Care integration goes Beyond Co-Location: Creating a Medical Home.

How to successfully integrate mental health and primary care remains a critically important question given the continued morbidity and early mortality of people with serious mental illness. This study investigated integration in a community mental health center (MHC) primarily treating people with SMI in a large, urban northeastern city where an on-site primary care center (PCC) was opened resulting in co-located mental health and primary care services being provided. Using focus groups and online surveys this study asked participants about their thoughts and interactions with the on-site PCC. Participants included staff from clinical, non-clinical, and leadership roles in the mental health center (MHC; PCC staff; and MHC clients who did not use the on-site PCC). MHC staff also offered their thoughts about and experiences with the on-site PCC one year and two years after the on-site PCC opened through an on-line survey. In both methods, staff reported limited awareness and expectations of the PCC in the first year. Staff indicated that successful care integration goes beyond co-location and peer health navigation can enhance integration. Finally, staff discussed desires for enhancing care integration and co-located services into a medical home that included communicating across medical records and providers at different agencies. Our results suggest that, in addition to the previously researched three C's of care integration (consultation, coordination, and collaboration), two more C's were essential to successful care integration: co-location and communication. Communication across medical records and providers at different agencies was an essential component of care integration, and co-location added increased ability to communicate across providers.

Reclaiming Self-care: Self-care as a Social Justice Tool for Black Wellness.

Black communities face multiple stressors including racism, discrimination, and navigating systems of oppression, all of which affect their mental health and wellbeing. In recent years, the practice of self-care has gained popularity as a strategy to cope with stress and to improve overall health. However, the current discourse often focuses on individual self-care behaviors and excludes systemic and community level factors that encourage, sustain, or inhibit self-care practices. This paper contextualizes a conceptual model of self-care with intersectionality theory and the psychology of liberation framework, in relation to the lived experiences of Black communities. The paper aims to underscore the necessity of self and community care as a tool for social justice, preservation, and resistance against oppressive systems that threaten the mental health and wellness of this community.

Structured and Unstructured Activities and Alcohol and Marijuana Use in Middle School: The Role of Availability and Engagement.

Background: Behavioral Theories of Choice applied to substance use suggests that use depends on availability of substances and alternative activities. Applying this theory to younger adolescents offers the possibility of investigating potentially malleable prevention and intervention targets. Objectives: The current study examines the role of perceived availability and engagement in structured and unstructured activities on adolescent alcohol and marijuana use controlling for substance availability. Methods: Data were collected as part of a longitudinal study of 6th-8th graders (N = 1023; 52% female; 76% White; Mage = 12.23 years). Multiple logistic regressions analyzed the impact of availability and engagement in structured and unstructured activities at Wave 1 on heavy drinking and marijuana use by study end in both unadjusted and adjusted models. Results: Availability of unstructured activities was associated with increased likelihood of both marijuana use (b* = .06, p = .04) and heavy drinking (OR = 1.20, p < .001), while availability of structured activities was not significantly associated with likelihood of either marijuana use (b* = -.10, p = .07) or heavy drinking (OR = 0.86, p = .16). Engagement in unstructured activities was significantly associated with increased likelihood of both marijuana use (b* = .06, p = .03) and heavy drinking (OR = 1.11, p = .003), while engagement in structured activities was significantly associated with decreased likelihood of both marijuana use (b* = -.25, p < .001) and heavy drinking (OR = 0.85, p = .046). Conclusions: Perceived availability of and engagement in unstructured activities may present a risk, while perceived availability of and engagement in structured activities may serve as a protective factor for youth substance use.

The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis.

BACKGROUND: People with substance use disorders (SUD) who have been involved in the legal system often experience stigma upon reentry into the community after incarceration. Although substance use treatment can sometimes be a source of stigma, it may also reduce stigma by facilitating connections with providers, reducing distress, or helping people feel more integrated in their community. However, research has rarely examined the potential for treatment to reduce stigma. METHODS: This study examined stigma experiences and the degree to which substance use treatment reduced stigma among 24 people with SUDs who were receiving care in an outpatient treatment facility after release from incarceration. Qualitative interviews were conducted and analyzed using a content analysis approach. RESULTS: Participants reported negative self-judgements as well as perceiving negative judgments from the community upon reentry. With regard to stigma reduction, themes emerged around substance use treatment repairing strained family relationships and reducing participants' self-stigma. Aspects of treatment that reportedly reduced stigma included the treatment facility having a nonjudgmental atmosphere, patients trusting the staff, and working with peer navigators who had lived experience of SUD and incarceration. CONCLUSIONS: Results from this study suggest that substance use treatment has the potential to decrease the negative impacts of stigma upon release from incarceration, which continues to be a major barrier. Though more research on stigma reduction is needed, we suggest some preliminary considerations for treatment programs and providers.

Breaking through social determinants of health: Results from a feasibility study of Imani Breakthrough, a community developed substance use intervention for Black and Latinx people.

Racial and ethnic disparities in substance use intervention design, implementation, and dissemination have been recognized for years, yet few intervention programs have been designed and conducted by and for people who use substances. Imani Breakthrough is a two-phase 22-week intervention developed by the community, run by facilitators with lived experience and church members, that is implemented in Black and Latinx church settings. This community-based participatory research (CBPR) approach is a concept developed in response to a call for action from the State of Connecticut Department of Mental Health and Addiction Services (DMHAS) with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to address rising rates of death due to opioid overdose, and other negative consequences of substance misuse. After nine months of didactic community meetings, the final design involved twelve weeks of education in a group setting related to the recovery process, including the impact of trauma and racism on substance use, and a focus on citizenship and community participation and the 8 dimensions of wellness, followed by ten weeks of mutual support, with intensive wraparound support and life coaching focused on the social determinants of health (SDOH). We found the Imani intervention was feasible and acceptable, with 42 % of participants retained at 12 weeks. In addition, in a subset of participants with complete data, we found a significant increase in both citizenship scores and dimensions of wellness from baseline to week 12, with the greatest improvements in the occupational, intellectual, financial, and personal responsibility dimensions. As drug overdose rates among Black and Latinx people who use substances continue to increase, it is imperative that we address the inequities in the SDOH that contribute to this disparity gap so that we can develop interventions tailored to the specific needs of Black and Latinx people who use drugs. The Imani Breakthrough intervention shows promise as a community-driven approach that can address these disparities and promote health equity.

Criminal Orders of Protection for Domestic Violence: Associated Revictimization, Mental Health, and Well-being Among Victims.

All states issue criminal protection orders (POs) with the intention of improving the lives of victims of domestic violence (DV); however, there is a dearth of research examining their impact. This study aims to examine the impact of criminal POs with different levels of restrictions on victims' revictimization, mental health, and well-being. A cross-sectional design was used to collect data regarding two time points during one interview among a sample of 298 victims in a criminal DV case. Across the three levels of PO restrictions (limited, residential stay-away, and full no-contact), participants reported significantly reduced physical, sexual, and psychological DV; unwanted pursuit behavior; post-traumatic stress and depression symptom severity; and perceived stress and fear of revictimization. The amount of change varied between groups for revictimization variables. Full no-contact restrictions were associated with the greatest decreases in revictimization. However, findings must be interpreted with caution given the heterogeneity in victims' experiences; some victims experienced an increase in revictimization and mental health problems and a decrease in well-being. Findings suggest that the court, through criminal POs, may be a system through which to reach victims who might not otherwise connect with services to promote safety and resilience.

If You Can't Say Something Nice: A Latent Profile Analysis of Social Reactions to Intimate Partner Violence Disclosure and Associations With Mental Health Symptoms.

The social reactions that victims receive when disclosing intimate partner violence (IPV) have important implications for recovery and well-being. Women from the community (n = 172) reported IPV, reactions to IPV disclosure, and mental health symptoms in individual interviews. Latent profile analyses revealed three subgroups of victims with varied experiences of reactions. The group characterized by high negative/low positive reactions reported the highest depression and posttraumatic stress disorder (PTSD) symptom severity; symptom severity was high regardless of IPV severity. However, symptoms were only severe at high IPV severity among individuals classified into groups characterized by high positive reactions, and by low negative and low positive reactions.