Guidelines for psychological practice for people with low-income and economic marginalization: Executive summary.

This is a summary of the guidelines for working with low-income and economically marginalized (LIEM) people developed by the American Psychological Association (APA) task force and approved by the APA Council of Representatives. The task force, consisting of psychologists from a range of psychological specialties and both practice and educational settings, created guidelines in four main categories: Education and Training, Health Disparities, Treatment Considerations, and Career Concerns and Unemployment. Each category includes specific guidelines and recommended interventions. Further, the task force identified two major assumptions that cut across all of the recommendations: (1) The intersection of economic status and other identities is critical to psychological and other aspects of health, and (2) biases and stigma exacerbate the negative experiences of living with LIEM, and must be acknowledged and confronted by psychologists and trainees. Many of the guidelines and corollary interventions reinforce the need for psychologists and trainees to engage in activities that increase their own self-awareness and knowledge of issues and concerns that are exacerbated by economic marginalization, as well as challenge their own implicit and explicit biases related to social class and poverty. The impact of economic marginalization on education, health, and career attainment are addressed, and adaptations to psychological interventions are recommended. The task force concludes with a call to engage psychologists in action that seeks and promotes economic justice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Responding to COVID-19 through an integrated primary care/behavioral health program.

Background and Implementation: Novel coronavirus disease 2019 (COVID-19) has presented unique challenges for patients and health care systems, including a surge in behavioral health (BH) needs. A community teaching public hospital system in Massachusetts (MA) whose 13 primary care (PC) clinics serve a diverse patient population, has developed a model for Primary Care Behavioral Health Integration (PCBHI) to provide brief, evidence-based interventions to patients in PC. In response to COVID-19, the system developed an intensive community management strategy to care for patients with COVID-19 outside of the hospital, and its PCBHI program adapted alongside this strategy to provide rapid support to patients in emotional distress. Over a 13-week period, 78 patients were specifically referred to the PCBHI COVID clinic and received rapid therapeutic support and/or care navigation. Recommendations: This article will discuss the development and implementation of the PCBHI COVID clinic, common presenting issues and clinical interventions used, and lessons that informed our adaptation of clinic operations and that can serve as recommendations to other health systems in establishing similar services. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prevalence of Hoarding Behavior Among Formerly Homeless Persons Living in Supported Housing.

Hoarding disorder has become an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Hoarding disorder affects approximately 1.5% to 5% of the general population, and there is no known literature that has examined the prevalence of hoarding disorder among homeless populations or those living in supported housing, although hoarding problems can jeopardize their housing situation. This study used the Clutter Image Rating to estimate the prevalence of possible hoarding behavior among 660 adults living in supported housing. The results indicate that 18.5% of supported housing residents had hoarding behavior, which is more than three times the prevalence reported in the general population. These results suggest that hoarding behavior and possibly hoarding disorder may be more prevalent among those with histories of homelessness and housing instability, which may be of concern because it may affect both housing and health statuses.

Barriers and Facilitators to Implementing a Short-Term Transdiagnostic Mental Health Treatment for Homeless Persons.

Despite the significant mental health needs and comorbidity in homeless individuals, there is a "science-practice gap" between the available evidence-based treatments (EBTs) and their lack of use in community health centers servicing homeless populations. To address this gap, it is imperative to evaluate and attend to the contextual factors that influence the implementation process of EBTs before their integration into routine care. The study aims to evaluate the barriers and facilitators to implementing a transdiagnostic EBT in a community health center serving homeless individuals. The results of the thematic analyses (7 focus groups, 67 participants) yielded 8 themes for barriers and 10 themes for facilitators to implementation. The findings of the current study highlight common tensions faced by community programs and clinicians when working toward integrating EBTs across different types of populations, and those unique to homeless persons. Results can inform subsequent strategies used in implementing EBTs.

An Evaluation of Racial and Ethnic Health Differences in State Mental Health Inpatient Services: 2002-2005 Versus 2010-2011.

This study analyzed racial-ethnic differences previously documented in the Connecticut Department of Mental Health and Addiction Services mental health inpatient system across two time periods (2002-2005 and 2010-2011). Comparisons of logistic regression analyses from the two time periods showed that, at time 1, significant racial-ethnic differences were found for referral by other sources (e.g., outpatient), length of stay, discharge against medical advice, and some diagnostic differences (e.g., schizophrenia, other psychotic disorders, cluster B discharge diagnosis), but these differences were not significant at time 2. Other diagnostic differences remained significant at time 2 (e.g., mood disorders, substance use disorders, other axis I disorders, mental retardation) as well as racial-ethnic differences in self-referral. These results suggest that the multiple national and state cultural competence initiatives between time 1 and time 2 could have resulted in decreases in racial-ethnic differences. Targeted interventions to alleviate the remaining differences are needed.