Randomized Trial to Evaluate Effects of Peer- and Clinician-Led Interventions for Caregivers of Individuals With Acquired Brain Injury.

Objective: To evaluate the effectiveness of 2 interventions for caregivers of patients with acquired brain injury (ABI) transitioning home after inpatient rehabilitation, to prepare them for the role of caregiving and reduce stress and depression. Design: Controlled trial with participants randomly assigned to (1) usual care (UC), (2) clinician-delivered Problem-Solving Training (PST), or (3) peer-led Building Better Caregivers (BBC) training; both experimental interventions initiated during the inpatient rehabilitation stay, delivered virtually, of similar intensity (six 60-minute sessions), and focused on managing stress and building skills related to caregiving. Setting: Nonprofit rehabilitation hospital specializing in care of persons with acquired brain and spinal cord injuries. Participants: Caregivers (n=169) of patients with ABI (54 stroke; 115 other ABI) admitted for rehabilitation whose discharge location was home with care provided by family members (caregivers: 83% women, 62% White, age [mean ± SD]: 51±11.5 y). Participants were recruited from February 2021 to November 2022, when COVID-19 restrictions were in place. Interventions: Noted above. Main Outcome Measures: Caregiver-reported stress, depressive symptoms, and caregiving self-efficacy; patient unplanned hospital readmissions and emergency department visits 30 days post discharge. Results: Only 61% of participants in the 2 intervention groups completed 3 or more of 6 intervention sessions and only 53% completed all data collection surveys. Statistically significant improvements between UC and PST groups were noted for caregiver stress (p=.039). Positive differences in caregiver self-efficacy found between UC and the BBC intervention groups approached significance at 30 days after discharge (p=.054). Patient unplanned hospital readmissions and days hospitalized were also higher, albeit not statistically significant, for UC participants than both intervention groups. Conclusions: Although positive findings were noted, results were negatively affected by study limitations including low enrollment and limited engagement (intervention completion and follow-up outcomes assessment). These limitations resulted, in part, from restrictions put into place during the COVID-19 pandemic, which limited contact with study participants and required alterations to the BBC intervention likely influencing its effectiveness. Despite limitations noted, the encouraging findings suggest the need for further research.

Supporting medication-assisted recovery in recovery residences: staff support, managing built environment threats, and building a supportive network.

Background: While medications for opioid use disorder (MOUD) are effective in reducing overdoses, widespread adoption and implementation of MOUD remains inadequate. Innovative approaches to promote MOUD use and to support people in their medication-assisted recovery (MAR) are needed. Recovery residences that serve people taking MOUD are steadily growing in number, yet little is known about how MOUD and the MAR pathway is promoted within the recovery residence setting.Objectives: The purpose of this qualitative analysis was to describe how recovery residences facilitate MOUD initiation and support residents' MAR pathway.Methods: We conducted interviews with 93 residents (59.1% male; 38.7% female) living in recovery residences located in five Texas cities that served people taking medication for opioid use disorder.Results: We found that recovery residence staff addressed linkage to care gaps in their communities by connecting people who might benefit from MOUD to appropriate providers. Recovery residence staff also strengthened participants' community of MAR-supportive peers by hosting or connecting residents to Medication-Assisted Recovery Anonymous meetings. Additionally, recovery residences helped some residents overcome common logistical barriers (e.g. transportation issues, housing instability, distance to providers) that hinder MOUD access.Conclusion: Recovery residences that serve people taking MOUD are a well-positioned recovery support service to promote MOUD initiation and the MAR pathway.

Person-centred crisis support services as alternatives to emergency departments: a systematic scoping review.

PURPOSE: To identify, critically appraise, and synthesise the published and grey literature on person-centred crisis support services as an alternative to support in emergency departments (EDs) for people experiencing mental health crises. This scoping review explores the characteristics and outcomes of these services. METHODS: A systematic scoping review was undertaken to identify publications describing person-centred crisis support services and their outcomes. Search strings were applied to multiple databases, and publications were subjected to quality appraisal. The review process was informed by The Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). RESULTS: Thirteen publications were included in the narrative synthesis, and these considered eight separate crisis support services. The methodological quality of the publications included was limited. Key findings were positive visitors' experiences, high rates of ED deflection, and overlaps between repeat visits, crises prevention, and hospital avoidance. Key recommendations included increasing opening hours and capacity and improving service awareness and accessibility. CONCLUSIONS: The available evidence suggests that person-centred crisis support services are perceived by stakeholders as safe and effective alternatives to EDs for people experiencing mental health crises, providing more timely and appropriate care while reducing ED mental health presentations. Due to the limited quality of the publications included, high-quality research is needed to better understand the model and confirm the findings reported in this review.

White privilege, ethnic disadvantage, and stigmatized linguistic capital: COVID-19 infection rates and lockdown law enforcement in Hong Kong.

The COVID-19 pandemic has exposed and exacerbated existing disparities in various societies. This study investigates disparities among racial, ethnic, and linguistic groups in Hong Kong's society in COVID-19 infection rates and lockdown enforcement practices that was imposed 545 times from January 2021 to September 2022 and affected 9% of the population. It is found that neighborhoods with more white individuals had lower infection rates than the overall population, while those with more ethnically minoritized groups had higher infection rates. Furthermore, hit rate tests reveal that the government targeted more neighborhoods with a higher share of individuals from linguistically minoritized groups. This novel finding suggests that not only race, but linguistic difference of the same ethnicity can cause bias. The study highlights the positive impact of providing ethnic support services on health outcomes in neighborhoods with a higher share of individuals from ethnically minoritized groups.

Quality of participants' relationships to peer recovery support specialists as a function of perceived similarities: An exploratory analysis.

Background: A growing evidence base supports the value of peer recovery support specialists (PRSS), particularly due to shared lived experience with participants (recipients of PRSS services). However, little research has examined whether congruence on certain aspects of "peerness" (e.g., demographics, experiences) matters for PRSS-participant relationships. Methods: Through a pilot study under the NIDA-funded Initiative for Justice and Emerging Adult Populations (JEAP), adults who had recently received PRSS services (N=100) were interviewed. Participants completed a modified version of the Scales for Participant Alliance with Recovery Coach (SPARC), a measure of PRSS-participant relationship quality, and rated themselves as different/similar to their PRSS in several domains using a six-point scale. Results: Participants had met with their PRSS for a median of 10 sessions over two months. SPARC scores were unrelated to participant demographics or lived experiences. However, better-quality relationships were reported by participants who believed their PRSS was similar to them in relationships with family (p=.004), spirituality/religion (p=.001), age (p<.001), and overall recovery pathway (p<.001). Total SPARC scores were not significantly correlated with perceived PRSS-participant similarities on gender, race/ethnicity, substances of choice, and history of incarceration or substance use treatment. Discussion: Results from this pilot study suggest that PRSS-participant alignment on past experiences (e.g., prior incarceration, choice of drugs) may not be needed to establish good-quality working relationships. However, similarities on factors related to current life stage (e.g., age, family relationships) and/or recovery process (e.g., overall pathway, spirituality) may be more important. Future research should employ mixed-methods approaches to elucidate these unique findings.

Online SMART Recovery mutual-help groups: a comparison of the characteristics and experiences of men living in rural and urban regions of Australia.

INTRODUCTION: Harms arising from alcohol and other drug (AOD) use are disproportionately felt by men living in rural locations. The detrimental impact of AOD use is compounded by a range of barriers to help-seeking. Online recovery support services (including mutual-help groups) are increasingly used to reach people who might not otherwise seek support for AOD use. Scant research examines the experiences of men attending online mutual-help groups, with the little available evidence focused on 12-step approaches and people living in urban areas. This short communication compared the characteristics and experiences of rural and urban men attending online Self-Management and Recovery Training (SMART Recovery) mutual-help groups in Australia. METHODS: A link to a voluntary online questionnaire was automatically provided at the end of each online group as part of routine data collection. Questions assessed participants' demographics, main reason for attending, engagement, experiences and perceived utility of the group. This study is a secondary analysis examining data provided by male attendees located in rural (n=259) and urban (n=996) areas. RESULTS: Alcohol use for both rural and urban attendees (73% v 66.8%) was the most frequently reported reason for attending SMART Recovery groups. Rural attendees were older than their urban counterparts (p<0.001) and were less likely to endorse 'other' drug use as a reason for attending (28.6% v 16.6%, p<0.001). Participants reported a high level of satisfaction with online SMART Recovery groups. No significant differences were found between the two groups. Rural and urban men reported that they felt welcome (93.1% v 95.1%) and supported (90% vs 92.5%), had the opportunity to contribute to discussions (91.5% v 92.1%), and felt the group was well facilitated (91.1% v 94.4%). Rural and urban attendees also experienced the groups as helpful (88.8% v 91.8%), took away practical strategies (86.5% v 85.2%) and planned to continue to attend the groups in the future (91.1% v 92.3%). Around a quarter of rural (20.8%) and urban (27.0%) attendees experienced technical difficulties during the meeting. DISCUSSION AND CONCLUSION: This study contributes new knowledge regarding similarities and differences in the experience of online SMART Recovery groups from the perspective of men living in rural and urban areas. Despite around a quarter of participants experiencing technical difficulties, their self-reported engagement, experience and perceived utility of the online group were highly rated. Online recovery support services provide a promising option for reaching men who experience issues with their AOD use, particularly in rural areas where access to face-to-face services is limited.

Understanding how community-dwelling persons with early dementia perceive health and community services: Informing the dementia strategy of Newfoundland and Labrador, Canada.

BACKGROUND: With an increased aging population, the number of individuals with dementia is expected to rise. The onset of dementia marks the start of negotiating access to a wide range of health and social services to find practical and emotional supports to deal with the management of changes and subsequent challenges that individual with dementia face. The toll of dementia goes beyond the health care system, affecting families and caregivers' quality of life. This places more pressure on family caregivers and health care institutions to provide services for affected individuals. It is important to understand the service needs of this population to enable them to live at home longer, contribute to society and maintain a positive quality of life. AIM: To increase understanding of how persons living at home with early dementia and their caregivers/significant others currently perceive and interact with health and community-based services and service providers. METHODS: A qualitative descriptive approach was used to explore the experiences of individuals with early dementia and care providers with health and community-based services using semi-structured interviews and content analysis. RESULTS: Participants included 16 individuals 50 years and older with mild/early dementia living at home, 22 informal caregivers of individuals with mild/early dementia, and 5 key community informants (community health nurses and social workers). Four thematic categories of barriers and two thematic categories of facilitators for access to and uptake of supportive services were identified. Five strategies to inform the development of an action plan to enhance access to, and uptake of, supportive services were determined. CONCLUSIONS: Early recognition of dementia through education and publicity enhanced public awareness, attention, and social inclusion with dementia-friendly neighborhoods and facilities need to be considered to achieve effective dementia-related services. Inclusion and recognition of the wishes of persons with dementia is key.

What We Know About the Peer Workforce and Economic Evaluation for Peer Recovery Support Services: A Systematic Review.

BACKGROUND: Peer recovery support services (PRSS) for substance use disorder (SUD) have expanded in the past 2 decades to be formally certified and reimbursed under Medicaid in almost every US state. This rapid expansion has been followed by a growth in research, but 2 persistent gaps remain: a lack of research on the peer workforce, and a lack of economic evaluation research. This systematic review examines the current literature on PRSS to summarize what is currently known about the SUD peer workforce and collect potential PRSS economic evaluation parameters, and clearly identify the current gaps in each category. METHODS: PRISMA methods were followed and a PROSPERO protocol was registered (CRD42022323516). The search included a database search of peer-reviewed journal articles and dissertations, and also a hand-search of conference presentations and evaluation reports. Manuscripts were categorized as either workforce development-related and/or those containing potential economic evaluation parameters. RESULTS: Forty-two total manuscripts were included, with 22 related to the peer workforce and 26 containing potential economic evaluation parameters. Manuscripts with workforce-related findings covered peer worker characteristics, characteristics of PRSS delivery, or peer worker training-related outcomes. Economic evaluation parameters were primarily costs related to service utilization patters with some limited reporting on peer worker pay, as well as multiple sources that can be used to estimate averted medical costs. Effectiveness parameters were primarily substance use related, as virtually all quality of life and life functioning parameters are not readily convertible to estimating quality-adjusted life years. CONCLUSION: Future PRSS research can contribute to filling these gaps in the evidence base by addressing remaining questions about the interrelationship between peer worker job satisfaction, job tenure, and patient outcomes, as well as by using more consistent outcome measures, especially in the realm of quality of life and life functioning.

Understanding the role of agency in the navigation of regional dementia care and support service pathways.

INTRODUCTION: Reliable dementia care and support service pathways are essential for timely diagnoses and for reducing the delay in time from diagnosis to care and support. However, carers commonly experience difficulties in finding information about where to go and what to do before and following a dementia diagnosis. In rural and regional areas, accessing dementia care and support services can be especially challenging. This qualitative, narrative inquiry study explores the agency of carers, and people living with dementia, in their navigation of regional dementia care and support service pathways. METHODS: Semi-structured interviews were conducted with ten carers of people living with dementia from a regional location in Victoria, Australia. Data analysis was guided by the tripartite framework of Giddens' Theory of Structuration which considered the carers' intentionality, capacity and power to act in the navigation of their dementia care and support service pathways. FINDINGS: Carers had intentionality; however, they did not always have the capacity and power to act. Information played a critical role in facilitating agency. Health literacy was important - as knowledge about where to look for/find information, and knowledge gained through experience, education or learning from others. Where carers encountered barriers, they lacked capacity and power. This occurred where there was an absence of information or knowledge, incorrect information (e.g. misdiagnoses), and where government bodies impeded carers' efforts. CONCLUSIONS: Information and knowledge are critical to the progression of dementia care and support service pathways. Health literacy is a significant resource, and carers would benefit from dementia education/training. The agency of carers in navigating their dementia care and support service pathways relies on carers themselves finding information and seeking out knowledge and education. However, GPs, local health providers, and dementia organisations have an important role to play in helping carers to find information towards accessing dementia care and support services.

Parental experiences of raising an autistic child in Ireland: A qualitative thematic analysis.

LAY ABSTRACT: Parenting an autistic child can be a challenging experience. Parents of autistic children often require social and professional support to cope with the various stresses they encounter and to ensure their children achieve their optimal potential. Recently, the way professional supports are organised in Ireland has changed. Very little previous recent research has investigated parents' experiences of raising an autistic child in Ireland. This study interviewed six parents asking them about their challenges, stress levels, coping strategies and their perceptions regarding professional support services. The data from these interviews were organised into themes. A major finding was that parents felt the healthcare system was failing to provide help for their children, and that support services in Ireland can cause more parental distress than dealing with their child's difficulties. Other causes of parental stress included the child's behaviours that they found challenging, stigma, a lack of awareness about autism and isolation. This study shows that both autistic children and their parents are at increased risk of developing mental health problems due to a flawed healthcare system that requires improvement urgently.

"Necessity is the mother of invention": Experiences of accessing and delivering dementia-related support services by information communication technology during the pandemic in the UK.

INTRODUCTION: The remote delivery of dementia-related support services by information communication technology, defined as any hardware or software, including the telephone and videoconferencing software, increased during the coronavirus pandemic. To guide the future use of information communication technology, this study explored the experiences of delivering and accessing social care and support services during the pandemic in the UK. METHOD: Remote semi-structured interviews with social care and support providers, people with dementia and family carers were conducted between May-December 2022. Topic guides were co-developed with two public advisors (one former family carer, one person with dementia) and garnered information on delivering and accessing services during the pandemic. Audio recordings were transcribed verbatim. Employing a mixture of inductive and deductive analytic approaches, a thematic analysis was conducted. RESULTS: Twenty-one interviews (n = 14 social care and support providers; n = 6 family carers; n = 2 people with dementia) were conducted. Three themes were generated: adapting to changing circumstances; responding to unmet needs by information communication technology and information communication technology should be a tool, not the default. Social care and support providers' creativity and motivation facilitated the adoption of information communication technology, however, available resources and guidance varied. While some people with dementia and family carers benefitted from accessing services by information communication technology to address some needs, the format was not suitable for everyone. CONCLUSIONS: Beyond the coronavirus pandemic, the use of information communication technology within service delivery needs to be carefully considered, to avoid disenfranchising some people with dementia and family carers, while empowering people with the option of how to access services. Digital training and guidelines advising the use of information communication technology within service delivery may facilitate its improved use during the current landscape, and amidst future pandemics.

Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute.

INTRODUCTION: Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda. METHODS: This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook. RESULTS: The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas. CONCLUSION: The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.

"My support groups have saved my life.": facilitators of positive or satisfactory experiences in behavioral healthcare for transgender and gender nonconforming older adults.

OBJECTIVES: Transgender and gender nonconforming (TGNC) older adults experience significant behavioral health and healthcare disparities. Facilitators that contribute to positive behavioral healthcare experiences among this population, however, remain uncertain. In this study, we investigate facilitators contributing to positive or satisfactory behavioral healthcare experiences among a sample of TGNC older adults in the United States (US). METHOD: Between September 2021 and January 2022, the first author conducted 47 semi-structured, individual interviews with TGNC adults aged 65 years or over in the US. Using an inductive grounded theory approach, we examined respondents' positive or satisfactory experiences with accessing and utilizing behavioral health services, support, and resources. Analyses were conducted using NVivo (Release 1.6) software. RESULTS: Findings underscore the importance of addressing the specific or unique needs of TGNC older patients to promote positive or satisfactory experiences in behavioral healthcare. Three themes emerged: (1) engaging with behavioral healthcare practitioners who offer compassionate, patient-centered care; (2) accessing and utilizing culturally tailored peer-support groups; and (3) receiving equitable access to gender-affirming care and social services. CONCLUSION: These findings highlight opportunities for expanding and incorporating these identified facilitators into behavioral healthcare research and practice, especially when promoting gender affirmation in care for TGNC older patients.

Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults With Polysubstance Use: Protocol for a Feasibility, Acceptability, and Appropriateness Study of Launch.

BACKGROUND: Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use. OBJECTIVE: This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch. METHODS: Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures. RESULTS: Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024. CONCLUSIONS: While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study's strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/60671.

Enhancing Mobility and Well-Being in Older Adults with Cancer.

OBJECTIVE: To analyze mobility challenges in older adult with cancer. METHODS: Data from previous literature was extracted and analyzed pertaining to the topic of interest. RESULTS: Mobility issues for the older adult with cancer are multi-factorial and are impacted by age-related changes, comorbidities, cancer itself, and cancer treatment. CONCLUSIONS: Proven benefits have been suggested with mobility assessments, exercise and dietary interventions, and cancer rehabilitation programs however further research is needed to define integration and utilization of programs, facilitation of cancer survivors returning to work, inclusion of socially disadvantaged patients, program compliance, economic aspects, and caregiver involvement to improve quality of life across the cancer continuum. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are in a key role to impact the care of the older adult with cancer with mobility through patient assessment of mobility function, facilitation of patient referrals for supportive services and cancer rehabilitation and execution of nurse-led intervention programs.

How Can Transitional Housing Be Improved? Insights from Residents' Experiences and Perceptions in New York City.

Homelessness, affecting over half a million Americans, significantly elevates the risks of mental and physical health issues, consequently diminishing life expectancy when compared with the general population. Homelessness is a critical public health issue, and efforts are needed to address lack of housing as a social determinant of health. Transitional housing (TH) programs emerge as vital interventions, offering a place to stay with various support services to facilitate the transition to permanent residency. Nearly half of the unhoused population in the country and over 90% in New York live in TH or shelters. Despite the high utilization rates of TH, engagement with support services and opportunities for improvement remain poorly understood. This study aimed to fill this gap by examining the factors influencing support service usage and opportunities for enhancement through semi-structured interviews with TH residents in New York City to capture their lived experiences and perspectives. Analysis of the interviews (n = 20) revealed five main factors affecting service engagement that aligned with constructs of the socioecological model: intrapersonal (self-efficacy, chronic health conditions, mental health), interpersonal (parenthood and well-being of children with special needs, individual staff interactions, and communication), institutional (bureaucratic challenges, administrative burden, and living facilities), community (social isolation and educational opportunity), and policy (challenge meeting basic needs and undocumented status). Recommendations for bridging service gaps primarily arose at the institutional and community levels, offering critical insights for administrators to tailor services more effectively to TH residents' needs, thus contributing to the broader goal of advancing health equity among the unhoused.

A web-based video messaging intervention for suicide prevention in men: study protocol for a five-armed randomised controlled trial.

BACKGROUND: More than 50% of people who die by suicide have not been in contact with formal mental health services. The rate of people who fly 'under the radar' of mental health services is higher among men than women, indicating a need to improve engagement strategies targeted towards men who experience suicidal thoughts and/or behaviours. In Australia, a range of mental health support services exist, designed specifically for men, yet, a substantial proportion of men do not use these services. The aim of this study is to evaluate whether a brief online video-based messaging intervention is an effective approach for encouraging men with suicidal thoughts and/or behaviours to engage with existing support services. METHODS: Informed by a literature review, surveys, and consultation with men with a lived experience of suicidal thoughts and/or behaviours, we designed five video-based messages that will be used in this five-arm randomised controlled trial. A total of 380 (76 per arm) men aged 18 years or older with suicidal thoughts who are not currently accessing formal mental health services will be recruited online and randomly assigned to watch one of the five web-based video messages. After viewing the video, men will be presented with information about four existing Australian support services, along with links to these services. The primary outcome will be help-seeking, operationalised as a click on any one of the four support service links, immediately after viewing the video. Secondary outcomes include immediate self-reported help-seeking intentions in addition to self-reported use of the support services during a 1-week follow-up period. We will also use the Discrete Choice Experiment methodology to determine what aspects of support services (e.g. low cost, short appointment wait times) are most valued by this group of men. DISCUSSION: This study is the first to evaluate the effectiveness of a brief web-based video messaging intervention for promoting engagement with existing support services among men with suicidal thoughts who are not currently receiving formal help. If found to be effective, this would represent a scalable, cost-effective approach to promote help-seeking for this at-risk population. Limitations and strengths of this study design are discussed.

Is peer support a tipping point for the opioid use disorder crisis in Appalachia? Research holds the answer.

BACKGROUND: The present commentary highlights the pressing need for systematic research to assess the implementation and effectiveness of medications for opioid use disorder, used in conjunction with peer recovery support services, to improve treatment outcomes for individuals with opioid use disorder in Central Appalachia. This region, encompassing West Virginia, Eastern Kentucky, Southwest Virginia, East Tennessee, and Western North Carolina, has long grappled with a disproportionate burden of the opioid crisis. Due to a complex interplay of cultural, socioeconomic, medical, and geographic factors, individuals in Central Appalachia face challenges in maintaining treatment and recovery efforts, leading to lower success rates. APPROACH: To address the issue, we apply an exploratory approach, looking at the intersection of unique regional factors with the utilization of medications for opioid use disorder, in conjunction with peer recovery support services. This combined treatment strategy shows promise in addressing crucial needs in opioid use disorder treatment and enhancing the recovery journey. However, there are significant evidence gaps that need to be addressed to validate the expected value of incorporating peer support into this treatment strategy. CONCLUSION: We identify nine obstacles and offer recommendations to address the gaps and advance peer recovery support services research. These recommendations include the establishment of specific partnerships and infrastructure for community-engaged, peer recovery support research; improved allocation of funding and resources to implement evidence-based practices such as peer support and medication-assisted treatment; developing a more precise definition of peer roles and their integration across the treatment and recovery spectrum; and proactive efforts to combat stigma through outreach and education.

Searching for choice and control: Western Australian service provider experiences of health, housing and migration.

This research aimed to inform approaches to increase access to secure housing and improve mental health outcomes for migrants from culturally and linguistically diverse backgrounds (hereafter migrants) who are generally invisible in health and social policy and service provision in Western Australia. We used semi-structured, in-depth interviews (n = 11) and interpretative phenomenological analysis to explore service provider experiences and perspectives of issues impacting service provision and the needs of migrants in this context. Five superordinate themes reveal complex experiences for both service providers and the migrants with whom they work. Findings reflect tensions between contemporary notions of choice and control and a social service system that is difficult to navigate, reflects systemic racism and appears to rely heavily on the non-government sector. Insights have important and practical implications for health promotion policy, practice and research. Recommendations include improvements to housing access, provision, funding and policies; addressing service barriers via staff training and more accessible community resources; and co-design and community outreach approaches.

Exploring access to support services for medical students: recommendations for enhancing wellbeing support.

BACKGROUND: Medical students have reported facing unique challenges in their academic journey that can have a significant impact on their mental health and wellbeing; therefore, their access to support services and wellbeing resources has been deemed crucial for dealing effectively with the various challenges they tend to face. While previous research has highlighted certain barriers affecting medical students' help-seeking and access to wellbeing support more generally, there is a pressing need for more in-depth research into the factors that may hinder or facilitate medical students' acceptability and uptake of the wellbeing resources available to them within institutional contexts. The current study aims to explore students' perceptions and utilization of wellbeing interventions and welfare resources within a medical school setting, as well as the factors influencing their help-seeking attitudes or behaviours. Additionally, it seeks to instigate medical students' deeper reflections on potential enhancements that could be applied to wellbeing resources so that they are better suited to address their needs. METHODS: This study employed a qualitative design, involving semi-structured interviews and a series of focus groups with medical students at the University of Nottingham (UK). Post-interview, focus groups were deemed necessary to gain deeper insights into emerging findings from the interviews regarding students' views on wellbeing support services. Qualitative data from the interviews was subjected to thematic analysis while a hybrid thematic analytic approach was applied for the focus group data in order to allow for both pre-defined themes from the interviews and newly emerging patterns to be identified and analysed in a combined manner. RESULTS: Twenty-five participants took part in the semi-structured interviews and twenty-two participants were recruited in a total of seven focus groups. Thematic analysis findings identified several key barriers to medical students' accessing wellbeing resources, including difficulties in finding relevant information, lengthy processes and difficulties receiving prompt help in urgent situations, learning environment issues, confidentiality concerns, and stigma around mental health. Student suggestions for the enhancement of wellbeing provision were centered around proposed improvements in the format that the relevant information was presented and in the structure underlying the delivery of support services. CONCLUSION: The study findings shed light on multi-faceted factors contributing to medical students' challenges in accessing support services; and provided a deeper understanding of medical students' wellbeing needs through a consolidation of their recommendations for the implementation of practical steps to address these needs. These steps can potentially inform key medical education stakeholders so that they can actively and proactively foster more supportive environments that may help improve medical students' help-seeking, as well as their acceptability and uptake of wellbeing services.