Telehealth Applications in Military and Veteran Healthcare Settings

COVID-19 has brought increasing health care challenges upon providers throughout the country, let alone military healthcare professionals. Behavioral telehealth applications in the United States date back to the 1950s in Nebraska rural state-run mental health hospitals and clinics. Drs James and Folen developed innovative behavioral telehealth in the mid-to-late-1990s since there was a paucity of behavioral telehealth clinical applications and research from the 1960s to the early 1990s. Then, the need to deliver behavioral health services via telehealth platforms became of critical importance as our military and veteran hospitals needed to offer services in response to the COVID-19 health crisis. In this chapter, the authors will define behavioral telehealth and provide the reader with examples of clinical and research applications as well as discuss potential ethical and practical challenges. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Patient-Centered Care Through Nurse Practitioner-Led Integrated Behavioral Health: A Case Study.

Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.

Using a Delphi Technique to Define Primary Care Behavioral Health Clinical Supervision Competencies.

There is an increasing need for Primary Care Behavioral Health (PCBH) workforce development (i.e., increase in well-trained PCBH providers) given the growth of behavioral health (BH) integration into primary care, specifically at a time when behavioral health needs are increasing because of the COVID-19 pandemic (Kanzler and Ogbeide in Psychol Trauma 12(S1):S177-S179, https://doi.org/10.1037/tra0000761 , 2020). Therefore, it is imperative to provide current and future behavioral health clinical supervisors in primary care settings specific competencies, given there are no current competencies specific to clinical supervision within the PCBH Model. Using a Delphi process, the authors identified and reached expert consensus on competencies for BH clinical supervisors in primary care. A purposive sample (in: Patton, Qualitative evaluation and research methods, Sage, Newbury Park, 1990) of fifteen experts (n = 15) in PCBH clinical training and education evaluated quantitative and qualitative domains and specific competencies associated with PCBH supervision gathered during an initial in-depth qualitative interview. This was followed by two subsequent rounds of quantitative Delphi surveys to reach consensus. The response rates from our panel of experts were 100% (15/15) for all stages (interviews, round one and round two surveys). Three domains (Primary Care Knowledge, Clinical Supervisor Development, and Clinical Supervision Skills) were rated as essential for providing clinical supervision with PCBH for pre-licensure level learners. The development of competencies will further support BH clinical supervisor needs, professional development, and provide a concrete way to evaluate progress towards teaching and training excellence. This will also have a great impact on the development of the future BH workforce within primary care.

Behavioral and psychosocial factors and their effects on insomnia among people undergoing entry quarantine in hotels during COVID-19 pandemic: a cross-sectional study in Guangzhou, China.

BACKGROUND: The COVID-19 pandemic continues to impact global health and China requires a 14-day quarantine for individuals on flights with positive COVID-19 cases. This quarantine can impact mental well-being, including sleep. This study aims to examine the impact of psychosocial and behavioral factors on insomnia among individuals undergoing quarantine in hotels. METHODS: This study was a cross-sectional survey carried out in Guangzhou, China. The data was gathered through online questionnaires distributed to international passengers who arrived in Guangzhou on flights and were required to undergo a 14-day quarantine in hotels arranged by the local government. The questionnaires were sent to the participants through the government health hotline "12,320." RESULTS: Of the 1003 passengers who were quarantined, 6.7% reported significant anxiety and 25.0% had varying degrees of insomnia. Anxiety was positively associated with insomnia (ß = 0.92, P < 0.001), while collectivism (ß = -0.07, P = 0.036), indoor exercise (ß = -0.50, P < 0.001), and the perceived people orientation of the public health service (ß = -0.20, P = 0.001) were negatively associated with insomnia. The study also identified moderating effects, such that a higher sense of collectivism, a greater frequency of indoor exercise, and a higher perception of the people-oriented of the public health service were associated with a lower impact of anxiety on insomnia. These moderating effects were also observed in participants with varying degrees of insomnia. CONCLUSIONS: This study reveals that a proportion of people undergoing entry quarantine experience insomnia and confirms how psychosocial and behavioral factors can alleviate insomnia in this population.

Lessening the Impact of Opioid Misuse at a Federally Qualified Health Center in New York: Outcomes of an Integrated Workforce Training Program.

The COVID-19 pandemic has placed an unprecedented burden on patients, health care providers, and communities and has been particularly challenging for medically underserved populations impacted by the social determinants of health, as well as people with co-occurring mental health and substance use risks. This case study examines outcomes and lessons learned from a multisite low-threshold medication-assisted treatment (MAT) program at a federally qualified health center in partnership with a large suburban public university in New York to integrate and train Health Resources & Services Administration Behavioral Health Workforce Education and Training-funded graduate student trainees in social work and nursing in screening, brief intervention, and referral to treatment and patient care coordination, including social determinants of health and medical and behavioral comorbidities. The MAT program for the treatment of opioid use disorder has a low threshold for entry that is accessible and affordable, reduces barriers to care, and uses a harm reduction approach. Outcome data showed an average 70% retention rate in the MAT program and reductions in substance use. And, while more than 73% of patients reported being somewhat or definitely impacted by the pandemic, most patients endorsed the effectiveness of telemedicine and telebehavioral health, such that 86% indicated the pandemic did not affect the quality of their health care. The main implementation lessons learned were the importance of increasing the capacity of primary care and health care centers to deliver integrated care, using cross-disciplinary practicum experiences to enhance trainee competencies, and addressing the social determinants of health among populations with social vulnerabilities and chronic medical conditions.

Pediatric Behavioral Health during the COVID-19 Pandemic: Expert Advice for Preparedness, Response, and Recovery.

The COVID-19 pandemic exacerbated the child mental health crisis and existing disparities. Child anxiety, depression, suicide attempts and completions, and mental-health-related emergency department visits significantly increased. In response to this crisis, the Administration for Strategic Preparedness and Response (ASPR) developed behavioral health task forces associated with funded pediatric centers of disaster excellence. The Health Resources and Services Administration (HRSA) funded the Pediatric Pandemic Network (PPN) to prepare for future endemics and pandemics, with behavioral health identified as a priority in mitigation, preparedness, response, and recovery. This commentary provides insights from pediatric disaster preparedness and response behavioral health subject matter experts. Our roles have been to identify how to build behavioral health professional competencies across disciplines and various medical settings and to strengthen emergency interdisciplinary behavioral health care capability regionally and at the national level. Specific examples of interdisciplinary training and demonstration projects are included as models for enhancing behavioral health situational awareness and developing curricula to support preparedness and response for the current ongoing pandemic and future natural and biological disasters. This commentary also includes a call to action for workforce development to move beyond a boots-on-the-ground mentality for pediatric behavioral health disaster preparedness and response toward a more inclusive role for behavioral health providers of varied specialties. This means that behavioral health providers should become more informed of federal programs in this area, seek further training, and find innovative ways to collaborate with their medical colleagues and community partners.

Optimizing the pediatric patient centered care medical home through a trauma informed care lens

The need for mental health services in primary care settings to address trauma remains a pressing issue for pediatrics. The existing literature supports the compatibility of Trauma-Informed Care Principles in Patient-Centered settings to address trauma, yet despite professional guidelines highlighting these models, a specific example within a primary care setting remains unrealized. This paper will conceptualize a Trauma Informed Medical Home model with Integrated Behavioral Health utilizing some aligning concepts such as safety, accessibility and collaboration found within the Trauma Informed Care and a Medical Home guideline. The resulting conceptualized model will represent a strengthened primary care setting where the delivery of mental health services using a trauma-informed lens can optimize patient-centered primary care medical home services.

A retrospective review of COVID-19 testing and mitigation strategies at a psychiatric hospital and subsequent COVID-19 acquisition.

BACKGROUND: Behavioral health settings present increased challenges in preventing the transmission of infectious agents. Characterizing the relative effectiveness of various strategies, including testing for asymptomatic carriage of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, will inform transmission reduction efforts in behavioral health settings. METHODS: A single-center retrospective study was conducted in an inpatient behavioral health hospital by reviewing COVID-19 mitigation and testing strategies with information collected from discharges between July 1, 2020 and February 28, 2021. RESULTS: During the study period, there were 3,694 total discharges and 3,229 unique admitted patients, including 86 (2.7%) patients who had positive SARS-CoV-2 polymerase chain reaction test results. Preadmission testing from noncongregate care settings (38, 44.1%), and testing after an in-hospital exposure (27, 31.4%) were the most common indications for testing among patients with a positive test. Up to 29 (33.7%) potentially acquired the infection during their hospitalization. Asymptomatic screening tests identified approximately two-thirds (55, 64.0%) of potentially contagious patients. CONCLUSION: Asymptomatic screening testing on admission and after exposure and universal masking were strong interventions to prevent SARS-CoV-2 transmission in this investigation Future studies of SARS-CoV-2 and other pathogens in behavioral health settings should endeavor to characterize the effectiveness of infection prevention interventions.

The Rapid Evolution of Crisis Mental Health Services in Utah: Opportunities and Challenges as a Result of the Global Pandemic.

Our country is facing a resurgence of behavioral health crises from over the past 30 years, further illuminated and exacerbated by the global COVID-19 pandemic. Increasing suicide crises among youths over recent decades, untreated anxiety and depression, and serious mental illness are signs of the need for improvements in accessible, affordable, timely, and comprehensive behavioral health services. Against the backdrop of high suicide rates and low behavioral health services in Utah, statewide collaborators aligned with a common goal: deliver crisis services to anyone, anytime, and anywhere. After its initiation in 2011, the integrated behavioral health crisis response system continued to expand and excel, ultimately improving access and referral to services, flattening suicide rates, and reducing stigma. The global pandemic further motivated the expansion of Utah's crisis response system. This review focuses on the unique experiences of the Huntsman Mental Health Institute as a catalyst and partner in these changes. Our goals are to: inform about unique Utah partnerships and actions in the crisis mental health space, describe initial steps and outcomes, highlight continuing challenges, discuss pandemic-specific barriers and opportunities, and explore the long-term vision to improve quality and access to mental health resources.

A Comprehensive Examination of Pediatric Behavioral Health Service Demand and Utilization in a Large, Academic Health System from 2019 to 2021.

Studies of the effects of COVID-19 on youth suggest a worsening in mental health globally. We performed a retrospective analysis of data from January 2019-November 2021 for all outpatient referrals, as well as outpatient, inpatient, and emergency department (ED) encounters for behavioral health (BH) reasons in children aged < 18 in a large academic health system in the United States. Mean weekly rates of outpatient psychiatry referrals, outpatient psychiatry visits, ED visits, and inpatient admissions for BH reasons were compared between pre-pandemic and pandemic periods. The average weekly rate of ambulatory referrals (8.0 ± 0.33 to 9.4 ± 0.31) and completed appointments (194.2 ± 0.72 to 213.1 ± 0.71) significantly increased during the pandemic, driven largely by teenagers. The weekly average of ED pediatric encounters for BH did not increase during the pandemic, although the percentage of all pediatric ED encounters that were for BH did increase from 2.6 to 4.1% (p < 0.001). Length of stay for pediatric BH ED patients increased from 1.59 ± 0.09 days pre-pandemic to 1.91 ± 0.11 days post-pandemic (p < 0.0001). Inpatient admissions for BH reasons overall decreased during the pandemic, due to a decrease in inpatient psychiatric bed capacity. However, the weekly percentage of inpatient hospitalizations for BH reasons that occurred on medical units increased during the pandemic (15.2% ± 2.8-24.6% ± 4.1% (p = 0.0006)). Taken together, our data suggest the COVID-19 pandemic had varying degrees of impact, depending on the setting of care.

A sketch of the problem

In 2019, the world changed in significant ways. The emergence and spread of the virus SARS-CoV-2, more commonly known as COVID-19 to note the year of its development into a pandemic, altered social and economic conditions everywhere. All nations of the world had to contend with the virus and its effects. This chapter draws on ecological systems theory to highlight the ways in which various systems were able to/unable to address children and adolescents' social, emotional, behavioral, and mental health needs during the pandemic. It lays out the assumptions that underlie ecological systems theory, a developmental theory that explores human development as the result of interacting and intertwined ecological contexts. The chapter provides an illustration of how the social, emotional, behavioral, and mental health needs of children and adolescents have been and continue to be shaped by interactions across these various ecological contexts. It considers next steps and outlines how research, policy, and practice might take up ecological systems theory in seeking to address the persistent and pervasive problems of children and adolescents' well-being in the context of intertwined and overlapping systems. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study.

BACKGROUND: During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. OBJECTIVE: This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. METHODS: In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. RESULTS: The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. CONCLUSIONS: UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings.

Primary care behavioral health in the time of COVID-19

People are commonly receiving mental health treatment from primary care providers rather than from behavioral health providers. To address this issue, the healthcare system has begun to integrate behavioral health providers into primary care clinics, known as integrated primary care (IPC). Research suggests that IPC can lead to a number of benefits, including increased likelihood of patients receiving the appropriate standard of care, as well as reduction in healthcare costs due to medical cost offset. While IPC is a promising method of healthcare delivery, additional research is needed to optimize this system. Additionally, the onset of the COVID-19 pandemic has drastically impacted the mental and physical health needs of the United States population, especially for low income and racial and ethnic minority populations. However, there is little research on how this has impacted the presenting problems seen in IPC, or how IPC utilization may have been impacted. This study will examine patient characteristics and IPC utilization of two clinics serving a low income and racial and ethnic minority population and assess how patient and provider characteristics are impacting the process of IPC. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Older adults' behavioral health during the COVID-19 pandemic

COVID-19's effects go beyond physical health, including impacts to behavioral health such as documented increases in loneliness, depression, anxiety, and alcohol misuse. Research on other disaster and mass trauma events suggests that behavioral health impacts may persist for many years after the initial onset of the event and could be compounded with other disasters. These impacts have not, and will not, be distributed evenly across the population. Of note, evidence from early in the pandemic suggests that older adults' (adults aged 65 and older) behavioral health may not be as adversely affected as expected, given past research on age and disasters. © 2023 The authors.

Alcohol screening during COVID-19 surges in an urban health system the United States.

In 2021, over 50% of U.S. adults drank alcohol in the past month with over 25% reporting binge drinking, an increase over previous years. Alcohol use is associated with increased risk of accidents, poor birth outcomes, cancer, chronic diseases, and mortality. During the COVID-19 pandemic alcohol consumption and alcohol-related deaths increased. National organizations recommend screening for unhealthy alcohol use in general health care settings as a prevention strategy. This observational study examined alcohol screening rates in primary care practices in Boston, MA in the context of the COVID-19 pandemic, from July 2019 through May 2022. Screening rates were mapped, by month, to the number of COVID-19 cases. Alcohol screening dropped substantially during the first COVID-19 surge but steadily increased to baseline between the second and third surges. This decline was likely due to competing pandemic-related priorities (e.g., testing, urgent care) and the transition to telemedicine. While some health screening cannot be completed virtually, screening for alcohol is possible. Innovative workflow strategies (e.g., pre-visit screening via patient portals, support staff screening using virtual rooming processes) should be considered to avoid future interruptions of screening for unhealthy alcohol use in primary care.

Barriers to recruiting primary care practices for implementation research during COVID-19: A qualitative study of practice coaches from the Stop Unhealthy (STUN) Alcohol Use Now trial.

Background: The COVID-19 pandemic has brought widespread change to health care practice and research. With heightened stress in the general population, increased unhealthy alcohol use, and added pressures on primary care practices, comes the need to better understand how we can continue practice-based research and address public health priorities amid the ongoing pandemic. The current study considers barriers and facilitators to conducting such research, especially during the COVID-19 pandemic, within the context of recruiting practices for the STop UNhealthy (STUN) Alcohol Use Now trial. The STUN trial uses practice facilitation to implement screening and interventions for unhealthy alcohol use in primary care practices across the state of North Carolina. Methods: Semistructured interviews were conducted with a purposive sample of 15 practice coaches to discuss their recruitment experiences before and after recruitment was paused due to the pandemic. An inductive thematic analysis was used to identify themes and subthemes. Results: Pandemic-related barriers, including challenges in staffing, finances, and new COVID-19-related workflows, were most prominent. Competing priorities, such as quality improvement measures, North Carolina's implementation of Medicaid managed care, and organizational structures hampered recruitment efforts. Coaches also described barriers specific to the project and to the topic of alcohol. Several facilitators were identified, including the rising importance of behavioral health due to the pandemic, as well as existing relationships between practice coaches and practices. Conclusions: Difficulty managing competing priorities and obstacles within existing practice infrastructure inhibit the ability to participate in practice-based research and implementation of evidence-based practices. Lessons learned from this trial may inform strategies to recruit practices into research and to gain buy-in from practices in adopting evidence-based practices more generally. Plain Language Summary: What is known: Unhealthy alcohol use is a significant public health issue, which has been exacerbated during the COVID-19 pandemic. Screening and brief intervention for unhealthy alcohol use is an evidence-based practice shown to help reduce drinking-related behaviors, yet it remains rare in practice. What this study adds: Using a qualitative approach, we identify barriers and facilitators to recruiting primary care practices into a funded trial that uses practice facilitation to address unhealthy alcohol use. We identify general insights as well as those specific to the COVID-19 pandemic. Barriers are primarily related to competing priorities, incentives, and lack of infrastructure. Facilitators are related to framing of the project and the anticipated level and type of resources needed to address unhealthy alcohol use especially as the pandemic wanes. Implications: Our findings provide information on barriers and facilitators to recruiting primary care practices for behavioral health projects and to implementing these activities. Using our findings, we provide a discussion of suggestions for conducting these types of projects in the future which may be of interest to researchers, practice managers, and providers.

Frontline Perspectives from the Implementation of Evidenced-Informed Interventions to Improve Behavioral Health and HIV Outcomes Among Black Men Who Have Sex with Men in the United States.

The perspectives and contributions of frontline staff are critical to the success of integrated HIV and behavioral health services in the United States (US). In this analytic essay, we share five key priority areas from frontline staff at four diverse sites funded by the Health Resources and Services Administration to support the implementation of interventions to improve HIV and behavioral health outcomes among Black men who have sex with men (BMSM) living with HIV. The five main priorities focused on: (1) COVID-19 pandemic adaptations; (2) recruitment/enrollment; (3) retention; (4) frontline self-care; and (5) replication considerations. Projects had to be nimble and innovative in their delivery of services; leverage existing infrastructure; and they had to try multiple approaches to reach BMSM and modify/drop them as needed. Future implementers should expect to support frontline staff self-care given the added stress of working under COVID-19 pandemic conditions and in communities with limited and uncoordinated behavioral health services.

Client-level barriers to successful utilization of telehealth for clients with autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and repetitive, restricted behaviors, with a current estimated prevalence of 1:54. Individuals with ASD typically benefit from a range of medical, psychological, and other services due to impairments caused by ASD as well as high rates of comorbid conditions. Despite this increased need, individuals with ASD and their families often report significant difficulty accessing services, an issue which is compounded for some groups including minoritized racial groups and people living in rural areas. The current study sought to identify challenges faced by clients with ASD and their families when attempting to access behavioral health services via telehealth within the context of the COVID-19 pandemic. Specific research questions were: (1) What are the most common challenges faced by clients with ASD and their families when attempting to access telehealth services? (2) What are the most problematic barriers (i.e., barriers most associated with being unable to access telehealth) faced by clients with ASD and their families when attempting access telehealth services? and (3) Which demographic groups (e.g., race, age, comorbidities) are least likely to be able to access telehealth?Data were extracted from client records of a multi-site provider of developmental disability (DD) services in Ohio following Institutional Review Board (IRB) approval. Results of our analyses suggest that the most common challenges faced by clients with ASD and their families were issues related to client behavior, including client inattention, client noncompliance, and need for in-person support. In regard to ability versus inability to access telehealth services, need for in-person support was found to be related to decreased likelihood of receiving telehealth services, and client inattention was found to be related to increased likelihood of receiving telehealth services. Demographic groups most likely to experience difficulty accessing telehealth services were African American/Black clients and clients with a language disorder.Results of the current study re-iterate challenges identified in previous studies on healthcare access for clients with ASD and their families, including issues related to behavior and communication difficulties. They also highlight the effects of race on access to services, with minoritized racial groups consistently being found to experience increased challenges in accessing healthcare. While future research should further study these effects on additional samples and outside of the context of COVID-19, the current results provide information on where interventions designed to increase access to behavioral health services may be most efficiently targeted. Possible solutions to address identified issues are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

COVID-19 and the healthy lifestyle behaviors of community college students

The young adult college student population has been the focus of lifestyle research showing a growing decline in this population's mental and physical health. The introduction of the contagious COVID-19 virus and accompanying shelter-in-place (SIP) orders drastically altered this population's lives and lifestyle behaviors. Although health behavior, mental health, stress, and anxiety information was available concerning COVID-19 for the 4-year college student population, there was minimal literature on the unique faction of community college students. Thus, this study was a means to compare the COVID-19 SIP orders with the healthy lifestyle behaviors of community college students before, during, and after the health crisis. The social cognitive theory provided a framework to understand better how personal, environmental, and behavioral factors played a role in the healthy lifestyle behaviors of this population. Purposive sampling was the approach used to obtain a sample of community college students. The participants completed a retrospective survey regarding their lifestyle behavior before, during, and after the COVID-19 SIP orders. Quantitative data analysis included descriptive statistics, crosstabulations, a coefficient of determination, and dependent and independent t tests to evaluate or compare lifestyle behaviors at different times related to COVID-19. Results indicated that the lifestyle behaviors of surveyed participants were not optimal before COVID-19 and further declined during and after the SIP orders. College administrators and local public health officials could use the results to educate and allocate resources related to lifestyle behavior best practices for virus protection and enhanced quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved)