental resources available, and the target population may affect program fidelity.

Understanding how police officers think about mental/emotional disturbance calls.

Police officers frequently respond to calls involving persons with mental illnesses and in doing so, they are key gatekeepers of access to mental health treatment as well as entry into the criminal justice system. Programs such as Crisis Intervention Teams (CIT) are being implemented across the United States and elsewhere to train officers to respond more effectively and facilitate access to mental health services when appropriate. These programs would benefit from a thorough understanding of these encounters from the perspective of police officers. We take as a premise that officers develop frames of reference or "schema" for understanding and responding to these encounters that are shaped by socialization, training, and their experience as police officers. In this study, we examine police officer schema of mental/emotional disturbance (M/EDP) calls. Qualitative interviews provided the foundation to develop the Needs on the Street Interview (NOSI) to tap officer schema of four types of M/EDP scenarios. The NOSI was administered to 147 officers in Chicago and Philadelphia. Latent Class Analysis (LCA) was conducted separately for each scenario to examine groups of officers with different schema as well as predictors of schema group. For three of the four scenarios, officers were classified into a two category or schema model, for the fourth (crime reported) a three category model was supported. Schema groups tended to be differentiated by ratings of level of resistance/threat and substance use. Contrary to our expectations, CIT and law enforcement experience did not predict officer schema group. While the CIT model emphasizes de-escalation skills to reduce resistance and the need for officers to use force, CIT and other training programs may want to consider increasing content related to factors such as co-occurring substance use and managing resistance.