Telehealth Use during COVID-19: An Exploratory Study on Adaptations and Experiences of Providers.

The current exploratory study examines the impact of the rapid acceleration of telehealth during the COVID-19 pandemic from the perspective of healthcare providers. Understanding provider perspectives, particularly in terms of adaptations made during this critical time, is a useful lens into service innovation in times of crisis and can help elucidate successful strategies for continuing the use of telehealth during the postpandemic period. Fourteen providers from 11 different service agencies in a southeastern state were interviewed. Findings identified three themes: (1) dynamic adaptations enacted by healthcare providers at the onset of the pandemic, such as hybrid services, rapid innovations in workflow, collective decision making among providers, and outreach to educate patients; (2) the relaxation of policies by regulators/insurers, focused most often on reimbursement of services; and (3) how patient engagement was impacted via telehealth, including openness to telehealth, more family-level accessibility, and reduced no-show rates. Implications for social workers include heightened professional training on telehealth as well as increasing the critical role that social workers serve in educating providers and patients on telehealth.

Exploring Social Work Practitioners' Perspectives on the Contributors to Burnout since the COVID-19 Pandemic.

Burnout has a historic and disproportionate impact on social workers and is one important contributor to the ongoing health and behavioral health workforce crisis in the United States. Little is known, however, about social workers' experiences of burnout and their perceptions of factors that contribute to burnout since the COVID-19 pandemic. This study sought to explore this by answering the following research questions: (a) To what extent are social workers in South Carolina experiencing burnout? and (b) What do South Carolina social workers view as the top reasons for burnout in their professional role? Seventy social work practitioners and leaders from South Carolina completed an online survey during Fall 2022 that included the Copenhagen Burnout Inventory and an open-ended question focused on identifying their perceptions of the top three reasons for burnout in the profession. Findings suggest that social workers in this study are experiencing moderate levels of burnout since the COVID-19 pandemic and report primarily organizational (83 percent) contributors to burnout. They also identified individual (36 percent), systemic (29 percent), and interpersonal (27 percent) contributors to burnout. Implications are discussed related to policy and practice responses to prevent and address burnout among social workers.

Development and initial validity and reliability of the Rural Practice Awareness and Skills Scale.

PURPOSE: The purpose of this study was to develop and provide initial evidence of the validity and reliability of the Rural Practice Awareness and Skills Scale (RPASS). METHODS: A pool of 63 items was reviewed by an expert panel, subjected to 2 additional face validity checks, and reduced to 39 items. The scale was then completed by 333 participants, and an exploratory factor analysis and confirmatory factor analysis were conducted. FINDINGS: Results revealed a 3-factor, 20-item scale with evidence of reliability and convergent validity. CONCLUSIONS: RPASS has utility for advancing research to support recruitment and retention of rural health providers and ultimately enhance rural health care delivery.

Benefits and Challenges of Implementing Telehealth in Rural Settings: A Mixed-Methods Study of Behavioral Medicine Providers.

Social workers and other healthcare professionals face increasing pressure to expand access, efficiency, and quality of healthcare to rural patients. Telehealth has become a viable and necessary tool to address gaps in healthcare for rural areas. Unfortunately, little is known about the benefits and challenges of using these services to meet the needs of rural communities. This mixed-methods study examines telehealth implementation among healthcare organizations in a predominantly rural state. Seventeen providers from 11 organizations were interviewed. Most had used live video conferencing, and about a third used mobile technologies, but fewer providers had experience with store-and-forward or remote patient monitoring. Analyses of qualitative data collected via interviews revealed two main themes among benefits of telehealth implementation: (1) increased inter- and intra-agency coordination and (2) savings in time, travel, and efficiency. Three main themes emerged among barriers to telehealth: (1) organizational capacity, (2) patient skills and comfort, and (3) provider knowledge and skills. Recommendations are provided for social workers and other healthcare professionals related to expanding utilization of telehealth services to improve access to healthcare for rural populations.

Process and Product Innovations from a Statewide Capacity-Building Initiative for Substance Use Treatment and Recovery.

Statewide behavioral health collaborative capacity-building initiatives are designed to support substance use agencies in strengthening their behavioral health services delivery and implementing evidence-supported practices. This study explored the types of innovations resulting from one such statewide behavioral health initiative, as well as the facilitators and barriers to implementing these innovations, from the perspective of the substance use agencies involved in the initiative. Data were collected through semistructured interviews with 67 agency stakeholders and 93 agency progress reports. Results indicated that 161 innovations emerged through this project for the substance use agencies, including staffing; policy, procedure, and technology; partnerships; training and media products; and service innovations. Agency facilitators included collaboration/partnership, project buy-in, and quality of agency staff. Barriers to implementation included lack of collaboration or partnerships, agency infrastructure or climate, lack of project buy-in, and funding and billing issues. The article concludes with a discussion on implications for social work practice in behavioral health.

Examining the Impact of Victimization on Girls' Delinquency: A Study of Direct and Indirect Effects.

Previous research has acknowledged that there is a relationship between victimization and later delinquency, but the specific attributes of this relationship are unclear because measures of both direct and indirect victimization are rarely explored in a single study. We included both indirect and direct victimization to examine which form of victimization was a stronger predictor of substance use, fighting, running away, and sex work among girls committed to a juvenile justice facility. Findings indicated that direct victimization was typically a more salient predictor of delinquency than indirect forms of victimization. Further, running away and sex work appear to be unique outcomes that are particularly likely when girls experience direct rather than indirect victimization. Findings are summarized with implications for health and public policy.

Examining collaborative leadership through interprofessional education: findings from a mixed methods study.

Collaborative leadership is essential as recent trends in healthcare service delivery necessitate interprofessional collaboration and care. Interprofessional education (IPE) efforts, therefore, have to prepare students for this type of leadership. The purpose of this study was to understand how students' perceptions of leadership change as a result of embedding a collaborative leadership model, the Social Change Model (SCM) of leadership, in an IPE course. Data were collected from 30 students participating in an interprofessional course through two interprofessional course reflections, pre/post leadership posters and poster reflections, and a pre/post survey. Results from paired sample t-tests suggested students significantly improved in their perceptions of leadership efficacy. These data also indicated improvements to the three group-level values of the SCM: collaboration, common purpose, and controversy with civility. Findings from the qualitative data suggest that students learned to view leadership as more of a team effort than the actions of a single individual and as more of a process than a role. Findings also revealed the benefits and challenges of using a visual process of poster development as a way of examining students' changes in perceptions of leadership over the course of the semester. Implications are discussed in relationship to the utility of the SCM in promoting students' shifts in conceptualizations of leadership that emphasizes collaboration and helps prepare students to engage in these ways within interprofessional teams in their practice.

A Meta-analysis of the Effectiveness of Interactive Middle School Cannabis Prevention Programs.

This meta-analysis examines the effectiveness of interactive middle school-based drug prevention programs on adolescent cannabis use in North America, as well as program characteristics that could moderate these effects. Interactive programs, compared to more didactic, lecture style programs, involve participants in skill-building activities and focus on interaction among participants. A systematic literature search was conducted for English-language studies from January 1998 to March 2014. Studies included evaluations using random assignment or a quasi-experimental design of interactive school-based substance use prevention programs delivered to adolescents (aged 12-14) in North American middle schools (grades 6-8). Data were extracted using a coding protocol. The outcomes of interest were post-treatment cannabis use, intent to use, and refusal skills compared across intervention and control groups. Effect sizes (Cohen's d) were calculated from continuous measures, and dichotomous measures were converted to the d index. A total of 30 studies yielding 23 independent samples were included. The random effects pooled effect size for cannabis use (k = 21) was small ([Formula: see text]= -0.07, p < 0.01) and favorable for the prevention programs. The pooled effect sizes for intention to use (k = 3) and refusal skills (k = 3) were not significant. Moderator analyses indicated significant differences in program effectiveness between instructor types, with teachers found to be most effective ([Formula: see text]= -0.08, p = 0.02). The findings provide further support for the use of interactive school-based programs to prevent cannabis use among middle school students in North America.

Substance abuse treatment engagement among mothers: Perceptions of the parenting role and agency-related motivators and inhibitors.

This qualitative study explored 1) the parenting role as a motivator and inhibitor to engaging in substance abuse treatment and 2) parenting-related, agency-imposed barriers and facilitators to substance abuse treatment engagement. Nine focus groups (n=45) were conducted with current and former male and female recipients of treatment services in one south eastern state. Using inductive thematic analysis, transcripts were analyzed to identify key themes related to parenting. Females were overrepresented in our groups and were more vocal than males regarding issues of parenting as these related to treatment. Among mothers, motivations for treatment related to parenting included involvement with child protective services and the desire to be a better parent. Inhibitors for treatment included anxiety over separation from child, debilitating guilt, and parenting demands. Facilitators for participation included mother-child residential programs, services for children, concrete support, and advocacy and emotional support. Barriers for participation included decreased access to the child and barriers specific to mother-child residential programs. To enhance treatment engagement among parents, providers can address agency-level barriers and draw upon the parenting role as intrinsic motivation for change. Policies and services are needed that promote flexibility, choice, and support parents to engage in treatment services.

Evaluating the association between childhood sexual abuse and attempted suicide across the lifespan: Findings from a nationwide study of women in jail.

Previous studies have found childhood sexual abuse to predict suicidal behavior in adulthood. Women in jail suffer disproportionately high rates of childhood sexual abuse and attempted suicide relative to women in the general population. Thus, better understanding the association between childhood sexual abuse and attempted suicide among women in jail may inform prevention, assessment, and treatment initiatives for this at-risk population. This study examined the association between childhood sexual abuse and the onset of attempted suicide across the life span in a nationwide sample of women in jail. Participants included a randomly selected subsample of women (N = 115), drawn from a larger probability sample (N = 491), who completed Life History Calendars, which were coded for the presence/absence of attempted suicide and childhood sexual abuse across life history stages. Survival analysis and Cox regression indicated that women with histories of childhood sexual abuse perpetrated by an adult or a peer were significantly more likely to have attempted suicide across the life span, including increased risk for the onset of attempted suicide in adulthood. This study demonstrates the salience of childhood sexual abuse as a predictor of suicidal behavior among women in jail, and extends previous research by demonstrating the temporal sequence of childhood sexual abuse relative to attempted suicide across the life span. Given these findings, researchers, clinicians, and policymakers should consider further the influence of childhood sexual abuse with regard to the high rates of attempted and completed suicide among women in jail. (PsycINFO Database Record

An Exploratory Study Examining Risk Communication among Adolescent Children, Their Incarcerated Mothers, and Their Caregivers.

Adolescent children of incarcerated mothers (ACIM) are typically left in the care of adults (primary caregivers) who play a crucial role in children's care and guidance, as well as in the facilitation of contact and communication with incarcerated mothers. The purpose of this study was to explore the nature of relationships and communication among adolescent children of incarcerated mothers, primary caregivers, and incarcerated mothers using pilot data. Semi-structured individual interviews were conducted with youth aged 12-17 (n=7) and caregivers (n=6) recruited through a non-profit organization working with incarcerated mothers and their children. Incarcerated mothers and primary caregivers represent an important family unit for ACIMs and may play a role in preventing risk behavior. A conceptual framework is offered for further consideration of mother and caregiver communication with youth and youth risk.

Trauma experiences and mental health among incarcerated women.

OBJECTIVE: Female offenders have different risk factors for offending than do male offenders, and elevated rates of interpersonal victimization such as physical, emotional, and sexual abuse, and family and community violence, are common in histories of incarcerated women. We used factor analysis to examine patterns of traumatic events experienced by women in jail and explored how these patterns were associated with 4 psychiatric disorders (posttraumatic stress disorder [PTSD], major depression, bipolar disorder, and substance use disorder) observed in this sample. METHOD: A total of 464 women from 9 jails in 4 geographic regions in the United States comprised the sample. Women participated in diagnostic interviews to assess trauma exposure and psychiatric disorders. RESULTS: Three factors described the observed patterns of trauma exposure: family dysfunction (FD), interpersonal violence (IPV), and external events (EE). Life events were analyzed as a separate group of items. FD and IPV each contributed independently to the odds of having each of the 4 mental disorders studied; significant odds ratios were in the range of 1.38-2.05. All 3 factors contributed to the diagnosis of bipolar disorder. The only diagnosis to which stressful life events made a unique contribution was to the likelihood of having PTSD. CONCLUSION: This work provides further support for the importance of assessing trauma exposure of women in jail, especially the family context, as well as mental health. Implementation and testing of evidence-based treatment approaches that address trauma-related distress in correctional settings are warranted. (PsycINFO Database Record

Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review.

The purpose of this integrative review is to examine and synthesize extant literature pertaining to barriers to substance abuse and mental health treatment for persons with co-occurring substance use and mental health disorders (COD). Electronic searches were conducted using ten scholarly databases. Thirty-six articles met inclusion criteria and were examined for this review. Narrative review of these articles resulted in the identification of two primary barriers to treatment access for individuals with COD: personal characteristics barriers and structural barriers. Clinical implications and directions for future research are discussed. In particular, additional studies on marginalized sub-populations are needed, specifically those that examine barriers to treatment access among older, non-White, non-heterosexual populations.

Barriers and Facilitators to Substance Use Treatment in the Rural South: A Qualitative Study.

PURPOSE: Little qualitative research has examined factors associated with care in substance abuse treatment agencies in Southeastern rural communities. This study explored client- and agency stakeholder-perceived barriers and facilitators to substance use treatment delivery in southeastern rural communities. METHODS: Group and individual interviews were conducted with 40 key stakeholders and 40 clients at 9 substance abuse agencies serving rural communities in a southeastern state. Qualitative thematic analysis was used to identify perceived barriers and facilitators to substance abuse services in rural communities. FINDINGS: Four primary themes emerged from the client and stakeholder interviews as both barriers and facilitators: availability of services for individuals with substance use disorders; access to the current technology for client services and agency functioning; cost of services; and stigma. CONCLUSIONS: This study identifies novel barriers and facilitators to substance use care in the rural South and highlights essential areas for consideration when developing and implementing substance use care in this geographic region. These findings can be used as guidelines to provide better care to individuals with substance use disorders living in rural communities.

Poly-victimization among girls in the justice system: trajectories of risk and associations to juvenile offending.

Life History Calendars and the Juvenile Victimization Questionnaire were used to collect data from 100 delinquent girls to (a) examine range and co-occurrence of different types of violence over the life span, (b) examine independent and cumulative trajectories of risk for varied types of victimization, and (c) examine the relationship of victimization to girls' offending. Risk trajectories demonstrate critical risk periods for different forms of violence exposure. Cox regression was used to examine the predictive value of different forms of violence exposure for the onset of delinquent and criminal behavior. Findings illuminate the need for programs addressing substance use and alternative coping mechanisms.

Risk profile and treatment needs of women in jail with co-occurring serious mental illness and substance use disorders.

Recent research has documented the unusually high rates of incarcerated women's serious mental illness (SMI) and substance use disorders (SUD). Complicating these high rates is the high comorbidity of SMI with SUD and trauma histories. Yet, incarcerated women have significantly less access to treatment and health services while incarcerated than men. We used data from a multi-site, multi-method project funded by the Bureau of Justice Assistance (2011-2012) to determine the risk profile of women in jail (n = 491) with a current co-occurring SMI (i.e., major depressive disorder, bipolar disorder, schizophrenia spectrum disorder) and SUD (i.e., abuse, dependence). The study spanned multiple geographic regions, and structured diagnostic interviews were used to understand better the women that comprised this vulnerable population. One-in-five of the women had a current co-occurring disorder (CCOD). The findings revealed that significantly more women with a CCOD had been exposed to violence and were exposed to drugs at a younger age. Further, about one-third of women with a CCOD had received no treatment from a health care professional in the past year, demonstrating a substantial unmet need. We conclude that investing in mental and behavioral health care in jails is critical to the health and safety of women as well as the communities to which they return.

A multisite study of the prevalence of serious mental illness, PTSD, and substance use disorders of women in jail.

OBJECTIVES: This multisite study aimed to answer the following research questions about women in urban and rural jails. First, what is the current and lifetime prevalence of serious mental illness (major depressive disorder, bipolar disorder, and psychotic spectrum disorders) of women in jail? Second, what level of impairment is associated with their serious mental illness? Third, what is the proportion of incarcerated women with serious mental illness who also have posttraumatic stress disorder (PTSD), a substance use disorder, or both? METHODS: Participants were 491 women randomly sampled in jails in Colorado, Idaho, South Carolina, and the metropolitan area of Washington, D.C. Structured interviews assessed lifetime and 12-month prevalence of disorders and level of impairment. RESULTS: Forty-three percent of participants met lifetime criteria for a serious mental illness, and 32% met 12-month criteria; among the latter, 45% endorsed severe functional impairment. Fifty-three percent met criteria for ever having PTSD. Almost one in three (29%) met criteria for a serious mental illness and PTSD, 38% for a serious mental illness and a co-occurring substance use disorder, and about one in four (26%) for all three in their lifetime. CONCLUSIONS: The prevalence of serious mental illness and its co-occurrence with substance use disorders and PTSD in this multisite sample suggest the critical need for comprehensive assessment of mental health at the point of women's entry into the criminal justice system and the necessity for more programs that offer alternatives to incarceration and that can address the complexity of female offenders' treatment needs.

Institutional responses to self-injurious behavior among inmates.

To date, little research has systematically investigated perceptions of mental health professionals regarding motivations for self-injury among prison inmates. To help fill this gap, the authors used descriptive techniques to examine self-injurious behavior among inmates from the perspective of correctional mental health professionals. A quantitative survey assessed perceptions of mental health staff regarding etiology, motivations, and manifestations of self-injury. A qualitative interview component was used to explicate responses from the survey. Inmate cutting, scratching, opening old wounds, and inserting objects were the most commonly witnessed behaviors. Findings suggest that self-injury occurred regularly and that a subset of inmates are responsible for recurrent events. Mental health professionals perceived the motivation for inmate self-injury to be both manipulative and a coping mechanism. They described current management strategies and corresponding needs for training and resources.

Prevention of elder mistreatment in nursing homes: competencies for direct-care staff.

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policy makers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.

Pathways to prison: impact of victimization in the lives of incarcerated women.

This study examines ways in which victimization may contribute to criminal involvement among incarcerated women. The authors conduct interviews with 60 women in a maximum-security prison to gather each woman's perspective on psychological, physical, and sexual victimization in her life. Qualitative analyses indicate ways that victimization relates directly to women's crimes as well as influences health, psychosocial functioning, or systemic involvement to create difficult situations with which the women struggle. Case histories are used to illustrate pervasive impacts of victimization, and the roles of multiple traumas and cumulative impact are discussed.