Justifying the need for a recovery related surveillance system: Exploratory focused interviews.

Background and Aims: No recovery related surveillance system exists but given the evidence of effectiveness and growing supply, a house- and resident- level recovery house (RH) surveillance system could be beneficial for data collection on recovery support service (RSS) engagement, and retention; for improved standardization of RH programs and services; and for identification of outcomes associated with long-term recovery. Methods: This study aimed to explore current data collection practices at the resident- and house- level through qualitative focus interviews of RH representatives. The 13 RH interviews were scheduled with 16 RH representative respondents. Results: The most frequently collected resident data was at entry (92%) and departure (85%) and included demographics (n = 5), substance use history (n = 6), treatment and recovery history (n = 5), legal and correctional history (n = 6) and mental health information (n = 7). Recovery support data was collected by 85% of houses. Post-stay data was only collected by four RHs (31%). Conclusion: These results indicate that there is a lack of standardized systematic collection, analysis, and reporting of recovery related data in the RH field. A recovery related surveillance system has the potential to fill this gap and inform and improve standard of resident care to support long-term recovery from substance use disorder.

Opioid use-related stigma and health care decision-making.

OBJECTIVE: Stigma is described as highly relevant to the treatment context for opioid use disorder (OUD) partly because it is known to influence providers' treatment decisions and care provision. However, further study is needed to directly test the salience of stigmatizing views for healthcare decision-making among providers, and particularly those including medication for opioid use disorder (MOUD). This study assessed whether stigma toward illicit opioid use was associated with a willingness to provide or refer patients for MOUD treatment among a sample of healthcare providers. It also evaluated variation in stigmatizing views as a function of familiarity with OUD and MOUD and provider type. METHOD: Structural equation modeling was utilized to evaluate the antecedents and healthcare decision-making consequences associated with stigma based on survey data from a sample of 144 clinicians participating in a buprenorphine waiver training program (30% female). RESULTS: Providers who have less familiarity with OUD and MOUD and those who are medical students or residents are significantly more likely to endorse stigmatizing views of illicit opioid use. In turn, greater stigma is significantly associated with a lesser willingness to provide treatment or refer patients to MOUD treatment. CONCLUSIONS: Further consideration of stigma is recommended in future research to improve clinical practice and increase the implementation of MOUD treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"We've been here all along:" The collective resilience of transgender and gender diverse U.S. service members.

Transgender and gender diverse (TGD) people in the United States face high rates of minority stressors, such as social rejection, homelessness, discrimination, and identity-based violence (James et al., 2016). Transgender and gender diverse service members are also exposed to unique military-specific stressors such as discriminatory military policies, combat stress, and military sexual trauma (Tucker et al., 2019). However, little is known about TGD troops' experiences of resilience when navigating stress and trauma exposure during their military service. A transaffirmative participatory research design and interpretative phenomenological analysis (IPA) analytic method were used to explore how troops made sense of their experiences of oppression and resilience. Researchers interviewed TGD service members (N = 40) about their gender identity and military service. Superordinate themes included: (a) understanding oppression; (b) survival strategies; (c) individual stress and resilience factors; and (d) collective resilience factors. Results suggest that both intrasubjective and intersubjective factors impacted how TGD troops made sense of their experiences of oppression and resilience. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing waivered and non-waivered physician barriers to treating patients with substance use disorders: a cross-sectional Kentucky pilot.

INTRODUCTION: Opioid and other substance use disorders (OUD/SUDs) have been and continue to be significant public health issues. The standard of care for OUD is the use of medication for opioid use disorder (MOUD) in conjunction with counseling or behavioral therapies, yet research has indicated that barriers exist for patients accessing MOUD as well as for physicians prescribing MOUD due to requirements associated with the DATA 2000 waiver. METHODS: A pilot cross-sectional survey was conducted among Kentucky physicians in order to reassess common barriers as well as to explore barriers that non-waivered providers face to becoming waivered. Barriers were compared by waiver status (waiver vs. non-waivered) as well as geographic location (rural vs. non-rural). RESULTS: Compared to waivered physicians, non-waivered physicians were significantly less likely to report positive personal beliefs related to the use of MOUD for OUD and reported significantly more barriers to treating OUD patients in the areas of physicians' practice and culture, auditing, and institutional support and resources (p < .05). The majority (69%) of all physicians indicated they would benefit from a tool kit with evidence-based clinical guidelines. CONCLUSIONS: The barriers and beliefs identified in this pilot study indicate the need for policy action at the federal level to reduce barriers and incentivize more physicians to obtain waivers to treat OUD. Further, the development of brief educational resources tailored to physicians to treat OUD patients including pregnant patients with OUD is recommended.

Psychometric evaluation of two indices assessing stigma toward opioid misuse and treatment among health care providers.

Background: Stigma is described as highly relevant to the treatment context for opioid use disorder (OUD) partly because it is known to influence clinicians' treatment decisions and care provision. However, appropriate measures are needed to test the salience of stigmatizing views held by clinicians directly.Objective: This study assessed dimensionality, reliability, and validity evidence for two measures - of public stigma toward opioid misuse and clinician stigma associated with medication for opioid use disorder (MOUD), respectively.Methods: Psychometric tests were conducted based on survey data collected from a sample of 144 clinicians participating in a buprenorphine waiver training program (30% female).Results: Factor analysis indicated that the indices of stigma associated with opioid misuse and MOUD stigma are best represented as separate measures. Spearman-Brown Prophesy estimates (opioid misuse stigma = .88; MOUD stigma = .93) and Cronbach's alpha coefficients (opioid misuse stigma = .93; MOUD stigma = .91) supported the reliability of both measures. Construct validity evidence was additionally found in correlation tests based on provider background characteristics, and discriminant validity evidence is supported by the between-factor correlation coefficient (r = .44, p = .04) for the opioid misuse stigma and MOUD stigma indices.Conclusions: Both indices examined in this report are psychometrically acceptable measures for assessing general bias among health care providers toward persons who misuse opioids and toward those seeking MOUD treatment. Further consideration of these forms of bias are recommended in future research to improve clinical practice and increase the implementation of MOUD treatment.

Assessing Technical Assistance Needs among Recovery Residence Operators in the United States.

Recovery support services such as recovery housing assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff, yet little is known about their areas of greatest need for technical assistance. We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N = 376). A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Differences were observed between number of owned residences: owners/operators of a single residence were interested in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were interested in technical assistance on building financial sustainability and incorporation of best practices into their recovery residences. As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.

Timely linkage of individuals to substance use disorder treatment: development, implementation, and evaluation of FindHelpNowKY.org.

BACKGROUND: Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. METHODS: Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. RESULTS: Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. CONCLUSIONS: FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment.