Engaging Law Enforcement Employees in Mental Health Help-Seeking: Examining the Utilization of Interactive Screening Program and Motivational Interviewing Techniques.

AIM: The Interactive Screening Program (ISP) is an anonymous screening and dialogue platform used in workplaces to encourage mental health help-seeking. This study examined utilization of ISP among law enforcement workplaces and assessed how motivational interviewing techniques were associated with various help-seeking outcomes. METHOD: This retrospective study used secondary ISP screening and dialogue data collected from 2013 to 2019 at four law enforcement workplaces or unions (N = 691). Independent variables include counselors' use of motivational interviewing techniques in their dialogue such as asking questions and showing empathy in their response. Help-seeking outcomes include requesting a referral, making a commitment to counseling services, decreased ambivalence about mental health services, and increased willingness to seek future services. RESULTS: Two-thirds of participants screened within the high distress level of ISP. Among them, 53% responded to the counselor's initial email and 50% of those who responded requested a referral for future services. Binary logistic regression models showed that counselors' use of confrontation in the dialogue was associated with improved willingness to seek services among ISP users (OR = 2.88, 95% CI = 1.24, 6.64). Further, ISP users who accessed ISP through their workplace peer support program, as compared to their employee assistance program (EAP), are more likely to show decreased ambivalence about seeking future services over time (OR = 0.28, 95% CI = 0.09, 0.80). CONCLUSION: This study demonstrates that the anonymous ISP program can successfully engage employees with high distress levels, including employees with suicidal ideation. Results highlight the importance of customizing ISP counselors' responses to be responsive for law enforcement employees.

Opioid-Related Overdose Deaths in Maryland (2018), by Industry and Occupation.

OBJECTIVES: Opioid-related overdose deaths (OROD) increase annually, yet little is known about workplace risk factors. This study assessed differences in OROD rates across industry and occupation in Maryland, in addition to demographic differences within industry and occupation. METHODS: The 2018 State Unintentional Drug Overdose Reporting System was used to compare OROD between industries and occupations. RESULTS: The leading industries in OROD included the following: construction, manufacturing, and transportation and warehousing. Occupational groups were similar: construction and extraction, production, and transportation and material moving. There were also differences by sex (greater rates in men), age (greater rates in older workers), and race/ethnicity (varied patterns in rates). CONCLUSIONS: Employers and state leaders should work collaboratively to target prevention and intervention for workplaces at highest risk for OROD. Construction was highest and needs supports that respond to the workplace culture.

Decreases in Employer Referrals to First-Time Substance Use Treatment for Adults From 2004 to 2020.

OBJECTIVE: The aim of the study is to examine trends of employer/employee assistance program referred admissions to outpatient substance use disorder (SUD) treatment in the United States. METHODS: The publicly available Treatment Episode Data Set was used. Full-time employed adults with no history of SUD treatment referred to outpatient treatment by an employer/employee assistance program from 2004 to 2020 were included ( N = 36,142). Joinpoint regression examined admission trends. RESULTS: Employer/employee assistance program referred admissions to outpatient treatment decreased annually by 6.4% from 2004 to 2020 ( P < 0.001). Joinpoint analyses identified 2 linear segments from 2004 to 2008 (increased but not significant) and from 2008 to 2020. From 2008 to 2020, an average annual percent decrease of 8.7% ( P < 0.001) was identified. CONCLUSIONS: Findings from this repeated cross-sectional study suggest a missed opportunity for workplaces to serve as a potential SUD treatment access point.

Effectiveness of man therapy to reduce suicidal ideation and depression among working-age men: A randomized controlled trial.

OBJECTIVE: This randomized controlled trial of the online intervention, man therapy (MT), evaluated efficacy to reduce suicidal ideation (SI) and depression among working-aged men. METHOD: Five-hundred and fifty-four men enrolled and 421 completed all surveys. Control Condition men explored the Healthy Men Michigan (HMM) website and Intervention Condition men explored HMM and MT. Hypotheses included men who used MT would report decreased SI and depression over time compared to Control Condition men. RESULTS: Latent growth curve modeling revealed improvements in SI (slope = -0.23, p < 0.001, 95% CI: -0.29, -0.16) and depression (slope = -0.21, p < 0.001, 95% CI: -0.23, -0.18) over time for men in both groups; however, there was no difference in slope based on group assignment. Depression, lifetime suicide attempts, and interpersonal needs were associated with SI. Interpersonal needs and poor mental health were associated with depression. No group differences in change in risk and protective factors over time were observed. MT sub-group analyses revealed significant improvements in risk and protective factors. CONCLUSION: While a direct effect of MT versus HMM on SI or depression was not observed, men in both groups improved. Results suggest online screening might play a role in reducing SI and depression among men and there are potential benefits to MT related to mental health, social support, and treatment motivation.

Help-seeking and Man Therapy: The impact of an online suicide intervention.

INTRODUCTION: Suicide is a leading cause of death for men in the United States. Men traditionally have been hesitant to seek help, based on masculine norms of stoicism and self-reliance, among other factors. Man Therapy (MT) is an online suicide prevention and mental health initiative that provides promise for facilitating male help-seeking. METHODS: This study draws on data from a randomized controlled trial which examined effects of MT on a sample of men residing in Michigan aged 25-64. The current study utilized logistic regression to test MT's effect on nonprofessional and professional help-seeking, controlling for marital status, education, and sexual orientation. RESULTS: A statistically significant positive association was found between MT and professional help-seeking (OR = 1.55, p = 0.049). A significant inverse association was also found with marital status, with partnered men less likely to seek professional help (OR = 0.53, p = 0.007). There was no significant association between MT and nonprofessional help-seeking. CONCLUSION: Man Therapy demonstrates the promise of web-based suicide prevention efforts to reach men who typically do not engage in help-seeking, providing a gateway to vital professional support. As technology continues to emerge, further suicide research is needed on use of this modality with working-age men from diverse backgrounds.

Higher perceived stress during admission is associated with shorter retention in short-term residential substance use disorder treatment.

Introduction: Over one million people in the U.S. received residential treatment for a substance use disorder (SUD) in 2020. Longer treatment retention is associated with better outcomes (e.g., reduced substance use). Entering treatment with higher stress may be associated with shorter retention. This paper examines the impact of perceived stress at admission on SUD treatment retention in short-term residential treatment. Methods: A sample of 271 treatment episodes with admissions between October 2019 and February 2020 were collected from de-identified records of an urban mid-Atlantic adult 28-day short-term residential SUD treatment facility. Treatment completion involved finishing 28 days. Sociodemographic, substance use, perceived stress, and treatment discharge variables were analyzed. Bivariate analyses examined differences between treatment completion and early discharge, and Cox regression investigated the effect of perceived stress on treatment retention with covariates. Results: The sample was primarily male (73.8%) and non-Hispanic Black (71.6%). A majority used heroin as their primary substance (54.6%) and reported polysubstance use (72.3%). About half (51.3%) completed treatment, and completed an average of 18.7 (SD = 10.7) days. Those who prematurely discharged from treatment stayed an average of 8.9 (SD = 7.0) days. The Cox regression model found that higher perceived stress (adjusted hazard ratio (AHR) = 1.028; 95% CI = [1.005, 1.053], p =.019) and a race/ethnicity other than non-Hispanic Black (AHR = 1.546, 95% CI = [1.037, 2.305], p =.033) predicted premature discharge. Conclusions: Perceived stress at admission is associated with shorter treatment retention. Early stress management interventions may help increase treatment retention.

Building Equitable Community-Academic Partnerships for Opioid Recovery Research: Lessons Learned from Stakeholder Engagement With Peer and Provider Organizations.

Forming equity-based community-academic partnerships focused on recovery research is a time- consuming and challenging endeavor, but one well worth the care and effort required. Through building trusting relationships, vital research collaborations emerge, which are driven by expressed community needs and supported with university resources. This article describes the stakeholder engagement process utilized by a university-based and opioid-focused initiative entitled Innovations in Recovery through Infrastructure Support (IRIS). IRIS developed a diverse and representative network of clinical providers, peer recovery workers, academics, and other behavioral health leaders. The process was informed by community-based participatory research (CBPR) practices and principles aimed at creating equitable partnerships. Lessons learned include the need to reshape the relationship between research and the community through an acknowledgment of harms committed by academia, as well as the importance of maintaining an approach of humility, accountability, and patience with the partnership process. Concrete benefits that go beyond the long-term promise of change, including compensating partners financially for their time, help ensure equity. A commitment to always asking "Who's missing?" and then filling those gaps builds a broad network inclusive of the various constituencies that make up the recovery support system. As IRIS builds on these lessons learned and plans next steps, we share our experience to support others engaged in forming community-academic partnerships through deep stakeholder engagement and use of participatory approaches within and outside of recovery research.

Introduction to the Special Issue on "Financial Capability and Asset Building for Family Financial Wellbeing".

The papers in this issue emerged from a 2020 social work academic conference focused on financial capability and asset building (FCAB) research. This introduction provides an overview of the challenging financial and economic realities for U.S. families that provide the context for these papers. An outline of social work?s unique role with these families precedes a brief introduction to each included paper. ?Building on these papers, the authors provide an overview of future directions for FCAB research in the areas of theory and methods. Regarding theory, the FCAB field will benefit from the further exploration of the role of access and context for financial capability, as well as the use of institutional theory in FCAB practice and research. The role of relationships on financial behavior is also under-researched along with the intersection of FCAB with clinical issues and other human needs. Regarding methods, future research that uses qualitative and longitudinal data is also needed to advance FCAB knowledge. Overall, interdisciplinary work across social work and consumer finance to build models that span professional boundaries and incorporate FCAB into consumer financial wellbeing models will advance theory and evidence.

Poor Sleep Quality and Other Risk Factors for Unemployment Among Patients on Opioid Agonist Treatment.

Purpose: Patients with opioid use disorder (OUD) face high rates of unemployment, putting them at higher risk of treatment nonadherence and poor outcomes, including overdose death. The objective of this study was to investigate sleep quality and its association with other biopsychosocial risk factors for unemployment in patients receiving opioid agonist treatment (OAT) for OUD. Methods: Using a cross-sectional survey design, participants from 3 OAT programs for OUD completed questionnaires to measure sleep quality (Pittsburgh Sleep Quality Index [PSQI]); pain disability; catastrophic thinking; injustice experience; quality of life; and self-assessed disability. Spearman's rank correlation was used to test for associations between sleep quality and other study variables. Results: Thirty-eight participants completed the study, with mean age 45.6 ± 10.9 years, 27 (71.1%) males, and 16 (42.1%) reporting a high school diploma/equivalent certification as the highest level of academic attainment. Poor sleep quality (defined as PSQI > 5) was identified in 29 participants (76.3%) and was positively correlated with pain disability (r = 0.657, P < .01), self-assessed disability (r = 0.640, P < .001), symptom catastrophizing (r = 0.499, P < .001), and injustice experience (r = 0.642, P < .001), and negatively correlated with quality of life (r = -0.623, P < .001). Conclusions: There was a high prevalence of poor sleep quality in patients with OUD on OAT and this was associated with multiple known risk factors for unemployment. These findings warrant the consideration of regular screening for sleep problems and the inclusion of sleep-related interventions to improve sleep quality, decrease the unemployment rate, and enhance the recovery process for individuals with OUD undergoing OAT.

Perceived social stigma, self-concealment, and suicide risk among North Korean refugee women exposed to traumatic events.

INTRODUCTION: Suicide among North Korean (NK) refugee women is one of the most concerning public health problems in South Korea. Pre-resettlement trauma exposure and post-resettlement factors can contribute to suicide risk among NK refugee women; however, few studies have explored these associations. METHODS: This study aimed to assess suicidal ideation and suicide attempts among NK refugee women in South Korea (N = 212) and to examine the impact of pre-resettlement trauma exposure on suicide risk. Perceived social stigma and self-concealment in the post-resettlement phases were investigated as moderating factors for suicide risk related to trauma exposure using multiple regression analyses. RESULTS: Trauma exposure significantly increased suicidal ideation severity and the risk of suicide attempt. Furthermore, perceived social stigma significantly moderated this relationship such that the impact of trauma exposure in the pre-resettlement phases was amplified as perceived social stigma increased. CONCLUSION: Based on our study findings, professionals working with refugee populations should assess for perceived social stigma and exposure to traumatic events to reduce and prevent suicidal ideation and attempts.

Workplace Support for Employees in Recovery From Opioid Use: Stakeholder Perspectives.

The dual challenges of COVID-19 and the opioid epidemic have heightened the need of Maryland workplaces for accessible resources and supports. This paper describes efforts of the Workplace PROSPER (Partnering to Reduce Opioid Stigma and Support Employment in Recovery) project team to explore opioid-related state employment needs from Key Stakeholder perspectives. Discussion revealed significant overlap between the needs identified by stakeholders and pre-existing recovery friendly initiatives in other states. However, this convening identified the need for increased training of medical professionals in communicating about work capacity and safety as well as for resources to support family members of individuals with Opioid Use Disorder and model programs for hiring individuals in recovery. Next steps include the creation and dissemination of a survey to obtain a broader base of feedback and the development of a robust set of online recovery resources for Maryland employers and employees.

Suicide intervention training with law enforcement officers.

Law Enforcement Officers' (LEO) interactions with people facing mental health crises have risen exponentially since the era of deinstitutionalization. On average, about 10% of the individuals law enforcement interacts with daily have mental health challenges. Several factors influence the outcome of these interactions, not least of which is an officer's role as a gatekeeper as well as their training related to people with mental health challenges. We hypothesized that participating in the online QPR Training for Law Enforcement Officers would be associated with improved knowledge about suicide, attitudes to suicide and suicide intervention, and self-efficacy. Additionally, we hypothesized that these outcomes would be associated with greater use of intervention skills when encountering individuals at risk for suicide in the community. Results of our longitudinal analysis find that most of the participating officers reported some prior training and yet demonstrated statistically significant improvements in knowledge and attitudes after controlling for previous training. No significant changes were observed in LEO's use of intervention skills following training. We conclude by suggesting that there is substantial need for increased training; and offering possible conceptual and empirical explanations for the observed results.

A National Survey of Challenges Faced by Hospices During the Opioid Crisis: Estimates of Pain Medication Shortages, Missing Medications, and Opioids Left in the Home Post-Death.

CONTEXT: No national data exist on hospice medication shortages, the frequency that opioid medications go missing, and drug disposal practices. OBJECTIVES: To provide national estimates for hospices on: drug shortages; frequency of missing medications; and opioids left in the home post-death. METHODS: A national survey of 600 randomly selected hospices stratified by state and profit status (data collection 2018). Sample weights were applied to adjust for non-response. Respondents were hospice representatives knowledgeable about agency policies and practices. Participants reported their knowledge and perceptions about medication shortages, frequency that opioid medications go missing, and the proportion of hospice deaths in which opioids are left in the home. Findings were stratified by agency size. RESULTS: 371 hospices completed surveys (response rate = 62%), half (50%) of which were mid-sized (26-100 patients), and not-for-profit. Respondents had 7.5 years (SD = 7.7) of agency experience. 42% of hospices - and 61% of large hospices - reported medication shortages. Among the full sample, 28% of agencies indicated shortages of morphine; 20% reported shortages of hydromorphone. Nearly half (43%) of hospice representatives reported that missing opioid medications occurred within the last 90 days. 52% of representatives reported employees are not allowed to dispose of medications after a home death; and, among home deaths, unused opioids were left in the home 32% of the time. This suggests opioid medications are frequently left in U.S. households after a hospice home death. CONCLUSION: Hospices face numerous challenges during the national opioid crisis. Interventions are needed to ensure access to needed treatments, mitigation of diversion, and safe medication disposal.

Confirmed Medication Diversion in Hospice Care: Qualitative Findings From a National Sample of Agencies.

CONTEXT: The nonmedical use of prescribed medications is a major public health concern in the U.S. Medications prescribed to hospice patients for pain management may be at risk of being diverted to be sold or used illicitly. OBJECTIVES: Use responses from hospice agency representatives to explore the details of confirmed cases of medication diversion in the hospice setting. METHODS: This is a qualitative descriptive study based on responses from hospice agency representatives with surveys completed by phone or online. Template analysis was used to describe the context of confirmed diversion, specifically 1) means of how the diversion was confirmed, 2) clues/red flags, 3) who diverted, and 4) agency responses to the confirmed diversion. RESULTS: A total of n = 112 open-ended responses were analyzed. Respondents reported multiple ways in which medication diversion was confirmed, such as drug screening, witnessed firsthand by staff, and an overdose. Clues/red flags included reluctance to allow medication monitoring, family discord, and higher medication doses being requested. Those who diverted medications included informal caregiver/family member, family friend, and facility staff. Agency responses to diversion included limiting the supply of medication, restricting access to the medication, and increasing staff visit frequency. CONCLUSION: Good clinical practice and vigilance may help agencies detect medication diversion. Moreover, diversion prevention techniques should not harmfully impact quality of patient care.

Preventing Suicide Among Working-Age Adults: The Correlates of Help-Seeking Behavior.

We aimed to identify the correlates with not seeking help among working-age adults with suicidal ideation. By adapting the integrated model of suicide help-seeking, we examined help-seeking behavior in the following 3 stages: problem recognition, decision to seek help, and sources of help. We used a sample of working-age adults between 26 and 64 years old, who reported suicidal ideation in the past year (N = 1414). Data were drawn from the 2011 and 2012 National Survey on Drug Use and Health, and multinomial logistic regression analyses were applied. Findings suggested that being male, being nonwhite, being employed full-time, having lower levels of general mental health needs, and not having health insurance were associated with not seeking help. Results also indicated how each factor was related in the help-seeking pathway. Strategies to help problem recognition can be effective in enhancing help-seeking behavior among men, racial/ethnic minorities, and those without serious clinical conditions. Help-seeking interventions for working-age adults with suicidal ideation should also consider that race/ethnic minorities and those with lower levels of functional impairment might rely on alternative sources of help, such as family, friends, and religious advisors.

Feasibility of Brief Screening for At-Risk Gambling in Consumer Credit Counseling.

Gambling disorder and problem gambling often lead to major suffering in the form of mental health problems, interpersonal conflict, and financial crises. One potential setting for detecting at-risk gambling is credit counseling as gambling problems may manifest themselves in the form of financial distress and bankruptcy. Research studies have not considered those seeking credit counseling as individuals at risk for gambling problems even though gambling may contribute to financial distress. Therefore, the current study sought to quantify the prevalence of at-risk gambling in credit counseling compared with national estimates, to compare at-risk gamblers in this population to lower risk individuals, and to assess the feasibility of gambling screening in these settings. Using a mixed methods approach, the current study found that almost 20% of callers to a national agency reported gambling behavior, and among those who gambled, they reported higher rates of problems related to gambling than the broader U.S. population, thus supporting the idea that screening in credit counseling may help identify those at risk. Low risk gamblers were slightly younger than non-gamblers, but no other differences in sociodemographic and financial status variables were found based on gambling risk status. Results from focus groups and individual interviews suggest that credit counselors and program administrators see the benefit to brief screening within their intake and counseling processes. Our findings suggest that gambling screening is feasible in consumer credit counseling and may be acceptable to staff and administrators at these agencies.

Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA.

Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization.

Psychosocial Assessment by Hospice Social Workers: A Content Review of Instruments From a National Sample.

CONTEXT: Hospice social workers are charged with completing a psychosocial assessment for every new enrollee. This assessment is part of the patient's comprehensive assessment and serves to inform the plan of care and key quality indicators. OBJECTIVES: To review the content of hospice social work assessments because little is known about what assessment topics are included or overlooked. METHODS: Using a cluster random sample from all 50 states, we contacted hospice agencies and requested a blank copy of the social work assessment completed at intake. We then systematically reviewed the content of these assessments to determine which domains were included and which were omitted. A total of 105 hospice agencies participated (response rate 42%). Among the assessments provided, 76 (72%) were unique assessments. RESULTS: Participating hospices were largely freestanding (65%), nonprofit (60%), and either medium (39%) or small (37%) in terms of average daily census. Over 60% of the sample, assessments included content on the following: financial resources; family structure; coping resources; bereavement risk; past losses; caregiver depression; religiosity/spirituality; patient anxiety, patient depression; and advance directives. However, most assessments did not include items evaluating the following: patient physical/functional status; preferences for treatment/care; awareness of diagnosis, prognosis, or disease progression; communication and literacy issues; changes in relationship intimacy/sexuality; and cultural values, beliefs, and customs. CONCLUSION: Hospice social workers should consider modifying their assessment practices to include a comprehensive array of assessment topics pertinent to patients and families. An accurate, comprehensive assessment that contributes to a holistic, interdisciplinary approach will likely lead to better clinical outcomes.

Modeling the Longitudinal Direct and Indirect Effects of Attitudes, Self-Efficacy, and Behavioral Intentions on Practice Behavior Outcomes of Suicide Intervention Training.

The purpose of this study was to use a longitudinal path analysis to test attitudes toward suicide prevention, self-efficacy, and behavioral intentions as mediators/moderators of clinical skill development over time following suicide intervention training. Results support a direct effect of attitudes on practice behaviors and self-efficacy, but no moderating effect. Self-efficacy performed as a mediator of practice behaviors over time. Behavioral intention had a direct effect on practice behaviors and mediated the relationship between attitudes and practice behaviors. Implications for research and practice are discussed.