Transitioning Behavioral Healthcare in Louisiana Through the COVID-19 Pandemic: Policy and Practice Innovations to Sustain Telehealth Expansion.

A statewide COVID-19 quarantine order forced an abrupt shift for Louisiana's behavioral health providers who provide mental health and substance abuse treatment services. The Center for Evidence to Practice conducted a study of this unprecedented shift to better understand the disruption and continuation of care during early statewide adoption of telemental health. The Center performed a mixed-method assessment including a series of focus groups and key informant interviews followed by a survey of over 300 responding providers. Over 85% of providers reported sustaining behavioral health services using a variety of telemental health strategies. While traditional referral networks and client volume were significantly disrupted, temporary relaxation of Medicaid regulatory and reimbursement policies appeared to be a key facilitator of telemental health adoption and continued services. Shifting to telemental health relied on provider's quick adaptations, engaging clients with a hybrid of teleconferencing platforms, calls/texts, and socially-distanced in-person visits. Larger multi-clinician providers and evidence-based practice (EBP) providers were better equipped to support the adoption of telemental health. Rural and EBPs providers disproportionately discontinued services. Although many practitioners viewed the original COVID-19 pandemic as a short-lived condition, the recent emergence of Delta and other variants has shown the impact on the BH care system may be lasting. Flexibility across policies and a variety of telemental health platforms are keys to telehealth adaptation. However, the contraction of the client base raises concerns of increasing disparities among vulnerable and hard-to-reach populations if telemental health becomes a sustained approach in response to future COVID-19 variants.

Specialization Within a Specialty: Advanced Practice Psychiatric Nursing Pathways for the Greatest Good.

Dr. Hildegard Peplau's theory on the primacy of the therapeutic interpersonal relationship remains central to the role of the psychiatric-mental health advanced practice nurse (PMH APN). In 1989, Peplau published her thoughts on how World War II (WWII) shaped early PMH APN practice. Following WWII and the return of hundreds of thousands of previously mentally healthy service members with combat-related psychiatric symptoms and disorders, the prevailing societal beliefs about mental illness began to shift from an innate/inherited etiological perspective to a broader appreciation of the additional contributions of social and environmental factors to mental well-being. With that awareness came a decrease in stigma and a shift from housing patients in psychiatric hospitals to treating them in community settings. The coronavirus 2019 (COVID-19) pandemic has likewise affected societal beliefs through exposure to the mental toll of massive infection rates, loss of life, social isolation, and other downstream consequences. During these times of crises, psychiatric nurses and educators are challenged to provide innovative solutions to meet the increased demands for psychosocial care. [Journal of Psychosocial Nursing and Mental Health Services, 59(10), 13-18.].

A 12-Week Evidence-Based Education Project to Reduce Cardiovascular and Metabolic Risk in Adults With Serious Mental Illness in the Integrated Care Setting.

BACKGROUND: Individuals with serious mental illness (SMI) such as schizophrenia spectrum disorders, severe bipolar disorder, or severe recurrent major depressive disorder have a shorter life expectancy compared with those in the general population. This is largely due to the higher rates of diabetes, hyperlipidemia, and hypertension. Treatment adherence, diet, exercise, and weight management are modifiable risk factors for these cardiometabolic conditions, yet the use of educational lifestyle interventions is not common practice in the clinical setting. AIM: The purpose of this project was to evaluate a 12-week evidence-based diabetes prevention education program integrated into a primary care behavioral health setting for adults with SMI, diabetes, or prediabetes, and who were overweight or obese. METHOD: This project utilized a pretest-posttest intervention design. Outcomes for this project included diabetes knowledge, self-care, and health indicators (blood pressure, hemoglobin A1C, weight, body mass index, and medication adherence). The project also addressed feasibility and acceptability of the program in this setting. RESULTS: Project outcomes showed a reduction in weight, waist circumference, hemoglobin A1C, and blood pressure. Outcomes also indicated an improvement in participants' self-knowledge and self-care. CONCLUSIONS: There was a high attendance rate and overall acceptability and feasibility described by participants. This project highlights the important role that primary care providers can play in providing health education to patients with SMI.

Rural-urban disparities in the distribution of dental caries among children in south-eastern Louisiana: a cross-sectional study.

INTRODUCTION: The purpose of this cross-sectional study was to assess the prevalence of dental caries among elementary school-aged children in rural compared to urban communities within south-eastern Louisiana that have participated in a school-based dental screening and sealant program. METHODS: The authors utilized de-identified Sealant Efficiency Assessment for Locals and States screening data for 2007-2014 provided by The Health Enrichment Network oral health program. The screening was conducted throughout 46 elementary schools in Louisiana. Screening forms recorded decayed, missing, and filled permanent teeth (DMFT). Descriptive statistics including demographic characteristics and oral health conditions were calculated. Univariate and multivariable logistic regression analyses were performed to assess the burden of caries in schools. RESULTS: Of 963 children screened, 32% had dental caries. There was an increased risk of having any DMFT among children who attended rural schools as compared to those who attended urban schools (prevalence odds ratio (POR)=2.17, 95% confidence interval (CI)=1.61-2.93). This study found that non-Hispanic black children had reduced odds of DMFT as compared to the children from other reported ethnicities (POR=0.695, 95%CI=0.503-0.960). CONCLUSION: A higher prevalence of dental caries was found in rural compared to urban communities. Further research is needed to assess the extent of geographic differences to improve oral health outcomes.

Prescription opioid use among individuals with serious mental illness.

Prevalence and correlates of prescription opioid use were explored in individuals with serious mental illness (SMI) by examining a sample of adults from two inner city community psychiatry clinics. Of 271 participants, 12.9% (n = 35) were on a prescribed opioid. Being on an opioid was significantly associated with history of heroin use and active prescription sedative-hypnotic use, including benzodiazepine use. Concurrent use of opioids with sedative-hypnotics was significantly associated with suicidal ideation. The results highlight risks of prescription opioid use in those with SMI, particularly in combination with prescription sedative-hypnotics.

Interrater reliability of the modified Monitoring of Side Effects Scale for assessment of adverse effects of psychiatric medication in clinical and research settings.

The assessment of adverse effects of psychiatric medications is important in clinical and research settings because they are often associated with medication discontinuation, symptom exacerbation, and reduced quality of life. Currently available assessment tools are either limited with regard to the number and variety of included adverse effects or are not practical for use in most clinical or research settings owing to specialized rater training required and administration length. This report describes a modification of the Monitoring of Side Effects Scale (MOSES), an established adverse effect rating scale, by adding severity anchors to improve its reliability and ease of use. Interrater reliability was good for 7 of the 8 bodily adverse effects assessed, with intraclass correlation coefficients ranging from 0.76 to 0.91 in a sample of patients with severe mental illness. This modified version of the Monitoring of Side Effects Scale holds promise as a useful tool for assessing medication adverse effects in clinical and research settings.