Prescriptions for Buprenorphine in Michigan Following an Education Intervention.

Importance: Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown. Objective: To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. Design, Setting, and Participants: This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023. Exposures: MOC engagement. Main Outcomes and Measures: County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100 000 population). Results: Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9 990 000. A total of 5 070 000 (50.8%) were female, 1 410 000 (14.1%) were African American or Black, 530 000 (5.3%) were Hispanic or Latino, and 7 470 000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100 000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100 000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P = .004) monthly increase after engagement compared with before. Conclusions and Relevance: In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.

The integration of behavioral health consultants within a state-wide psychiatry consultation program: a community case study.

This paper describes the integration and role of masters-prepared behavioral health consultants (BHCs) within a state-wide psychiatry consultation program for children, adolescents, and perinatal women. Data from the Michigan Clinical Consultation and Care (MC3) program are reviewed, with attention to the role that BHCs play in the consultation process, integrated care, screening, and their dual roles with Community Mental Health Services Programs (CMHSPs) in Michigan. Approximately 82% of MC3 services are provided by the BHCs and involve resources or integrated care. BHCs play a role in managing provider consultations and connecting patients and providers to resources in the MC3 program.

The Michigan Child Collaborative Care Program: Building a Telepsychiatry Consultation Service.

This column describes the establishment of the Michigan Child Collaborative Care (MC3), a statewide telepsychiatry consultation program that provides support to primary care providers (PCPs) in meeting the mental health needs of youths and perinatal women. The MC3 program provides cost-effective, timely, remote consultation to primary care providers in an effort to address the lack of access and scarcity of resources in child, adolescent, and perinatal psychiatry. Data from 10,445 service requests are summarized. Common diagnoses included attention-deficit hyperactivity disorder, mood disorders, anxiety disorders, and autistic spectrum disorders, with many cases (58%) deemed moderate to severe. Co-occurring psychological trauma was suspected in 9% of service requests. Partnerships, stakeholder roles, PCP engagement, and workflow integration are highlighted as keys to the program's success.

Is one secure attachment enough? Infant cortisol reactivity and the security of infant-mother and infant-father attachments at the end of the first year.

Attachment security is theorized to shape stress reactivity, but extant work has failed to find consistent links between attachment security to mothers and infant cortisol reactivity. We examined family configurations of infant-mother and infant-father attachment security in relation to infant cortisol reactivity. One-year old infants (N = 180) participated in the Strange Situation with mothers and fathers in two counterbalanced lab visits, one month apart (12 and 13 months). Infants with secure attachments only to their fathers and not their mothers had higher cortisol levels than infants with a secure attachment to mother and also exhibited a blunted cortisol response (high at baseline and then a decrease after stress). Results suggest that a secure attachment to father may not be enough to reduce infant stress reactivity when the infant-mother attachment is insecure, and future research is needed to uncover the family dynamics that underlie different family configurations of attachment security.

Maternal and paternal trajectories of depressive symptoms predict family risk and children's emotional and behavioral problems after the birth of a sibling.

The current study examined trajectories of maternal and paternal depression in the year following the birth of an infant sibling, and relations with family risk factors and firstborn children's internalizing and externalizing behavior problems. Latent class growth analysis was conducted on 231 families in a longitudinal investigation (prebirth and 1, 4, 8, and 12 months postbirth) and revealed four classes of families: both mother and father low in depressive symptoms (40.7%); mother high-father low (25.1%); father high-mother low (24.7%), and both mother and father high (9.5%). Families with both mothers and fathers high on depressive symptoms were higher on marital negativity, parenting stress, and children's internalizing and externalizing problems, and lower on marital positivity and parental efficacy than other classes. Children, parents, and marital relationships were more problematic in families with fathers higher on depressive symptoms than in families in which mothers were higher, indicating the significant role of paternal support for firstborn children undergoing the transition to siblinghood. Maternal and paternal depression covaried with an accumulation of family risks over time, no doubt increasing the likelihood of children's problematic adjustment after the birth of their infant sibling.

Exploring the Telepsychiatry Experience: Primary Care Provider Perception of the Michigan Child Collaborative Care (MC3) Program.

BACKGROUND: Pediatric mental healthcare is a growing component of primary care practice. However, there is a lack of access to mental health services, particularly those provided by Child and Adolescent Psychiatrists. The Michigan Child Collaborative Care (MC3) Program is a telepsychiatry service that offers embedded behavioral health consultants within primary care practices, telephonic consultation, video consultation and embedded care. Primary care provider (PCP) utilization of telepsychiatry services is predicated on perceiving the consultation service as user-friendly, helpful, and feasible in their practice. OBJECTIVE: A survey of PCPs was conducted over a 5-year period to assess PCP attitudes and perceptions regarding MC3 consultation, including measures of efficiency, user-friendliness, and confidence in providing mental healthcare. The survey contained 4 items, (2 quantitative and 2 qualitative), and took less than 2 minutes to complete. RESULTS: 649 responses were received out of 1475 possible responses (44% response rate). Common themes elicited from the qualitative items included perception of improved patient care for youth with mental illness (45.3%), improved comfort and confidence in caring for youth with mental illness (30.9%), greater comfort with the prescribing and monitoring of psychotropics (25.9%) and improved access to mental healthcare for youth (23.1%). PCPs strongly agreed that MC3 was user-friendly, efficient, and enhanced their confidence in managing pediatric mental health concerns. CONCLUSIONS: This study demonstrates that the MC3 Telepsychiatry Program is well accepted by PCPs with self-reported improvements in providing mental healthcare to patients. Future research should explore how PCP perception impacts PCP practice, knowledge, as well as outcomes for patients and families longitudinally.