Exception Reporting: A Novel Approach to Tracking of Multiple Behavioral Health Outcomes.

Federally funded medical and behavioral healthcare programs often have substantial evaluation outcome tracking and reporting requirements, which can become burdensome to program staff resulting in decreased buy-in, increased chance of staff burnout and turnover, and less rigorous and consistent data collection efforts. To address this issue, a novel data collection approach, "exception reporting," was implemented to supplement and support the required data collection for a federally funded Assertive Outpatient Treatment (AOT) program. This work details the process and outcomes related to exception reporting for this comprehensive behavioral health treatment program that serves justice involved clients with serious mental illness (SMI). Results indicate that exception reporting was easily integrated into clinician's normal workflows and resulted in a number of benefits. Specifically, results indicated that exception reporting decreased the data collection burden for program staff while allowing them to efficiently track program outcomes required by the funder. Additional research into which practice settings exception reporting can most easily be integrated into, and which client outcomes may be best tracked using this methodology, is indicated.

Predictors of Stigma toward Alcohol Misuse in Mexico.

Objective: This study explored factors associated with public stigma toward individuals misusing alcohol in Mexico. Methods: A randomized experimental vignette methodology was used to assess multiple domains of substance use-related stigma and their relationship to the gender of the vignette subject and the sociodemographic characteristics of respondents. Results: Although levels of stigma toward women who were misusing alcohol did not differ significantly from stigma toward men misusing alcohol, stigma levels and type of stigma reported varied with the sociodemographic characteristics of respondents. Education level, gender, self-stigma and openness to seeking mental health services were differentially associated with the three stigma domains. Conclusions: Accordingly, targeted community based stigma reduction efforts are needed to decrease stigma toward those misusing alcohol, and to support treatment initiation, ongoing treatment engagement and long term recovery efforts. Suggestions for future research on the relationship between substance use and stigma are offered.

Public Stigma Toward Schizophrenia Within Latino Communities in the United States.

Public stigma toward those experiencing symptoms of schizophrenia in the general population is high; yet research into such stigma within the diverse Latino communities remains under-investigated. This study employed a randomized experimental vignette methodology to assess various domains of public stigma toward individuals experiencing psychosis and/or diabetes within Latino communities. A communitybased sample of 243 Latino adults participated. Contrary to our expectations, respondents who were more sympathetic toward those with mental health problems tended to score higher on public stigma. The belief that a person was responsible for their own mental health problems was associated with higher levels of stigma. Results indicate that perceptions of dangerousness toward someone experiencing psychosis were common, and the perception that a person was responsible for their mental health problems was associated with higher levels of stigma Results emphasize the complex nature of stigma within the diverse Latino communities and the need for ongoing research.

Predictors of stigma toward alcohol misuse in Latino communities: a path model.

This study explores stigma-related beliefs within the Latino community concerning alcohol misuse. A community-based convenience sample of 251 self-identified Latino adults were recruited to participate in a research study using an experimental vignette methodology. Participants were randomly assigned one of four vignettes about alcohol misuse and asked to share their attitudes and stigma-related beliefs about the problem and the person in the vignette. Sociodemographic characteristics of participants differentially predicted alcohol-related stigma. These data may be used to inform health literacy and stigma reduction interventions within the Latino community.

Barriers and Facilitators to DATA Waivered Providers Prescribing Buprenorphine: A Qualitative Analysis Applying the Theory of Planned Behavior.

Background: Provider beliefs about the treatment of people with addiction may influence their prescribing behavior. Objective: This study applied the Theory of Planned Behavior (TPB), to identify the salient beliefs of Drug Addiction Treatment Act of 2000 (DATA 2000) waivered providers, concerning prescribing buprenorphine to patients with Opioid Use Disorder (OUD). Methods: Texas buprenorphine providers participated in one of four online focus group discussions conducted in fall 2019. The focus group discussion were audio recorded and the total length was between 60-90 minutes. Thematic analysis was conducted to identify emerging themes and to categorize the behavioral, normative, and control beliefs related to buprenorphine prescribing. Results: Of the 14 total participants, 57% of the participants were male and annually treated between zero to sixty patients with buprenorphine. The codes generated were represented in thematic maps, specifying the positive or negative aspects of buprenorphine prescribing. Results indicate that providers' primary motivation to prescribe buprenorphine was, implementation of a whole-patient approach through collaboration with behavioral health providers, in the provision of medications for opioid use disorder (MOUD). Providers primary normative belief was the recognition of key members of the medical community and patients' families and friends as influential groups. Providers' control beliefs focused on their ability to use buprenorphine in different practice settings. Conclusion: These results indicate that buprenorphine access may be expanded by increasing support for DATA waivered providers from other parts of the healthcare system such as behavioral health providers and pharmacists. Implications for clinical practice and future research will be discussed.

The Intersection of the "Opioid Crisis" with Changes in US Immigration Policy: Contextual Barriers to Substance Abuse Research with Latinx Communities.

One of the 12 Grand Challenges facing contemporary social work is to close the health gap experienced by those in historically marginalized communities (Uehara et al., 2013). As social workers, we seek to understand the individual, interpersonal, social, and environmental factors along with the structural inequities leading to initiation and continuation of substance misuse. We are constantly contextualizing the circumstances under which substance misuse occurs, as well as contextualizing our approaches to addressing this issue from both a public health and social justice perspective. In order to adequately meet this challenge, considerably more research-based knowledge on the substance use treatment needs and preferences of America's largest ethnic/cultural group, Latinx, is needed. This brief report outlines current challenges associated with substance use research focusing on active Latinx heroin users living in a border state in a time of rapidly evolving social policy related to immigration, substance regulation, and public health.

The moderating effects of ethnicity on key predictors of trauma in child welfare involved adolescents.

Key predictors of trauma were examined using a multi-group analysis of a nationally representative sample of 716 child welfare involved youth ages 11-17. Results indicate that co-occurring clinical depression was associated with trauma across all racial/ethnic groups. Results also support that youth's ethnicity moderates the relationship between gender, history of sexual abuse and sexual orientation and the development of trauma. Contrary to prior research, trauma was not significantly associated with substance abuse or having experienced out of home placement for all ethnic groups. Implications for policy, practice with child welfare involved adolescents and future research in this area are discussed.

Prior Experiences of Behavioral Health Treatment among Uninsured Young Adults Served in a Psychiatric Crisis Setting.

This study qualitatively explored the past treatment experiences of uninsured young adults who sought public emergency psychiatric care. Qualitative interviews were conducted with a racially diverse sample of 55 young adults (ages 18-25) using a semi-structured interview guide, and analyzed using a team-based open coding approach. Findings emerged in three broad areas-provider-related factors, treatment-related factors, and environmental factors. Young adults talked about the importance of providers respecting and listening to them, the perceived advantages and disadvantages of therapy and medication treatment, and aspects of the environment that resulted in positive and negative experiences, particularly in inpatient settings. Providers need to convey respect and caring that transcends job duties and provide tangible skills and supports.

A pilot feasibility study of virtual patient simulation to enhance social work students' brief mental health assessment skills.

This study presents preliminary feasibility and acceptability data on the use of virtual patient (VP) simulations to develop brief assessment skills within an interdisciplinary care setting. Results support the acceptability of technology-enhanced simulations and offer preliminary evidence for an association between engagement in VP practice simulations and improvements in diagnostic accuracy and clinical interviewing skills. Recommendations and next steps for research on technology-enhanced simulations within social work are discussed.

Mental health help-seeking in Mexico.

Most people in need of mental health services in Mexico do not seek formal support or professional services to address their mental health needs. Understanding help-seeking behaviors is crucial to addressing underutilized mental health services and to leverage health promotion efforts. Data were collected as part of a larger research project on stigma and help-seeking for mental-health-related concerns in Mexico. A convenience sample of 469 adults residing in Mexico City participated in the study using an experimental vignette methodology assessing stigma toward individuals with mental health conditions, along with characteristics and demographic correlates of help-seeking. All survey measures were administered in Spanish. A structural regression was conducted for the outcome 'openness to professional help seeking for mental health problems' as a latent variable. Compared with males, females were more open to professional help seeking (b = 0.09, p = 0.038), as were people who endorsed higher spirituality (b = 0.01, p = 0.006); while people who experienced self-stigma were less open to professional help-seeking for mental health concerns (b = -0.15, p = 0.005). Self-stigma was a major driver of low service utilization. Contrary to previous studies, spirituality was a significant positive predictor of professional help-seeking. A more nuanced understanding of mental health help-seeking in Mexico can be useful for outreach efforts to increase service utilization both in Mexico and among Latinos in the United States (US). Given historical, geographic, and cultural ties with the US, it is important to understand mental health help-seeking in Mexico, which may relate directly to help-seeking behaviors in many US Latinos who have immigrated to the US. Directions for future research and practice implications are discussed, including a roadmap for health promotion activities.

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico.

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member's ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities.

The Relationship Between State Level Policy, Insurance and Health Care Engagement for LGBTQ+ Foster Alumni.

Minority stress theory posits that external environmental factors such as state level policies around equity and inclusion of LGBTQ+ people can have a significant impact on the health and wellness of those identifying as part of the larger LGBTQ+ community, as well as on their decisions to seek needed physical or mental health care. This secondary data analysis explored the relationship between state level policies related to LGBTQ+ equity and inclusion and physical and mental health care engagement for foster care alumni. Using data from the Jim Casey Opportunity Passport Survey (n = 2,420), the research team conducted a longitudinal analysis of youth's engagement with healthcare professional as needed physical and mental health care, using sociodemographic characteristics of the respondents and state level policies, such as Medicaid expansion and state level protections for LGBTQ+ citizens as predictors. Results indicate obtaining health insurance increased the likelihood that the youth would seek physical health care. LGBTQ+ young adults assigned female at birth had higher odds of not receiving physical health care relative to non-LGBTQ+ peers. Compared with non-LGBTQ+ youth, LGBTQ+ youth showed higher odds of not seeing mental health professionals when they needed to. Implications for practice, policy and advocacy are presented.

Predictors of Help-Seeking for Mental Health Treatment Among Latinos.

OBJECTIVES: Despite mental health disorders being a leading cause of disability among Latinos, treatment-seeking behaviors are very low. Latinos are confronted with significant disparities in mental health treatment. This research study sought to examine (1) what are the attitudes toward professional help-seeking for mental health concerns among Latino individuals and (2) what participant characteristics and demographic factors are associated with Latino individuals' help-seeking attitudes. METHODS: Employing a cross-sectional sampling strategy, 469 participants were recruited for a community-based survey study in the greater Houston area measuring mental health stigma and help-seeking attitudes. Structural equation modeling was used to estimate the associations between Latinos' help-seeking attitudes and sociodemographic characteristics of participants. RESULTS: Findings indicate that openness towards seeking professional help for mental health concerns is influenced by participants' age, marital status, gender, region of origin, education, public stigma, and self-stigma towards mental health problem. Findings support future research to examine broader systemic factors associated with help seeking and how they interact with sociodemographic characteristics and stigma. CONCLUSIONS: Latinos, even in parts of the country where they reside in high concentrations, continue to have low levels of mental health service utilization. Understanding the specific pathways that predict help-seeking for mental health issues is essential to systematically promoting early detection and entry into evidence-based treatments for Latinos.

The impacts of COVID-19 on LGBTQ+ foster youth alumni.

BACKGROUND: LGBTQ+ youth frequently experience disparities in outcomes related to permanency and overall well-being while in out-of-home care. These negative outcomes often persist after youth have transitioned out of care, particularly in the domains of housing, education, employment, and mental health. Initial research has found that the ongoing COVID-19 pandemic has exacerbated negative physical and mental health outcomes, as well as decreased economic stability among transition age youth. OBJECTIVE: This study seeks to determine if COVID-19 has resulted in unique impacts on foster care alumni, and if these impacts are the same for LGBTQ+ and non-LGBTQ+ transition age youth. PARTICIPANTS AND SETTING: This study used data from the 2020 Jim Casey Youth Opportunities Initiative Opportunity Passport Survey to explore these questions. METHODS: This survey was administered electronically to a national sample of 1223 youth ages 18-26 with lived experience in foster care. RESULTS: Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, black, indigenous and other people of color (BIPOC) youth and LGBTQ+ youth being most frequently impacted. CONCLUSIONS: Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, BIPOC youth and LGBTQ+ youth being most frequently impacted. Implications for practice and policy are explored.

Latinos' Conceptualization of Depression, Diabetes, and Mental Health-Related Stigma.

Depression and diabetes are two of the most common health conditions experienced by those from Latino backgrounds. However, community-based stigma toward these health conditions may discourage those experiencing symptoms of depression or diabetes from seeking professional assistance. To assess stigma in the Latino community toward these common health conditions, a community-based sample of 469 Latino participants in a major urban area in the [Southwestern United States - Houston, TX] completed a face-to-face survey using an experimental vignette methodology. Participants were asked to name the problem that the subject of the vignette was experiencing based on the symptoms described in the vignette. This survey also inquired about public stigma toward individuals experiencing symptoms of depression and/or diabetes. Results indicate that although the majority (60%) of the sample were able to correctly identify symptoms of depression, it was more difficult for them to identify symptoms of depression with co-occurring diabetes. Overall levels of public stigma toward those experiencing depression were moderate, and co-occurring symptoms of diabetes did not moderate stigma toward those experiencing depression. These findings indicate a need for intervention approaches within the Latino community to increase health literacy related to depression and type 2 diabetes, as well as an ongoing need to reduce stigma toward those experiencing symptoms of depression. Implications for future research, practice, and health promotion are discussed.

Conceptualizations of suicide and suicide-related stigma in Latino communities in the United States.

Suicide continues to be a significant public health concern impacting all cultural and ethnic groups in the United States. Although prior studies indicate that Latino individuals die by suicide at lower rates than their non-Hispanic White or Asian peers, recent data in this area indicate that suicide rates for Latino individuals are rising. Currently, little is known about how Latino individuals perceive those who are experiencing suicidal ideation and the factors that are associated with stigma toward people contemplating self-harm. To address this gap, a convenience sample of 248 adults in the United States identifying as Latino participated in an experimental vignette study investigating their perceptions of persons experiencing suicidal ideation. Results show that generation of immigration significantly predicted various domains of stigma toward individuals with suicidal ideation. Older participants and participants with more children were associated with higher levels of stigma. The gender or age of the person experiencing suicidal ideation did not impact the levels of stigma across domains. Results indicate a need to increase the overall health literacy in relation to suicide within Latino communities, particularly in relation to early identification of suicidal ideation. Implications for future research and practice with Latino communities are offered. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Web-based Acceptance and Commitment Therapy (ACT) for symptoms of anxiety and depression: Within-group effect size benchmarks as tools for clinical practice.

COVID-19 has highlighted the need for evidence-based behavioural health interventions that can be delivered remotely. This article provides within-group effect size benchmarks for randomised controlled trials of Internet-based Acceptance and Commitment Therapy for the treatment of adults with anxiety and depression. Effect sizes were calculated using the Glass approach, adjusted using Hedges g, then aggregated to produce separate benchmarks for measures of anxiety and depression. These benchmarks can be used by community-based treatment providers to evaluate the effectiveness of their web-based Acceptance and Commitment Therapy intervention to determine if it should be continued, modified for the unique needs of their client population and practice setting, or discontinued.

A Pilot Study of Peer-to-Peer SBIRT Simulation as a Clinical Telehealth Training Tool During COVID-19.

Screening, Brief Intervention and Referral to Treatment (SBIRT), is an evidence-based approach to screening and early intervention for those at risk of substance use disorders. With the ongoing health concerns related to COVID-19, there is an increased need for social workers who can competently deliver evidence-based interventions, such as SBIRT, via telehealth. Due to the COVID-19 pandemic, traditional SBIRT training approaches using face-to-face (FTF) instruction and FTF simulated practice may not be a safe or feasible way to develop students' SBIRT- related skills. This study explores 35 social work graduate students' experiences of learning SBIRT skills in a remote learning format and subsequently delivering a SBIRT intervention to a live "client" via a peer-to-peer simulated telehealth session. Overall, students reported that the shift from FTF to remote learning made learning SBIRT skills difficult, and that providing brief intervention and referral was the most difficult step of the simulated SBIRT telehealth intervention. Qualitative feedback indicates that overall, students found the simulated telehealth sessions a valuable learning experience, but also reported that richer educational experiences would have resulted from additional practice opportunities and real time feedback. Implications for future research, simulation-based education and clinical practice are discussed.

Immigration Policy Changes and the Mental Health of Mexican-American Immigrants.

In recent years, significant policy changes focused on immigrants migrating through the southern United States border have been implemented. To determine if there was an association between time since immigration and increases in negative mental health symptomology, 249 Mexican-American immigrants ages 18-65 were field recruited to participate in a survey exploring their physical and mental health. Results indicate that inconsistent with the Hispanic Health Paradox, the psychological health of immigrants arriving since 2015 was significantly worse than that of more established immigrants. New arrivals had a .38 increased risk of experiencing clinically significant depression and a .47 increased risk of experiencing global psychological distress. Time since immigration was not significantly related to past 30-day alcohol use. Implications for future research and clinical practice with immigrants are explored, and suggestions on how better identify and assist Mexican-American immigrants with mental health concerns are offered.

Licensed Master of Social Workers' Engagement in the Process of Evidence-Based Practice: Barriers and Facilitators.

Purpose:This article describes the qualitative responses from licensed masters-level social workers (LMSWs) regarding what they perceive as barriers and facilitators to consistently engaging in the process of evidence-based practice (EBP). Method:Two open-ended questions were posed to determine what helps social workers consistently use the EBP process and what inhibits them from regularly applying EBP to guide clinical decision-making. A total of 113 responses were recorded. Content analysis was used to identify emergent themes. Results:Facilitators to the consistent use of EBP included: the belief that EBP improves outcomes, research that was vetted and disseminated by trusted partners such as the National Association of Social Workers (NASW), and ethical mandates. Barriers included: time, lack of applicable research, client-specific factors, and cost. Factors identified as both facilitating and impeding the EBP process were lack of necessary technology, organizational context, provider beliefs, and research knowledge/training. Discussion and Conclusion: Providers identified a number of barriers and facilitators to engaging in the process of evidence-based practice, which guided the extent to which they consistently engaged in the process, and how difficult they perceived itto be.