Comparison of telehealth and in-person mental health care in military veterans and active-duty service members.

Telehealth services are increasingly utilized to improve mental health care access for active-duty service members (ADSM) and military veterans. This article examines mental health outcomes for veterans (n = 4,536) and ADSMs (n = 378) who met Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnostic criteria for depression, posttraumatic stress disorder, or generalized anxiety disorder (N = 4,914) and were treated at Cohen Veterans Network Clinics using either telehealth or in-person treatment modalities. Results demonstrate small but statistically significant advantages for telehealth in terms of discharge scores, rates of clinically significant change, and efficiency of treatment. For depression and posttraumatic stress disorder, veterans reported greater changes than ADSMs, but there was no interaction between treatment modality and client type. These findings support the use of telehealth as a viable option for mental health care in these populations, while suggesting several areas requiring further study. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating Suicide Risk Stratification in Outpatient Settings: A Vignette-Based Approach.

Suicide risk assessment and stratification are a key suicide prevention strategy in mental health care systems that treat military service members and veterans. The aim of the current mixed-method project was to address a gap in our knowledge as to how therapists make these important clinical decisions. This manuscript reports the results of a project during which six vignettes were developed reflecting varying levels of risk according to the Rocky Mountain MIRECC Risk Stratification Table. Mental health therapists were asked to evaluate the risk level of each vignette, determine a treatment disposition, and provide justification for their ratings. The results of the study indicate that therapists can reliably evaluate risk, but that treatment planning tended to be based more on vignette-specific factors than essential features of the risk model. The qualitative findings revealed variations in the definition and perception of foundational concepts, suggesting a need for further research and training in these domains. Overall, the results support the use of vignettes as a method to assess clinical decision-making and provide several areas for further training and research.

Implementing Behavioral Couples Therapy for Substance Use Disorders in Real-World Clinical Practice.

Behavioral couple therapy (BCT) is an evidence-based, manualized treatment that has been primarily developed to treat alcohol use disorder. The treatment model leverages the intimate partner relationship to support recovery. Although the efficacy of BCT is well-supported in randomized controlled trials, little attention has been given to the translation of BCT to everyday practice settings. This article presents recommendations for implementing BCT in such settings. We describe a stepwise approach for getting a couple into BCT and determining whether it is an appropriate treatment for the couple. In addition, we provide recommendations for broadening inclusion criteria for everyday practice settings, including the use of BCT with couples who have drug use disorders with couples where both members exhibit substance use disorders and with couples who choose controlled drinking or drug use versus abstinence. Whereas BCT has mostly been researched in speciality substance use disorder settings, we provide recommendations for its use in general couple therapy settings. Based upon the extant research, we suggest implementing BCT as a standalone treatment or as an add-on to individual counseling for substance use disorders. We provide guidance for delivering BCT through telehealth and encourage future research to investigate this delivery modality. Future research should prioritize investigating the effectiveness of various BCT dissemination strategies and seek to determine what dosage and components of BCT will result in the best outcomes.

La terapia conductual de pareja (TCP) es un tratamiento factual y estandarizado que se ha desarrollado principalmente para tratar el trastorno por consumo de alcohol. El modelo de tratamiento aprovecha la relación de pareja para ayudar a la recuperación. Aunque la eficacia de la TCP está bien respaldada en ensayos controlados aleatorizados, se ha prestado poca atención al traslado de la TCP a los entornos de la práctica diaria. Este artículo presenta recomendaciones para implementar la TCP en dichos entornos. Describimos un método gradual para introducir a una pareja en la TCP y determinar si es un tratamiento adecuado para ella. Además, ofrecemos recomendaciones para ampliar los criterios de inclusión para los entornos de la práctica diaria, incluido el uso de la TCP con parejas que tienen trastornos por consumo de sustancias, con parejas donde ambos miembros presentan trastornos por consumo de sustancias y con parejas que eligen beber o consumir drogas de manera controlada en lugar de la abstinencia. Si bien la TCP se ha investigado principalmente en entornos especializados en trastornos por consumo de sustancias, ofrecemos recomendaciones para su uso en entornos de terapia de pareja general. Sobre la base de las investigaciones existentes, sugerimos implementar la TCP como tratamiento autónomo o como complemento de la terapia individual para trastornos por consumo de sustancias. Brindamos orientación para implementar la TCP mediante telesalud e incentivamos futuras investigaciones para estudiar esta modalidad de atención. Las futuras investigaciones deben priorizar el estudio de la eficacia de diferentes estrategias de difusión de la TCP y determinar qué dosis y qué componentes de la TCP producirán mejores resultados.