The Martinsburg Initiative: A Collaboration Between Public Safety, Public Health, and Schools to Address Trauma and Substance Use.

The Martinsburg Initiative (TMI) is a community-based model developed in Martinsburg, West Virginia, that implements a comprehensive approach to adverse childhood experiences and substance use prevention and mitigation by leveraging partnerships in public health and health care, public safety, and education. TMI receives coordinated federal funding and technical assistance from the Centers for Disease Control and Prevention, the Washington-Baltimore High Intensity Drug Trafficking Agency, and the National Association of County and City Health Officials to integrate evidence-based and promising strategies. It advances such strategies by translating them for implementation within the community, evaluating the reach and potential impact of the model, and by engaging key stakeholders. Preliminary results describing program reach and short-term outcomes collected for a subset of the interventions during implementation are presented. The model uses touchpoints across multiple community sectors in the city of Martinsburg to break the cycle of trauma and substance use across the life span.

Exploring Levels and Correlates of Depression Literacy Among Older Korean Immigrants.

OBJECTIVES: Despite the high prevalence of depression among older Korean Americans (KAs), there has been very little research on depression literacy among older KAs. This study identified specific areas of improvement in depression literacy to address mental health promotion among KAs. Twenty-two items on the depression literacy scale were grouped under five key themes: incidence and prognosis, differential symptoms, symptom recognition, non-pharmacological effectiveness, and pharmacological knowledge. This study aimed to assess the level of understanding depression literacy based on five domains and identify factors associated with depression literacy and its domains among older KAs. METHODS: A cross-sectional study with 178 KAs aged 60 years and older was conducted in the Washington DC Metro area. Interviewer and self-administered questionnaires were used to collect data. Multiple linear regression analyses were conducted to identify factors associated with depression literacy and its domains. Statistical significance was set at p < .05 for analyses. RESULTS: Knowledge pertaining to all 5 depression literacy domains was low, particularly on pharmacological treatment and differential symptoms were noticeably low. The majority of participants had misconceptions about antidepressants. 86% believed that antidepressants can have a rapid effect on symptoms, 82.6% believed people with depression should stop taking antidepressants as soon as they feel better, and 66.3% believed antidepressants were addictive. CONCLUSION: Misperception about depression and antidepressants may be associated with poor mental health outcomes among older KAs. Culturally-tailored education for older KAs with limited English proficiency could be beneficial in promoting depression literacy and reducing stigma or misconceptions regarding depression and treatments.

Risk of depression in pregnant women with low-normal serum Vitamin B12.

High prevalence rates of both Vitamin B12 insufficiency and depressive symptoms exist in pregnant women. Although the association between depressive symptoms and certain nutrient deficiencies like iron, folate, or Vitamin B12 has been established, the specific relationship between low-normal serum Vitamin B12 levels and depressive symptoms in pregnant women in the United States has not been studied closely. Using 2005-2006 National Health and Nutrition Examination Survey data, a secondary analysis was conducted to examine the association between low-normal serum Vitamin B12 level and depression, as measured by a score of 10 or higher on the Patient Health Questionnaire-9, in pregnant women (N = 174). In bivariate regression models, Vitamin B12 level, experiencing poverty, and pre-pregnancy body mass index (BMI) were significant predictors of depression. In multivariate logistic regression models, pregnant women with low-normal serum Vitamin B12 levels (OR = 3.82, 95% CI [1.10-13.31], p < 0.04) were 3.82 times more likely to experience depression, controlling for sociodemographic characteristics, pre-pregnancy BMI, and the biomarkers hemoglobin and folate. Identifying and treating pregnant women with low-normal Vitamin B12 levels may enhance prenatal depression management.

Staying Connected: Sustaining Collaborative Care Models with Limited Funding.

Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed.

Racial/ethnic differences in medication for addiction treatment for opioid use disorders among pregnant women in treatment facilities supported by state funds.

INTRODUCTION: Medication for addiction treatment (MAT) for opioid use disorder (OUD) in pregnant women is known to improve neonatal health outcomes. Despite the benefits of this evidence-based treatment for OUD, MAT has been underutilized during pregnancy among certain racial/ethnic groups of women in the United States. The purpose of this study was to examine racial/ethnic differences and factors that affect MAT administration among pregnant women with OUD seeking treatment at publicly funded facilities. METHODS: We used data from the 2010-2019 Treatment Episode Data Set system. The analytic sample included 15,777 pregnant women with OUD. We built logistic regression models to examine associations between race/ethnicity and MAT and determine differences and similarities in factors that may influence the use of MAT across racial/ethnic groups of pregnant women with OUD. RESULTS: Although in this sample only 31.6 % received MAT, an increasing trend of MAT receipt has been observed during 2010-2019. Approximately 44 % of the Hispanic pregnant women received MAT, and this was significantly higher than non-Hispanic Black (27.1 %) and White (31.3 %) women. Even after adjusting for potential confounders, the adjusted odds of receiving MAT during pregnancy were lower for Black (AOR = 0.57, 95 % CI 0.44, 0.75) and White (AOR = 0.75, 95 % CI 0.61, 0.91) women compared to Hispanic women. Not being in the labor force increased the odds of receiving MAT in Hispanic women relative to their employed counterparts while homelessness or dependent living decreased the odds of MAT for White women compared to those living independently. Regardless of their racial/ethnic background, pregnant women younger than 29 years old were less likely to receive MAT relative to older women; however, if they were arrested once prior to admission to treatment, they had significantly higher odds of receiving MAT than those with no arrests. Treatment of at least 7 months was associated with a higher likelihood of MAT across all racial/ethnic groups. CONCLUSIONS: This study highlights the underutilization of MAT, particularly among pregnant Black and White women who seek treatment for OUD in publicly funded treatment facilities. A multi-dimensional approach to MAT intervention programs is needed to increase MAT for all pregnant women and reduce racial/ethnic inequities.

Supply-side predictors of fatal drug overdose in the Washington/Baltimore HIDTA region: 2016-2020.

BACKGROUND: Rising rates of fentanyl- and polydrug-involved drug overdose deaths have prompted inquiry into the role of drug supply in fatal overdose outcomes in the United States. To date, however, there have been few empirical investigations of drug enforcement strategies on fatal overdose rates, despite knowledge that both drug use and supply are often geographically distributed. To address this limitation, we examined measures of drug enforcement as predictors of next-year fatal overdose rates in the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA). METHODS: We conducted mixed-effects models to examine the role of drug seizures and disruption in drug trafficking organizations (DTOs) and money laundering organizations (MLOs) on fatal overdose rates over a 5-year period (2016-2020) across 45 local jurisdictions in the W/B HIDTA region. Outcomes included any, opioid-involved, and fentanyl-involved fatal overdose. RESULTS: Adjusting for covariates, both the total number of drug seizures and amount of cocaine seized (in dosage units per capita) positively predicted next-year opioid- and fentanyl-involved fatal overdose rates. Disruption to DTO and MLO operations did not significantly predict next-year fatal overdose rates for any outcome. CONCLUSION: Supply-side enforcement activities alone may have limited impact on reducing fatal overdose rates, but may serve as important markers to identify communities at high risk of fatal overdose and facilitate targeted intervention. Our findings underscore the importance of comprehensive law enforcement approaches that extend beyond drug enforcement to integrate prevention, linkage to treatment, and harm reduction strategies as needed to address the overdose epidemic.

Implementing evidence-based nursing with student nurses and clinicians: uniting the strengths.

Implementing evidence-based practice (EBP) is challenging for both clinicians and students. Facilitating collaboration among students and clinicians can improve the process of both teaching EBP in the academic setting and utilizing EBP in the clinical setting. A unique and successful EBP program is described, and other schools are encouraged to emulate this model.

Managing Substance Use and Emotions in the Context of Trauma: A Case Study.

The reciprocal interaction between substance use, trauma, and emotions is well documented. Trauma is associated with neuroendocrine and neurobiological dysfunction and the subsequent development of psychopathology in adults. Cumulative trauma triggers, aggravates, and increases the recurrence of psychiatric symptoms. Individuals suffering the psychiatric sequelae of cumulative trauma have a more complex clinical profile, ultimately resulting in worse treatment outcomes. Limited guidance exists in the form of treatment guidelines or clinical evidence on the management of substance use and emotions in the context of trauma. This article chronicles one patient's experience with cumulative trauma, depression, anxiety, and iatrogenic opioid dependence. The authors review the impact of trauma on brain function and discuss evidence and treatment strategies engaged in the management of this patient.