Experiences Administering Naloxone Among People in Different Social Roles: People Who Use Opioids and Family Members and Friends.

Unintentional drug overdose deaths continue to be a critical public health issue. Naloxone, a nonscheduled, safe, and effective drug that reverses opioid-involved overdoses is available to non-medically trained individuals ("lay people"), but there is scant information about how people in different social roles experience naloxone administration. We conducted 24 in-depth interviews with people who use opioids (PWUO; n = 15) and family members and friends of people who use opioids (FF; n = 9) who had administered naloxone in response to an opioid overdose. Compared with PWUO, members of the FF group were less reticent to administer naloxone in response to an overdose. PWUO and FF had different perspectives of law enforcement and demonstrated varied knowledge of the Good Samaritan Law. While PWUO found that having and administering naloxone was empowering, FF took a more pragmatic approach, reporting the need for naloxone as an unfortunate reality of their loved one's drug use.

Research-Practice Partnership to Develop and Implement Routine Mental Health Symptom Tracking Tool Among Older Adults During COVID-19.

OBJECTIVE: Older adults are disproportionally impacted by the COVID-19 pandemic, causing a mental health crisis in late life, due to physical restrictions (e.g., quarantine), limited access to services, and lower literacy and access to technology. Despite established benefits, systematic screening of mental health needs of older adults in community and routine care settings is limited and presents multiple challenges. Cross-disciplinary collaborations are essential for identification and evaluation of mental health needs and service delivery. METHODS: Using a research-practice partnership model, we developed and implemented a routine mental health needs identification and tracking tool at a community-based social services organization. Repeated screenings were conducted remotely over 5 months and included depression, anxiety, perceived loneliness, social support, and related domains such as sleep quality, resilience, and trauma symptoms linked to COVID-19. We examined symptomatic distress levels and associations between different domains of functioning. RESULTS: Our project describes the process of establishing a research-practice partnership during the COVID-19 pandemic. We collected 292 screenings from 124 individuals; clients were mildly to moderately depressed and anxious, reporting large amounts of time alone and moderate levels of loneliness. Those reporting higher depressive symptoms reported higher anxiety symptoms, poorer sleep quality, lower quality of life, lower capacity to adapt to challenging situations, and greater trauma symptoms due to COVID-19. CONCLUSION: Our routine screening tool can serve as a blueprint for case management agencies and senior centers nationwide, beyond the pressing mental health crisis due to COVID-19, to continue identifying needs as they emerge in the community.

Love in the Time of COVID-19: Experiences of a Psychology Trainee.

As the novel coronavirus (COVID-19) swept across the country, graduate students faced challenges they could have never anticipated. The future of coursework, research, graduation, and practica was unclear; for some, the circumstances were more dire as university closures resulted in a lack of housing, food, and internet access. While there is extant research of clinical trainee experience, significantly less has been written on their experiences of major events, let alone how it impacts our clinical work or theory-making. Perhaps even more to our detriment, literature has continued to shy away from the most basic component of clinical work: love. What follows is my account of analytic love, loss, and healing during a turbulent time in my clinical training at a large metropolitan hospital. The goal of this article is not extravagant. By sharing these experiences, I hope to record these events, name my experience, and remind the analytic community of the power of love, and the necessity of discussing love, particularly its salience during times of immense distress.

Fentanyl preference among people who use opioids in New York City.

BACKGROUND: Several studies have pointed to a sub-sample of people who use drugs (PWUD) who prefer the use of non-pharmaceutical fentanyl (NPF) and, as such, pose a unique challenge for public health initiatives amidst the continued rise in overdose mortality. However, matters of drug preference and autonomy of choice remain under-studied and often misunderstood. This paper examined the experiences of PWUD reporting a preference for NPF or an NPF-heroin mixture, specifically how they navigate the perceived benefits of NPF and its established risks. METHODS: 22 in-depth interviews were conducted in New York City between March 2018 and August 2019 with PWUD who self-reported a preference for NPF or an NPF-heroin mix. Interviews were audio-recorded, and the resulting transcripts analyzed using a thematic approach. RESULTS: Participants highlighted various factors that contributed to expressed preference for NPF or an NPF-heroin mix, including a desire to feel good, financial resources, drug availability, decreased consumer autonomy, and physiological demand. Participants reported practicing several risk reduction strategies; however, they highlighted that many, particularly carrying naloxone and always using with someone else, were difficult to implement in the context of illicit drug use. CONCLUSIONS: Our results demonstrate participants' decreased consumer agency and greater exposure to systemic factors in the illicit markets, highlighting the need for expansion of various services, including drug checking resources and systems of outreach for PWUD who do not use intravenously. To promote tailored interventions, continued efforts in overdose prevention ought to more thoughtfully consider the context, perceptions, preferences, and behaviors of PWUD.

The beginning of the end: A comparison of treatment completers and early dropouts in trainee-provided time-limited Cognitive Behavioral Therapy.

About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.

Deepening the Group Training Experience: Group Cohesion and Supervision Impact in Alliance-Focused Training.

OBJECTIVE: The aim of the current study is to explore experiences of trainees engaged in alliance-focused training (AFT), a group supervision modality with an explicit focus on awareness of ruptures and implementation of repair strategies. Using Cognitive Behavioral Therapy (CBT) group supervision as a point of comparison, the study examines supervisory alliance, ruptures, group cohesion and safety, and supervision impact. METHOD: Eighty-three trainees (clinical psychology interns, advanced-level psychology externs and psychiatry residents) at a metropolitan medical center in New York City who received supervision in CBT (N = 38) or AFT (N = 45) reported on their group supervision experience. Participants had a mean age of 29.5 (SD = 4.9); 77% were women; 84% of participants identified as White, 7% as Multiethnic, 6% as Hispanic/Latinx, 1% as Black, and 1% as Asian. Participants reported on occurrence of ruptures with their supervisor, supervisory alliance (Working Alliance Inventory-Short), group safety, supervision depth and smoothness (Session Evaluation Questionnaire), and group cohesion (Group Climate Questionnaire). Mixed and general linear models, and correlation analyses were used for analysis. RESULTS: All trainees reported equally low incidence of ruptures with their supervisor alongside high ratings of supervisory alliance. Trainees in AFT reported experiencing less safety, smoothness, and greater intergroup conflict than trainees in CBT supervision; however, they also reported stronger group engagement and a deeper supervision experience. CONCLUSIONS: Results suggest that AFT may provide a rich environment to foster a certain level of discomfort and risk-taking that may facilitate an engaging and meaningful learning experience.