Interdisciplinary training academy for integrated substance/opioid use disorder prevention and health care: A workforce catalyst report.

INTRODUCTION: Addressing the opioid crisis requires attention to the fact that people with opioid use disorder are affected by multiple systems and professionals working across disciplines (e.g., primary health care, social work, psychology). Thus, we developed the Interdisciplinary Training Academy for Integrated Substance/Opioid Use Disorder Prevention and Health care (ITA). The purpose of the ITA is to connect multiple systems to aid in the development of practitioners who are broadly prepared to address the opioid crisis. METHOD: Herein, we use preliminary descriptive methods to illustrate early outcomes related to 30 weeks of interprofessional training rotations across all system levels related to policy, prevention, treatment, integrated care, harm reduction and recovery support services. RESULTS: Overall, the ITA has assisted fellows in garnering 7,257 hr of training to become holistically competent behavioral health providers. Preliminary data indicate that most cohort graduates intend to pursue employment in a telehealth or primary care setting that serves medically underserved communities. DISCUSSION: In sum, we offer a new concept for remote field education that engages learners as curriculum developers, educators, and emerging practitioners with expertise across ecological systems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Expanding interprofessional teams: Training future health care professionals in screening, brief intervention, and referral to treatment (SBIRT).

INTRODUCTION: Substance misuse persists and is undertreated across the United States (Substance Abuse and Mental Health Services Administration, 2021). Further enhancing the skill sets and capacity of interprofessional members of primary care teams to include proficiency in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model could help to alleviate the "treatment gap" (those requiring treatment, but not receiving it) by enhancing interprofessional teams at the pregraduate level (e.g., health educators, health coaches) to expand capacity and meet the volume of patients with substance use-related needs. METHOD: In this study, SBIRT knowledge, training satisfaction, and efficacy were evaluated among undergraduate and graduate health and behavioral health students before and after exposure to a series of online training modules. RESULTS: On completion of the training, there were positive percent increases in overall mean knowledge and self-efficacy when compared with pretraining. At posttraining, graduate level students, regardless of discipline, reported greater knowledge than undergraduate students; there were no differences in efficacy or satisfaction among the groups. Additional analysis at the graduate level evaluated differences between behavioral health and medical trainees. No differences were found in knowledge or efficacy between groups at posttest, despite medical trainees reporting significantly lower efficacy at pretest. DISCUSSION: The findings of this study reinforce the need and potential to incorporate SBIRT training into higher education curricula for interprofessional health care professions to begin expanding the integrated care team's knowledge and efficacy in the provision of SBIRT to address the treatment gap. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Finding hearts at peace: A new workforce competency.

While there is no single agreed upon set of competencies for the behavioral health workforce in primary care, there is a consensus about the importance of communication, the role of the behavioral health provider as part of a larger team, and the critical need to value diverse perspectives. In this column, the current and incoming Presidents of the Collaborative Family Healthcare Association (CFHA) present a framework that focuses on a "way of being"; a lens to reflect and process the sense of division and injustice, and to pave the path ahead. We believe that the fundamental question that can scale this "way of being" to a higher level of acquired skill or internalized competency for ongoing workforce development is: as we engage in dialogue on difficult, highly personal, moral, and valued topics with others, "Is your heart at peace, or is your heart at war?" May each of us in the CFHA family and community be anchored in hearts of peace as we continue to advance the mission of providing equitable care through our love of integrated behavioral health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

From surviving to thriving: Strategies to cultivate individual and organizational resilience in the health care workforce.

In this president's column, the author notes that resilience has been identified as a strategy to mitigate the triumvirate of burnout, compassion fatigue, and moral distress. Once viewed as an innate personality trait, there has been an increased focus on the cultivation of resilience among health care providers, with attention to evolving educational models depending on the career stage of the provider and interventions for interprofessional health care workers. Strategies to develop the "7Cs" of individual resilience, which were initially applied to children and adolescents, have begun to be applied to physicians. If we are to really celebrate our frontline workers, we need to not only promote their personal wellbeing, but also make conscious efforts to restructure the environments and health care systems in which they work. Only through thoughtful and comprehensive interventions-targeting both the individual and the institution-can we truly foster well-being. Such efforts can help move our workforce and teams from the constant state of merely surviving that they have been in the past several years to thriving and finding joy again in their work. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Just ask: Promoting inclusive and holistic sexual health in primary care.

While the full scope of sexual health treatment is unlikely to ever be exclusively provided in primary care, it is increasingly important that interdisciplinary teams are poised to address this issue more effectively and comprehensively than we currently are. Providers need to seek out training and resources as they work toward meeting recently articulated competencies in an effort to provide whole person care. And, in the meantime, open the door to conversations about holistic sexual health by simply asking patients about their experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Leveraging interprofessional education to build high functioning teams.

As a psychologist, the author says that her role in the integrated primary care team has always been that of the behavioral health provider, serving to promote the holistic health of the patients and families with whom she works as part of the larger integrated team. Central to both Primary Care Behavioral Health and the Collaborative Care model-as well as other models of integration-is that the health care team works to address fragmented care in order to most comprehensively address patient needs. And yet we often focus on training to the model in which behavioral health providers work. As we think about the future of integrated health care workforce development, shouldn't we instead focus on training future health care professionals to develop and lead high functioning teams? As we work toward more comprehensively addressing the holistic needs of marginalized populations, it is becoming increasingly clear that we need to consider how our functions and roles be leveraged across diverse models of integration, team composition, and practice sites, while recognizing that our current educational systems might not yet adequately prepare us to do so. More widespread adoption of interprofessional education (IPE) across the educational life span may serve as one mechanism to enhance interprofessional competencies, though IPE is not without its challenges. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Culturally responsive refugee and migrant health.

As the number of forcibly displaced vulnerable populations accelerates worldwide, it is increasingly important that health care systems and professionals be prepared to offer comprehensive, culturally, and linguistically appropriate services to migrant and refugee populations. Understanding the unique needs and lived experiences of these populations, including their risks to health and wellbeing as well as opportunities to promote resilience, is necessary to support these populations' diverse needs. Integrated primary care teams are uniquely poised to support these populations by reducing barriers to health and promoting equitable and holistic care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Disability-affirmative integrated primary care.

The development of an antiracist and culturally responsive integrated health care professionals necessitates attention to, and appreciation of, the diverse intersectional identities of the patients with whom we work. Pamela Hays' (2001) ADDRESSING model (Age and generational influences, Developmental and acquired Disability, Religion and spiritual orientation, Ethnic and racial identity, Socioeconomic status, Sexual orientation, Indigenous heritage, National origin, and Gender) can provide a useful framework to understand the complex interaction of diverse identities, particularly among people with disabilities (PWD). PWD represent more than a quarter of the United States population (Centers for Disease Control and Prevention [CDC], 2020), and the lived experiences of PWD are varied, with disability often serving as an "umbrella term" for functional differences in mobility, cognition, hearing, vision, self-care and independent living across the life span. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Developing antiracist integrated health professionals.

As the Collaborative Family Healthcare Association (CFHA) has increased its focus on justice, diversity, and inclusion in integrated care delivery, it is increasingly evident that widespread upstream transformation is needed to ensure that the integrated care workforce is appropriately prepared to deliver equitable care. This column highlights the need for systemic change in admissions standards, integrated care curricula, student mentorship/sponsorship, and faculty development within higher education in order to support the success of Black, Indigenous, and People of Color (BIPOC) students and increase antiracist approaches among health care professionals. CFHA members working in, or in collaboration with, academia are uniquely poised to influence higher education systems to promote diversity, inclusion, and antiracism among future integrated health professionals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Burnout trauma both? Identifying and addressing needs during COVID-19 through informatics.

In this brief article, the author notes that discussion of work/life integration have become increasingly com mon at her institution, as school-age children regularly make appearances in Zoom meetings, and team mem bers have to shift between dynamic roles in their work and family lives throughout the day. Talk of burnout abounds-and she often find herself wondering if in fact they are only experiencing burnout as an occupational phenomenon, or whether it is a compounded experi ence of burnout and the emotional exhaustion of collective trauma and grief. Even when concerns dissipate about COVID's relentless spread and severe disease, there is no doubt that we will have lingering mental health hangovers from the psychologi cal impacts of the past year; we must be pre pared to leverage informatics and technology to stem the tide. We will navigate through these uncharted waters through thoughtful and effective leadership that culti vates community and a work environment that is with aligned with our organizational and personal values; and as the past year has demonstrated, it is evi dent that technology and informatics will play a piv otal role in the future of work. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Testing a Screening, Brief Intervention, and Referral to Treatment (SBIRT) interdisciplinary training program model for higher education systems.

INTRODUCTION: An estimated 21 million Americans meet the criteria for a substance use disorder (SUD), whereas 24% of the population engages in risky alcohol use leading to tremendous health and economic impacts (Substance Abuse and Mental Health Services Administration, 2017). Opioid misuse is a national public health emergency, with an estimated 46,802 opioid-related deaths occurring in 2018 (National Center for Health Statistics, 2020). Despite the high prevalence of risky substance use and SUDs, preservice education related to screening for and treating SUDs in health and behavioral health professions is inadequate (Dimoff, Sayette, & Norcross, 2017; Russett & Williams, 2015; Savage et al., 2014; Tabak et al., 2012). A critical need exists for an interdisciplinary, implementation science-informed approach for developing academic training programs in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model within higher education systems. METHOD: We delineate a training model implemented within 5 health and behavioral health disciplines (nursing, social work, clinical psychology, counseling psychology, and integrated behavioral health), informed by prominent implementation scientists (Proctor et al., 2011; Rogers, 2003). RESULTS: Faculty surveys (n = 33), interviews (n = 24), and syllabi and training records reviews indicated the Brief Intervention, and Referral to Treatment model was infused into course content by 89.47% of trained faculty and sustained in 90.47% of course syllabi at project close. CONCLUSION: The model demonstrated successful uptake and sustainability in higher education systems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Primary Care Provider's Guide to Sexual Health for Individuals With Spinal Cord Injury.

The collaboration with individuals regarding their sexual health is an important component of patient-centered health care. However, talking about sexual health in primary care settings is an area not fully addressed as a result of time limitations, medical task prioritization, awareness or knowledge deficit, and discomfort with the topic of sexuality. A critical shift in professional focus from disease and medical illness to the promotion of health and wellness is a prerequisite to address sexual health in the primary care setting. This article provides guidance for practitioners in primary care settings who are caring for persons with spinal cord injury. Clinicians should seize the opportunity during the encounter to reframe the experience of disability as a social construct status, moving away from the narrow view of medical condition and "find it, fix it" to a broader understanding that provides increased access to care for sexual health and sexual pleasure.

Adaptive leadership: Becoming the change.

Presents a column from the presidents of the CHFA who discuss the current impacts of COVID-19 in the United States and in health care. The inconsistent, unscientific, and divisive response to the COVID-19 pandemic, and the racial inequality made evident by it, may serve historians and future leadership educators of what not to do in times of crisis, painful lessons that may be productive if we learn from our mistakes. The column then discusses the importance of racial and ethnic diversity within CHFA, workforce development, stragetic partnerships and policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The State and Future of the Primary Care Behavioral Health Model of Service Delivery Workforce.

The growth of the Primary Care Behavioral Health model (PCBH) nationally has highlighted and created a workforce development challenge given that most mental health professionals are not trained for primary care specialization. This work provides a review of the current efforts to retrain mental health professionals to fulfill roles as Behavioral Health Consultants (BHCs) including certificate programs, technical assistance programs, literature and on-the-job training, as well as detail the future needs of the workforce if the model is to sustainably proliferate. Eight recommendations are offered including: (1) the development of an interprofessional certification body for PCBH training criteria, (2) integration of PCBH model specific curricula in graduate studies, (3) integration of program development skill building in curricula, (4) efforts to develop faculty for PCBH model awareness, (5) intentional efforts to draw students to graduate programs for PCBH model training, (6) a national employment clearinghouse, (7) efforts to coalesce current knowledge around the provision of technical assistance to sites, and (8) workforce specific research efforts.

Disability culturally competent sexual healthcare.

Though cultural competence and inclusion of diverse identities are increasingly emphasized in psychological training and practice, sexual health and well-being among people with disabilities (PWD) continue to be underrecognized areas in which disability cultural competence is needed. The experience of disability is best conceptualized as an interaction between physical, sensory, or cognitive differences and environmental and sociocultural contexts that facilitate or impede adaptive functioning; these complex interactions, coupled with an individual's age, gender, ethnicity, religious background, and sexual orientation, often inform one's sexual health and well-being. Disability can be thought of as a minority cultural status-a marginalized and stigmatized identity. Given the imperative that psychologists must be culturally competent and self-aware, as well as the centrality of sexual health and well-being to quality of life including among PWD, assessment of sexuality as a facet of overall well-being among individuals with physical disabilities should be part of routine clinical practice. A discussion of disability cultural competence is offered as a foundation to explore disability sexual health and wellness competence in clinical assessment. The disability and sexuality health care competency model is introduced to address the need for evidence-based sexual health and wellness assessment of PWD. Specific conceptual and behavioral sexuality and disability competencies that correspond to the provision and facilitation of these services are delineated. (PsycINFO Database Record

Decisions by Default: Incomplete and Contradictory MOLST in Emergency Care.

OBJECTIVES: What patients intend when they make health care choices and whether they understand the meaning of orders for life-sustaining treatment forms is not well understood. The purpose of this study was to analyze the directives from a sample of emergency department (ED) patients' MOLST forms. PROCEDURES: MOLST forms that accompanied 100 patients who were transported to an ED were collected and their contents analyzed. Data categories included age, gender, if the patient completed the form for themselves, medical orders for life-sustaining treatment including intubation, ventilation, artificial nutrition, artificial fluids or other treatment, and wishes for future hospitalization or transfer. Frequencies of variables were calculated and the associations between them were determined using chi-square. An a priori list of combinations of medical orders that were contradictory was developed. Contradictions with Orders for CPR (cardiopulmonary resuscitation) included the choice of one or more of the following: Comfort care; Limited intervention; Do Not Intubate; No rehospitalization; No IV (intravenous) fluids; and No antibiotics. Contradictions with DNR orders included the choice of one or more of the following: Intubation; No limitation on interventions. Contradictions with orders for Comfort Care were as follows: Send to the hospital; Trial period of IV fluids; Antibiotics. The frequencies of coexisting but contradictory medical orders were calculated using crosstabs. Free text responses to the "other instructions" section were submitted to content analysis. RESULTS: Sixty-nine percent of forms reviewed had at least one section left blank. Inconsistencies were found in patient wishes among a subset (14%) of patients, wherein their desire for "comfort measures only" seemed contradicted by a desire to be sent to the hospital, receive IV fluids, and/or receive antibiotics. CONCLUSIONS: Patients and proxies may believe that making choices and documenting some, but not all, of their wishes on the MOLST form is sufficient for directing their end-of-life care. The result of making some, but not all, choices may result in patients receiving undesired, extraordinary, or invasive care.

"We Are Strangers Walking Into Their Life-Changing Event": How Prehospital Providers Manage Emergency Calls at the End of Life.

CONTEXT: Emergency 911 calls are often made when the end stage of an advanced illness is accompanied by alarming symptoms and substantial anxiety for family caregivers, particularly when an approaching death is not anticipated. How prehospital providers (paramedics and emergency medical technicians) manage emergency calls near death influences how and where people will die, if their end-of-life choices are upheld and how appropriately health care resources are used. OBJECTIVES: The purpose of this study was to explore and describe how prehospital providers assess and manage end-of-life emergency calls. METHODS: In-depth and in-person interviews were conducted with 43 prehospital providers. Interviews were audiotaped, transcribed, and entered into ATLAS.ti for data management and coding. Qualitative data analysis involved systematic and axial coding to identify and describe emergent themes. RESULTS: Four themes illustrate the nature and dynamics of emergency end-of-life calls: 1) multifocal assessment (e.g., of the patient, family, and environment), 2) family responses (e.g., emotional, behavioral), 3) conflicts (e.g., missing do-not-resuscitate order, patient-family conflicts), and 4) management of the dying process (e.g., family witnessed resuscitation or asking family to leave, decisions about hospital transport). After a rapid comprehensive multifocal assessment, family responses and the existence of conflicts mediate decision making about possible interventions. CONCLUSION: The importance of managing symptom crises and stress responses that accompany the dying process is particularly germane to quality care at life's end. The results suggest the importance of increasing prehospital providers' abilities to uphold advance directives and patients' end-of-life wishes while managing family emotions near death.

Comparing Outcomes of Kinect Videogame-Based Occupational/Physical Therapy Versus Usual Care.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a game-like exercise tool as a component of occupational and physical therapy treatment for patients with shoulder pain and impairment in an outpatient physical therapy clinic. MATERIALS AND METHODS: The product evaluated is a hands-free therapy (HFT) prototype, using Microsoft(®) (Redmond, WA) Kinect™ technology. HFT was designed as a home exercise program (HEP), or adjunct to a clinic-based exercise program, with the goal to improve patient compliance and outcomes by providing patients with continuous immediate feedback and engaging them in a game-like experience. Eight patients with shoulder injuries were randomly assigned to study groups. Outcomes in pain, range of motion, and function were assessed. The experimental group received six sessions using HFT; the control group received six sessions of treatment as usual. RESULTS: The research demonstrated that patient outcomes were as good in the group using HFT as outcomes achieved with usual care. HFT was found to be a useful adjunct in an outpatient therapy clinic, allowing patients to complete exercises with real-time feedback and minimal therapist oversight. CONCLUSIONS: These preliminary findings support the potential use of technology to provide an effective therapy and HEP system. Additional research utilizing a larger sample size is warranted to determine if this product can be an effective tool to improve HEP compliance and to determine the effectiveness of HFT as an adjunctive treatment in the clinic.

Sexuality among wounded veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND): Implications for rehabilitation psychologists.

OBJECTIVE: The sexual lives of returning Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans have only been discussed minimally in the psychological literature. Given the nature of military social and cultural contexts, the potential for exposure to combat-related stressors that may lead to posttraumatic stress disorder (PTSD), and the risk of traumatic brain injury secondary to physical injury, the potential for significant psychological and relational ramifications exists. This article focuses on the intimate relationships and sexuality of returning OIF/OEF/OND veterans within the context of their personal cultural variables and the diverse experience of being a part of military life. CONCLUSIONS: Culturally competent assessment and evidenced-based treatment approaches are highlighted to offer clinicians initial strategies to begin treatment of sexuality issues within the returning Veteran population. These clinical tools are discussed within a positive psychology approach that emphasizes healthy sexuality as a part of overall satisfactory quality of life.