Psychosocial Needs of Parents Engaged in Treatment for Opioid Use Disorder.

Background: Little research has examined the needs of parents with opioid use disorder (OUD) who are receiving medications for OUD (MOUDs), which is striking given growing rates of OUD among parents. Objective: The current study expands the literature by examining psychiatric, psychosocial, and parenting-related functioning, as well as 12-month MOUD treatment retention among parents versus non-parents participating in a buprenorphine program at an academic family medicine residency clinic. Methods: Patients (N = 144; 61 parents) completed measures of psychiatric and psychosocial functioning at the first MOUD visit; parents also completed measures of parental functioning. Results: Parents endorsed less anxiety and loneliness, as well as greater social connection, life satisfaction, and life meaning. Parents were also older, more likely to be female, of a race other than white, married, employed, and had higher incomes. Although parents endorsed high levels of parental self-agency and strong bonds with children, many also reported elevated parental shame. Among parents, higher levels of shame were also associated with higher depression, anxiety, anger, stress, and loneliness. Over 25% of parents reported that a child lived with friends/relatives over 3 months, and 11% noted a child having been removed from the home by child protective services. Finally, parents were more likely to be retained in treatment at 12 months, although this finding was non-significant after controlling for covariates. Conclusions/Importance: These findings illustrate the needs experienced by parents engaged in MOUD treatment, which may prove valuable in informing policy, program development, and treatment approaches for parents with OUD.

Providing Psychotherapy in an Urban, Underserved Community during the COVID-19 Pandemic.

Psychologists housed in two family medicine residency clinics located in underserved communities quickly transitioned their mode of psychotherapy from in-person to completely virtual at the beginning of the COVID-19 pandemic. We share numerous successes and advantages of a telehealth model in serving our community and describe challenges we have encountered.

Mental Health and Psychosocial Needs of Patients Being Treated for Opioid Use Disorder in a Primary Care Residency Clinic.

Purpose: Primary care is an ideal setting to deliver efficacious treatments for opioid use disorder (OUD). Primary care providers need to be aware of other concerns patients with OUD might have in order to provide comprehensive care. This study describes the prevalence of mental health, comorbid substance use, and psychosocial concerns of patients seeking treatment for OUD in primary care and their relation to 6-month treatment retention. Methods: Patients (N = 100; M age = 34.9 years (SD = 10.8), 74% white, 46% female) with OUD who were starting treatment with buprenorphine at an academic family medicine residency clinic completed surveys of mental health concerns (depression, anxiety, trauma), psychosocial needs (food insecurity, income, transportation, employment), and demographic variables. Chart reviews were conducted to gather information on comorbid substance use, mental health diagnoses, and 6-month treatment retention. Results: Mental health symptoms were highly prevalent in this sample (44% screened positive for anxiety, 31% for depression, and 52% for posttraumatic stress disorder). Three-quarters reported use of illicit substances other than opioids. Many patients also had significant psychosocial concerns, including unemployment (54%), low income (75%), food insecurity (51%), and lacking reliable transportation (64%). Two-thirds (67%) of the sample were retained at 6 months; patients who previously used intravenous opioids were more likely to discontinue treatment (P = .003). Conclusions: Many patients receiving treatment for OUD have significant mental health problems, comorbid substance use, and psychosocial concerns; interestingly, none of these factors predicted treatment retention at 6 months. Primary care clinics would benefit from having appropriate resources, interventions, and referrals for these comorbid issues in order to enhance overall patient well-being and promote recovery.

Novel cytokinetic ring components drive negative feedback in cortical contractility.

Actomyosin cortical contractility drives many cell shape changes including cytokinetic furrowing. While positive regulation of contractility is well characterized, counterbalancing negative regulation and mechanical brakes are less well understood. The small GTPase RhoA is a central regulator, activating cortical actomyosin contractility during cytokinesis and other events. Here we report how two novel cytokinetic ring components, GCK-1 (germinal center kinase-1) and CCM-3 (cerebral cavernous malformations-3), participate in a negative feedback loop among RhoA and its cytoskeletal effectors to inhibit contractility. GCK-1 and CCM-3 are recruited by active RhoA and anillin to the cytokinetic ring, where they in turn limit RhoA activity and contractility. This is evidenced by increased RhoA activity, anillin and nonmuscle myosin II in the cytokinetic ring, and faster cytokinetic furrowing, following depletion of GCK-1 or CCM-3. GCK-1 or CCM-3 depletion also reduced RGA-3 levels in pulses and increased baseline RhoA activity and pulsed contractility during zygote polarization. Together, our results suggest that GCK-1 and CCM-3 regulate cortical actomyosin contractility via negative feedback. These findings have implications for the molecular and cellular mechanisms of cerebral cavernous malformation pathologies.

The quality of assessments for childhood psychopathology within a regional medical center.

Accurate assessment is essential to implementing effective mental health treatment; however, little research has explored child clinicians' assessment practices in applied settings. The current study thus examines practitioners' use of evidence-based assessment (EBA) instruments (i.e., self-report measures and structured interviews), specificity of identified diagnoses (i.e., use of specific diagnostic labels vs. nonstandardized labels, not otherwise specified [NOS] diagnoses, and adjustment disorder diagnoses), and documentation of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR, American Psychiatric Association, 2000) criteria. Use of these practices was evaluated via analysis of documentation contained within a regional medical center's medical records. This analysis was limited to 2,499 session notes from patient appointments associated with psychiatric disorders newly diagnosed during 2013. In total, session notes were linked to 694 children aged 7 to 17. Results indicated that EBA use was low overall, although self-report measures were utilized relatively frequently versus structured interviews. Diagnostic specificity was also low overall and clinicians rarely documented full diagnostic criteria; however, EBA use was associated with increased diagnostic specificity. Further, clinicians practicing in psychological, psychiatric, and primary care settings were more likely to use self-report measures as compared to those practicing in an integrated behavioral health social work setting. In addition, structured interviews were most likely to be utilized by clinicians practicing in a psychological services setting. Finally, clinicians were more likely to use self-report measures when the identified primary concern was a mood disorder or attention-deficit/hyperactivity disorder (ADHD). Based on these results, we provide suggestions and references to resources for clinicians seeking to improve the quality of their assessments via implementation of EBA. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Use of evidence-based assessments for childhood anxiety disorders within a regional medical system.

Anxiety disorders represent a common and serious threat to mental health in children and adolescents. To effectively treat anxiety in children, clinicians must conduct accurate assessment of patients' symptoms. However, despite the importance of assessment in the treatment of childhood anxiety disorders, the literature lacks a thorough analysis of the practices used by clinicians' when evaluating such disorders in community settings. Thus, the current study examines the quality of assessment for childhood anxiety disorders in a large regional health system. The results suggest that clinicians often provide non-specific diagnoses, infrequently document symptoms according to diagnostic criteria, and rarely administer rating scales and structured diagnostic interviews. Relatedly, diagnostic agreement across practice settings was low. Finally, the quality of assessment differed according to the setting in which the assessment was conducted and the complexity of the patient's symptomatology. These results highlight the need to develop and disseminate clinically feasible evidence-based assessment practices that can be implemented within resource-constrained service settings. (PsycINFO Database Record

Use of evidence-based assessment for childhood anxiety disorders in community practice.

High-quality assessment is essential to the delivery of effective treatment for childhood anxiety disorders. However, relatively little is known about how frequently child clinicians utilize evidence-based assessment (EBA) techniques in practice, and even less is known about the factors that influence EBA use in such settings. Thus, the current study presents data from a survey of 339 clinicians from a variety of professional backgrounds concerning their use of EBA for childhood anxiety disorders and explores issues preventing EBA implementation. Results indicated infrequent EBA use with clinicians citing practical barriers (i.e., time, access, knowledge, cost) and negative beliefs about EBA techniques (i.e., unhelpful) as issues preventing implementation. Implications for future EBA dissemination and implementation efforts are discussed.

Is elderspeak appropriate? A survey of certified nursing assistants.

Elderspeak is a form of patronizing speech that is sometimes used with older adults and can result in unintended negative consequences. Certified nursing assistants (CNAs) working in long-term care facilities may be particularly prone to using elderspeak because they frequently interact with vulnerable and frail older adults who require assistance with activities of daily living. The purpose of the current study was to assess contextual variables that may prompt the use of elderspeak by CNAs. One hundred thirty-four CNAs completed a 36-item questionnaire intended to determine their evaluations of the appropriateness of elderspeak in a variety of contexts. Results indicated that specific resident-related variables (e.g., age, cognitive impairment) and situational variables (e.g., the absence of others during a CNA-resident interaction) were associated with higher ratings of appropriateness of elderspeak. These findings may have implications for improving communication training for CNAs.