Young people in foster care and substance use.

Adolescents are at high risk for using substances and for young people in foster care, substance use rates are estimated to be as high as 49 %. Adolescence is an important period for preventing substance use and SUD. Universal screening, brief interventions, and substance use treatment can be used to decrease substance use and substance use disorders among adolescents. Brief interventions often used with adolescents include motivational interviewing and contingency management. Of the many types of outpatient therapies utilized to treat adolescents with substance use disorder, some of the most established include cognitive behavioral therapy, family-based therapy, and a combination of different types of interventions. Medication treatment is less frequently offered to adolescents due to buprenorphine being the only drug FDA approved for youth under the age of 18. Residential treatment is also an option if lower levels of care are not adequate to safely support youth. Lastly, limited research has looked at the effectiveness of continuing care options to support youth in maintaining treatment results.

Speech-Language Outcomes in the COVID-19 Milieu for Multilingual Jamaican Preschoolers and Considerations for Telepractice Assessments.

PURPOSE: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions. METHOD: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English-speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica. RESULTS: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate. CONCLUSIONS: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25461505.

Professionals ready to integrate care (PRI-Care): A mental health training collaborative.

INTRODUCTION: Increasing demand for integrated care necessitates interprofessional training of mental and behavioral professionals. This study examines the effect of an interprofessional training program for social work and counseling trainees (PRI-Care) in 3 areas: interprofessional valuing and socialization, team skills, and professional development, including the interrelationship between these 3 areas. METHOD: A cross-sectional survey-based pre-post design was utilized across 4 cohorts of students participating in the training program from 2018 through 2021. RESULTS: Among 111 students, interprofessional valuing and socialization, team skills, and professional development increased in pre- to post surveys. Older trainees had higher self-perceptions of interprofessional valuing and socialization. Further, higher levels of interprofessional valuing after training predicted higher self-perceived professional development. DISCUSSION: Students entering work in mental and behavioral health benefited from the specialized interprofessional training. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pandemic-Related Disruptions in Nursing Education: Zooming Out for an Innovative Interprofessional Simulation.

When the COVID-19 global pandemic began, many higher education systems had to restructure their educational delivery system and transition to online learning. This posed a challenge for students in health professions education programs as it impacted their ability to participate in hands-on learning regarding patient care. As a result, the University of Cincinnati College of Nursing developed and implemented simulation-based learning experiences to allow graduate-level social worker, counselor, and psychiatric-mental health nurse practitioner students the opportunity to learn as an interdisciplinary team in a virtual format. The Opioid Use Disorder Simulation Case Study discussed in this article was developed as part of the Serving At-risk Youth Fellowship Experience Training program with the overarching aim to prepare culturally competent providers to deliver direct patient care and education around prevention and recovery services to individuals with substance use disorders.

Outcomes of an interprofessional SBIRT training program: Knowledge attainment and perceived competence for practice.

Background: One way to address substance misuse is to train health professional students in Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention strategy. This study evaluated a semester-long, 50-hour elective SBIRT training that blended online coursework with interprofessional experiences. Medicine, nursing, pharmacy, and social work students completed an interprofessional standardized patient experience and completed a minimum of two interprofessional SBIRT experiences at community agencies. Methods: We analyzed longitudinal data from 197 students using structural equation modeling to examine gains in knowledge and perceived competence, as well as to test if background variables predicted 30-day application of SBIRT knowledge and skills, 30-day satisfaction' 12-month frequencies of care for performing SBIRT; and number of SBIRT clients/patients served directly. Results: Overall, student SBIRT knowledge and perceived competence both increased by more than a standard deviation during the course. Students who experienced larger gains in perceived competence rated the course significantly higher in terms of relevance and usefulness and, in turn, served significantly more SBIRT clients/patients during the following year. We did not find evidence that intra-individual growth in knowledge impacted the degree to which students ultimately applied SBIRT components. Finally, students who had more previous training and experience related to substance abuse ultimately reported greater application of SBIRT knowledge and skills. Interprofessional differences included: At baseline, medicine students had significantly lower substance abuse education knowledge as compared to the other disciplines. Pharmacy and social work students were more likely to have had previous experience with motivational interviewing. Baseline perceived competence in applying SBIRT was higher in social work and nursing. Upon completion, pharmacy and medicine students had lower satisfaction with the course. Conclusions: These findings suggest that SBIRT courses can increase knowledge and perceived competence; moreover, student background characteristics, work settings, and experiences may have important effects on learning SBIRT.

Structure and longitudinal invariance of the Short Alcohol and Alcohol Problems Perception Questionnaire.

Many studies have employed the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) to measure professionals' attitudes toward working with people experiencing alcohol problems. However, research has not confirmed the internal structure of the SAAPPQ, leaving open the possibility that scale scores are not valid empirical proxies for underlying attitudes. It is also unclear if measurement invariance holds over time or across groups. This is an important gap in light of evidence that (a) experiences can change the structure of scales and (b) structures of some popular scales differ dramatically between groups. Thus, measurement bias may confound comparisons of composite SAAPPQ scores between measurement occasions or groups. To address these gaps in the literature, we conducted a longitudinal examination of the psychometrics of the SAAPPQ using data from 241 human services professionals-in-training. We found a four-factor structure, rather than the previously reported five factors. Configural, metric, and a strong degree of scalar invariance held longitudinally. Few factor intercorrelations were significant at time one and they strengthened over time, suggesting that the SAAPPQ should not be aggregated at higher-order levels (i.e., global scores should not be used). Findings suggest four SAAPPQ subscale scores may be used as valid proxies for attitudes toward alcohol users; however, additional confirmatory studies are needed to ensure that measurement bias does not compromise inferences based on SAAPPQ scores.

Preparing Master of Social Work Students for Interprofessional Practice.

PURPOSE: This study aims to measure growth in interprofessional knowledge, skills, and values in MSW students from three universities who participated in a Behavioral Health Workforce Education and Training program focused on serving children, adolescents, and transition-age youth. METHODS: Students participated in an interprofessional field placement and specialized educational sessions that addressed interprofessional team-based care, engaging at-risk youth and families, and working with vulnerable populations. The Interprofessional Socialization and Valuing Scale (ISVS) was administered pre- and post-experience. RESULTS: Paired t-tests of the ISVS total score and each subscale showed statistically significant increases over time. Multiple regression models indicated only the pretest score was a significant predictor of the posttest score for the total or subscale of the ISVS. CONCLUSION: Social work programs that create interprofessional education and training opportunities can achieve positive outcomes in student attitudes toward interprofessional practice.

Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care.

BACKGROUND: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. OBJECTIVE: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. METHODS: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. RESULTS: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. CONCLUSIONS: Subject matter experts, although generally amenable to one another's disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building.

Assessing the Digital Divide Among Low-Income Perinatal Women: Opportunities for Provision of Health Information and Counseling.

OBJECTIVES: Technology-based health interventions may provide a means to reach low-income perinatal women and improve outcomes for both mother and infant, yet little is known about technology access and interest among this population. This study explored interest, attitudes, and concerns regarding technology to deliver health information and interventions. METHODS: Between May and October 2014, a cross-sectional study of 161 low-income pregnant and/or postpartum mothers (up to 1 year) was conducted, assessing attitudes and behaviors regarding the current use of devices and receptivity to interventions delivered through devices. Participants (ages 18-41) were pregnant or postpartum and able to read and comprehend English. Women were recruited from waiting areas at two urban clinics affiliated with the local health department in a Midwestern city in the United States. Surveys included 46 questions and were completed at the time of invitation. Descriptive statistics, independent sample t test, or chi-square for independence tests were completed using SPSS (version 23). RESULTS: Participants from this sample were mostly African American (60%) and had a mean age of 26 years. Most were postpartum (67%). The majority of the sample used mobile phones (most being smartphones), with less access and use of computers and tablets. CONCLUSION: A moderate level of interest in utilizing technology for health-related information and interventions was found, with concerns related to privacy and time.

Patient perspectives of pregnancy loss in the emergency department.

OBJECTIVES: While threats to pregnancy such as vaginal bleeding are common, half will miscarry. The ED environment is not always conducive to the emotional and psychological needs of women grieving the loss of a pregnancy. Healthcare providers have a great impact on the women's experience of pregnancy loss. This study describes the perspectives of women experiencing a pregnancy loss in the ED. METHODS: The study used a qualitative descriptive research design interviewing women diagnosed with a pregnancy loss in the ED. Data analysis consisted of descriptive statistics of the sample and content analysis of interviews. RESULTS: Eight participant interviews generated five themes related to the ED as part of the crossroads of motherhood and pregnancy loss. The themes were (a) Decisions to get help, (b) The environment of emergency care, (c) Not knowing, (d) Finally knowing and moving on, (e) Assisting with the grieving process. CONCLUSIONS FOR PRACTICE: Understanding the needs of women diagnosed with pregnancy loss allows emergency nurses and providers to provide more holistic, compassionate care. Knowledge of pregnancy loss experiences will assist in the improvement of future patient care, and may positively impact recovery and transition to normalcy.

A Review of the Management of Loss of Pregnancy in the Emergency Department.

INTRODUCTION: Women frequently seek ED care for complications in early pregnancy, including loss of pregnancy. This review evaluates the current literature and discusses the care of patients experiencing loss of pregnancy in the emergency department. METHODS: A review of pertinent studies identified through multiple database searches was conducted to determine the existing body of knowledge for the care of ED patients diagnosed with loss of pregnancy. Each of the studies was examined for inclusion criteria and a subsequent analysis of the included studies identified themes related to the care of the women. RESULTS: Thirty-two original research articles and systematic reviews published between 1990 and 2016 were included in the review. Eleven articles addressed recommendations for clinical practice, 5 reported statistics related to pregnancy outcome and clinical presentation, 4 discussed the use of speculum examinations, 4 discussed interventions to decrease ED length of stay, and 3 investigated the use of ultrasound in the emergency department. Only 5 of the articles reviewed discussed emotional support and/or experiences of women with loss of pregnancy in the emergency department. CONCLUSION: Although there are multiple recommendations for the clinical management of loss of pregnancy in the emergency department, the psychological and emotional support of women was addressed infrequently. Additional studies investigating holistic care would be beneficial for ED providers in the management of early loss of pregnancy.

A mixed-methods study of smoking attitudes and behaviors among dual-smoker stroke survivor-caregiver dyads.

Although cigarette smoking is a major contributor to continued health problems after stroke, the majority of stroke survivors do not quit smoking. This may be due in part to the high rate of smoking among committed partners of stroke survivors. This study investigated the experiences of 11 dual-smoker stroke survivor-caregiver dyads, identifying themes which may be useful for understanding this entrenched population: managing the addiction as a dyad; conflicting feelings about whether smoking is an individual versus mutual concern; and dyad-level barriers and facilitators of quitting. We also present specific cessation strategies that dual-smoker dyads participating in the study described.

Barriers to Research Recruitment of Women Experiencing a Pregnancy Loss in the Emergency Department.

Women often come to the emergency department (ED) with signs and symptoms suggesting an early pregnancy loss; yet, little is known about their experience and how it relates to future outcomes. To improve patient outcomes and experiences of women seeking care for a pregnancy loss, research is required. However, recruitment of participants experiencing an event such as a pregnancy loss is challenging. The purpose of this article is to discuss the application of an electronic medical record (EMR)-based participant screening tool recruiting women seeking care for a pregnancy loss in the ED. This study implemented an EMR-based prompt to assist participant screening completed by ED nurses: (a) The prompts were based on criteria built into triggers that activated a recruitment screening form to print upon discharge; (b) nurses completed the form with patients, asking for willingness to be contacted at home; and (c) participants were subsequently contacted and enrolled in the study. Our research screening program was implemented continuously in 2 EDs: a large, urban, academic medical center and a community academic hospital. Data were analyzed through descriptive statistics of reports built within the EMR. These reports signaled when the screening tool flagged participants and subsequently tied the corresponding information to the completed forms. The recruitment tool fired 1,169 times, with 61% (n = 714) screened. Fifty percent (n = 37) of women experiencing an early pregnancy loss were willing to be contacted at home for research recruitment. Of those approached after discharge (n = 24), 33% (n = 8) enrolled in the study. Of note, at one site, 14% (81/577) of potential participants with early pregnancy loss symptoms left before seeing a provider, with 26% (150/577) of these encounters were repeat visits. Staff education, nurse reluctance to approach potential participants, and patients who left without being seen led to barriers in participant screening.

Facilitators and Barriers to Cigarette Smoking While Pregnant for Women With Substance Use Disorders.

INTRODUCTION: Cigarette smoking among pregnant women diagnosed with substance use disorders (SUD) is four times higher than smoking among pregnant women without SUD. However, much of the literature on pregnancy and smoking has centered on the latter group. This study used the Health Belief Model as a framework to explore smoking cessation in pregnant women with SUD. METHODS: Four 60-minute focus groups were conducted with a semistructured moderator guide. Participants (N = 21) were women who smoked during pregnancy, gave birth within the past year, and were residing at a women's SUD treatment center. A directed content analysis approach was utilized for examining focus group data. RESULTS: Similar to women without SUD, barriers to smoking cessation were smoking behaviors of partners and using cigarettes to cope with stress; reasons to stop included the child's health. Participants reported that having children gave them a sense of purpose and their guilt about smoking became stronger once the child was born. Smoking also provided them with a sense of freedom. Women's triggers for smoking were interconnected with those of other addictive substances. Women identified behaviors that helped and hindered them. CONCLUSIONS: Lack of internalization of the negative effects of smoking was a barrier to stopping, indicating a need for health literacy. Furthermore, women struggled with the perception of tobacco as a drug as compared with other addictive substances. Exploring facilitators and barriers to smoking cessation among pregnant women with SUD is critical to the health and well-being of this vulnerable population. IMPLICATIONS: This study adds to the literature by identifying childbirth as an opportunity to address smoking for women with SUD. Furthermore, it supports the interconnectedness of triggers for smoking with those of other addictive substances, and the perceptual barrier tobacco is often not viewed as a drug by women with SUD. Findings demonstrate a need for increased health literacy and enhanced external supports around smoking cessation for this population.

Pregnant women with substance use disorders: The intersection of history, ethics, and advocacy.

Pregnant women with substance use disorders face many obstacles, including obtaining evidence-based treatment and care. This article (1) briefly reviews the history of pregnant women in clinical trials and substance use disorders treatment research; (2) identifies current ethical issues facing researchers studying pregnant women with substance use disorders; (3) presents and describes an ethical framework to utilize; and (4) identifies future directions needed to develop appropriate research and treatment policies and practices. Current research is not providing enough information to clinicians, policy-makers, and the public about maternal and child health and substance use disorders, and the data will not be sufficient to offer maximum benefit until protocols are changed.

Environmental tobacco smoke exposure among smokers and non-smokers receiving outpatient substance abuse treatment.

INTRODUCTION: Environmental Tobacco Smoke (ETS) has been linked to numerous health problems. While research has demonstrated high prevalence of tobacco use among individuals receiving treatment for substance use disorders (SUDs), no studies have examined ETS among individuals receiving treatment for SUDs, paying specific attention to non-smokers who may be at risk for high exposure to ETS. METHODS: Participants (N=261) enrolled in outpatient substance abuse treatment completed a survey, in which 14 items were used to quantify ETS exposure and smoking policies across several environments. RESULTS: Among smokers, 85% reported that their significant others also smoked as compared to 15% among non-smokers (χ(2)=6.624, p<.05). A logistic regression examined the characteristics that predicted smoking in the home. The overall model was significant, (χ(2)=36.046, p<.0005) with variables that independently predicted smoking in the home included having less than a high school diploma, being female, and living with a smoker. Income, age, and living with children were not found to be significant. Overall, 42% white collar workers 26% of service workers and 30% of blue collar workers reported no exposure to ETS. Sixty-seven percent of smokers strongly agreed or agreed that the hazards of secondhand smoke have been clearly demonstrated versus 58% of non-smokers. CONCLUSIONS: Smokers and non-smokers enrolled in outpatient substance abuse treatment are frequently exposed to ETS at home, work, and in social settings. The dangers of ETS should be addressed among this population through education, smoke-free policies, and cessation resources, with help from their treatment facility.

Student perspectives on interprofessional education and experiences.

PURPOSE: The purpose of this mixed-method study was to explore students' attitudes, knowledge, experience, and receptiveness to interprofessional education (IPE) in the health sciences. METHODS: An embedded mixed-method design was used whereby 29 students from 5 health sciences schools (Law, Medicine, Nursing, Pharmacy, Social Work) were administered The Readiness for Interprofessional Learning Scale (RIPLS) and participated in semi-structured interviews. RESULTS: Quantitative results indicated that there was no significant difference regarding readiness for interprofessional learning among the different academic disciplines. Qualitative interviews identified that students were exposed to two types of interprofessional learning experiences: curricular IPE and clinical interprofessional training (IPT). The majority of interprofessional experiences occurred through internships, student activities, and community service opportunities, not in the classroom. The study findings also uncovered lost opportunities for IPE, characteristics of successful interprofessional learning, and students' personal and organizational barriers to IPE. CONCLUSION: Results have implications for creating and implementing IPE and IPT experiences for students in the health sciences. Specifically, it is important to bring these students together as a collaborative team, both within the classroom and within a clinical setting. This will require a unique type of curriculum and team of instructors.

Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities.

The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) versus non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics.

Interprofessional leadership training in MCH social work.

The need to train health social workers to practice interprofessionally is an essential goal of social work education. Although most health social workers have exposure to multidisciplinary practice within their field work, few social work education programs incorporate interprofessional learning as an integrated component of both course work and field experiences (McPherson, Headrick, & Moss, 2001; Reeves, Lewin, Espin, & Zwaranstein, 2010; Weinstein, Whittington, & Leiba, 2003). In addition, little is written about the kinds of curricula that would effectively promote interdisciplinary training for social work students. These findings are particularly puzzling since there is increasing and compelling evidence that interdisciplinary training improves health outcomes (IOM, 2001). This article describes a social work education program that incorporates an Interprofessional education and leadership curriculum for Maternal and Child Health Social Work (MCHSW) at the University of Maryland's School of Social Work. The University of Maryland's Interprofesisonal Training Model is described along with the components needed to formulate an interdisciplinary learning experience. Various outcomes and lessons learned are discussed.

Client incentives versus contracting and staff incentives: how care continuity interventions in substance abuse treatment can improve residential to outpatient transition.

Interventions for improving transition from short-term residential to outpatient treatment were examined. Usual care (UC; n=114) was referral to a preferred outpatient program with advance appointment optional. Client incentive (CI; n=97) offered up to $100 in gift cards for intake and attendance during the first 30days of treatment. Contracting with staff incentives (CSI; n=49) consisted of meeting with an outpatient counselor prior to residential discharge, signing an attendance contract, receiving an appointment and payment to staff if clients attended. CSI significantly improved rates of successful transition (84%) and admission (74%) compared to UC (64% contact; 49% admitted). CI did not result in significantly improved outcomes (74%; 60%). CSI was likely mediated by the reliability (92 versus 52% in UC) and immediacy (1.0 versus 3.9days) of appointment scheduling. This study supports use of CSI for improving rates of transition between residential and outpatient continuing care treatment.