Substance use approaches among peer support specialists in community mental health early psychosis programs.

OBJECTIVE: Substance use (SU) is common among adolescents and young adults, including those experiencing early psychosis. Coordinated Specialty Care (CSC), a community-based multidisciplinary team-based service model, is increasingly used to support people experiencing first-episode psychosis. In addition to prescribers, clinicians, and vocational specialists, CSC includes peer support specialists who use their own living/lived experience with mental health and treatment to engage and support young people with their recovery goals. Peer support is also foundational in SU recovery. However, little is known about how peer support specialists navigate client SU in CSC. The purpose of this article is to detail CSC peer support SU practice. METHOD: Informed by community-based participatory research methods, a PhD-level qualitative researcher and a former peer support specialist conducted virtual interviews with 20 CSC peer support specialists. A multidisciplinary team including researchers with lived mental health experiences thematically coded interview transcripts. RESULTS: A spectrum of CSC peer support specialist SU responses emerged: (a) leverages lived SU experiences; (b) does not explore SU with clients; (c) shares client SU information with the CSC team; (d) educates, mentors, and advocates; (e) shares SU consequences and/or challenges substance use; (f) nonjudgmental, nondirective SU exploration; and (g) promotes harm reduction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: CSC peer specialist SU practice is influenced by several contextual tensions that must be better understood and addressed in future research to improve peer SU practice. Study findings speak to practice nuances that are helpful for CSC peer support training and supervision. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reasons for Discharge in a National Network of Early Psychosis Intervention Programs.

BACKGROUND: Discharge from early psychosis intervention is a critical stage of treatment that may occur for a variety of reasons. This study characterizes reasons for discharge among participants in early psychosis intervention programs participating in the Early Psychosis Intervention Network (EPINET) which comprises >100 programs in the United States organized under 8 academic hubs. STUDY DESIGN: We analyzed 1787 discharges, focusing on program completion, unilateral termination by the client/family, and lost contact with the client/family. We performed exploratory analyses of demographic, clinical, and functional predictors of discharge reason. Variables predictive of discharge type were included in multilevel logistic regressions, allowing for the estimation of predictors of discharge reason and variability in rates by program and hub. STUDY RESULTS: An estimated 20%-30% of enrolled patients completed the program. Program completion rates were higher among participants who were older on admission, had lower negative symptoms severity, spent more time in education, employment, or training, and who were covered by private insurance (a close proxy for socioeconomic status). Programs were more likely to lose contact with male participants, Black participants, and participants who were never covered by private insurance. After accounting for patient-level factors, there was substantial program-level variation in all 3 discharge outcomes, and hub-level variability in the proportion of participants who completed the program. The impact of race on program completion varied substantially by program. CONCLUSIONS: Participants were discharged from early psychosis intervention services for diverse reasons, some of which were associated with sociocultural factors. Disengagement is a widespread problem affecting all hubs.

Exploring trainee perspectives on barriers and facilitators in serious mental illness doctoral training.

Although there have been momentous and critical advancements in serious mental illness (SMI) psychology doctoral training models and competencies, there is still much systemic change needed to increase access to evidence-based SMI training for psychologists. In the last decade, there has been little to no growth or expansion of SMI training opportunities in clinical psychology doctoral programs in the United States, and psychologists are underrepresented in serving clients with SMI. As trainees and trainers committed to careers in SMI, the contributors aimed to identify barriers and facilitators throughout each stage of the SMI doctoral training pathway, including pregraduate school, graduate school, and internship to reflect critically on systemic issues that have impeded trainees from accessing the appropriate tools for SMI training. This conceptual article reviews the existing literature on barriers and facilitators to accessing SMI training. In centering trainee perspectives, the contributors also reflect on their own experiences through brief narratives illustrating the barriers and facilitators they have faced across training stages with existing empirical research. Recommendations made by the contributors include increasing access to financial support and mechanisms, diversifying departments and practicum sites to include SMI-focused training, and people in positions of power advocating for and centering trainee voices in departmental training decisions and development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Confronting the dialectic between quality and access in early psychosis care in the United States: Finding the synthesis by leveraging psychological expertise.

Coordinated specialty care (CSC) is the dominant model for early psychosis care in the United States, representing a proactive recovery-oriented approach to serious mental illness in its early stages. CSC involves broad multidisciplinary support for participants, including from psychologists in some CSC teams, encompassing educational and vocational support, medication management, psychotherapy, case management, peer support, and family interventions. CSC programs have proliferated in the last 20 years, leading to a quality-access dialectic, where increasing access to treatment simultaneously prompts concerns about care quality, particularly in the context of staffing shortages and funding limits. Evidence-based psychosocial treatment, including psychotherapy, is an integral part of CSC, yet workforce training deficits, workforce turnover, and CSC financing pose threats to intervention fidelity and thus CSC participants' ability to access high-quality care. We propose an enhanced role for psychologists as a way of resolving the quality-access dialectic in the area of psychosocial treatment, specifically evidence-based therapy. We describe the potential of psychologists' skills in clinical supervision, formulation, evidence-based interventions and measurement-based care, drawing on practice examples. After considering possible limitations, we outline implementation models, for example, drawing on Early Psychosis Intervention Network and Project Extension for Community Healthcare Outcomes. We conclude with four recommendations: Psychologists should be placed in CSC team or network-leadership roles; psychological expertise should be made available to CSC teams for training, consultation, and technical assistance; psychological expertise should be used to address CSC implementation challenges; and research is needed to demonstrate psychologists' value to stakeholders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perspectives of young adults diagnosed with early psychosis using coordinated specialty care in Texas on substance use and substance use interventions.

AIM: Despite known prevalence of substance use (SU) among young people experiencing early psychosis and increasing evidence for the relationship between certain substances (e.g., cannabis) and psychosis, there are no specialized interventions developed for effectively addressing substance use among young people participating in coordinated early psychosis services. This study elicited the perspectives of young people with early psychosis participating in Coordinated Specialty Care (CSC) programs about their substance use, including their motivations and concerns around their use, and their ideas on how to best support young people who are interested in reducing or quitting substance use. METHODS: We recruited young adults (ages 18 to 30) from CSC programs across Texas through flyers sent to program staff inviting young persons willing to talk about substance use to engage in a 60-90 min person-centered, semi-structured, audio-recorded Zoom interview. RESULTS: A total of 22 young adults were recruited and 18 completed an interview. Participants described mixed positive and negative responses to substance use, and while many understood the importance of discontinuing substance use, many expressed ambivalence related to social, contextual, mental and physical factors that motivated them to keep using. Participants desired practical substance use information, opportunities to explore their substance use ambivalence in supportive relationships, positive peer communities to support healthy choices, help engage, with work, school, and hobbies, and strategies for addressing psychological and physical pain that did not include substance use. CONCLUSION: Study findings illuminate what motivates young people with early psychosis to initiate, continue, or cut back on substance use, and ideas for CSC practices for exploring substances and helping young people to reduce substance use.

Addressing a Mental Health Intervention Gap in Juvenile Detention: A Pilot Study.

Research suggests that 60-70% of adolescents detained in the juvenile justice system meet criteria for a mental health disorder compared to 20% of the general adolescent population; however, the vast majority do not receive services. Unfortunately, mental health symptoms often worsen during detainment, and detainment is linked to lower levels of educational attainment and increased risk of adult recidivism. Thus, not only are these adolescents unlikely to receive needed mental health care, but also the lack of interventions in detention may exacerbate inequities of contact with the criminal justice system in adulthood. In addition to these youth being an underserved population broadly, youth of color are also disproportionately incarcerated compared to their white counterparts. The current paper describes results of a pilot study of an Acceptance and Commitment Therapy (ACT)-based behavioral skills intervention, aimed at providing evidence-based mental health treatment for an adolescent population at risk of long-term adverse mental health outcomes. The study included 128 males aged 14-17 who resided in juvenile detention. Results demonstrated that the intervention was acceptable to participants, feasible to provide in detention, and could be implemented with fidelity and competency. Intervention participants demonstrated declines in symptoms of mental health, and ACT-specific constructs of experiential avoidance, cognitive fusion, and perceived barriers to moving toward their values. These results have important implications for the possibility of an effective intervention that could disrupt systemic inequity in youth mental health, and thus support further testing of this intervention in a randomized controlled trial.

Expanding Early Psychosis Care across a Large and Diverse State: Implementation Lessons Learned from Administrative Data and Clinical Team Leads in Texas.

The U.S. is facing an unprecedented youth mental health crisis. Translating the findings from mental health intervention trials into large scale, accessible community-based services poses substantial challenges. Examination of state actions as a result of research-informed federal policy to improve youth access to quality mental healthcare is necessary. This mixed-methods study examines the implementation of evidence-informed multidisciplinary coordinated specialty care (CSC) for first-episode psychosis (FEP) services across Texas. The study explores CSC service model components, site location and participant characteristics, and implementation barriers. This cross-sectional study analyzes State of Texas public mental health administrative data from 2015 to 2020, including CSC site (n = 23) characteristics and CSC participant (n = 1682) demographics. Texas CSC site contracts were compared to OnTrackNY, a leading CSC model in the U.S. for CSC service element comparison. In-depth interviews with CSC Team Leads (n = 22) were analyzed to further understand CSC service elements and implementation barriers using qualitative content analysis. CSC was implemented across three waves in 2015, 2017, and 2019-serving 1682 participants and families. CSC sites were located in adult mental health programs; approximately one third of CSC participants were under 18 years. CSC implementation challenges reported by Team Leads included: staff role clarification, collaboration and turnover, community outreach and referrals, child and adult service billing issues, and adolescent and family engagement. Study findings have implications for large state-wide evidence-based practice implementation in transition-to-adulthood community mental health.

Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations.

Military culture relies on hierarchy and obedience, which contradict the implementation and use of collaborative care models. In this commentary, a team of lived experience, clinical and research experts discuss, for the first time, cultural, communication and policy considerations for implementing collaborative care models in military mental healthcare settings.

Multidisciplinary partnership: Targeting aggression and mental health problems of adolescents in detention.

Justice-involved adolescents meet diagnostic criteria for mental health disorders at much higher rates than their counterparts, and this increased risk persists into young adulthood (Abram et al., 2015; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002). Despite growing recognition of this problem, there remains a dearth of adequate therapeutic services in juvenile detention and marked variation in the quality and availability of community-based services (Kretschmar, Butcher, Flannery, & Singer, 2016). This article presents the development of a multidisciplinary partnership among clinical research psychologists and court professionals to address aggressive behaviors and unmet mental health needs of adolescents in the juvenile justice system. We describe the early stages of collaboration, in which experts from disparate disciplines joined forces to address a mounting problem in the juvenile justice system that represented both a gap in the research-practice continuum and a lack of vital mental health resources in the local community. We delineate the team composition, outline key players' roles and contributions, and describe the principles that guided our collaboration across disciplines and agencies. We were effective in developing a sustainable multidisciplinary team, developing a new intervention, and implementing this new intervention in a challenging setting. The challenges we encountered throughout the process as well as the solutions that were generated and the lessons learned are discussed in detail. We discuss the substantive outcomes of our research and conclude with recommendations for readers interested in organizing similar academic-research/community partnerships. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review.

OBJECTIVE: Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. METHOD: In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. CONCLUSION: The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies.

Frontal asymmetry as a mediator and moderator of emotion: An updated review.

For over 35 years, research has examined frontal alpha EEG asymmetry, discussed in terms of relative left frontal activity (rLFA) in the present review, as a concurrent and prospective marker of affective processing and psychopathology. Because rLFA may index (a) neural correlates of frontal asymmetry, or (b) psychological constructs to which frontal asymmetry relates, rLFA can advance our understanding of both neural and psychological models of emotion and psychopathology. In order to improve such understanding, the specific role of rLFA in extending or challenging existing theory must be clear to researchers and readers alike. In particular, in 2004, Coan and Allen argued that examination of rLFA as a mediator or moderator may improve our theoretical understanding of rLFA. Despite being a commonly cited paper in the field, most rLFA research today still fails to acknowledge the statistical role of rLFA in the research. The aim of the present paper is to (a) convince the reader of the importance of distinguishing rLFA as a predictor, outcome, mediator, or moderator in order to conduct theory-driven research, and (b) highlight some of the major advances in rLFA literature since the review by Coan and Allen (2004) in the framework of mediators and moderators. We selected a broad range of search terms to capture relevant rLFA research and included only those studies utilizing established methods for rLFA measurement.

Laboratory-induced learned helplessness attenuates approach motivation as indexed by posterior versus frontal theta activity.

Research suggests that midline posterior versus frontal electroencephalographic (EEG) theta activity (PFTA) may reflect a novel neurophysiological index of approach motivation. Elevated PFTA has been associated with approach-related tendencies both at rest and during laboratory tasks designed to enhance approach motivation. PFTA is sensitive to changes in dopamine signaling within the fronto-striatal neural circuit, which is centrally involved in approach motivation, reward processing, and goal-directed behavior. To date, however, no studies have examined PFTA during a laboratory task designed to reduce approach motivation or goal-directed behavior. Considerable animal and human research supports the hypothesis put forth by the learned helplessness theory that exposure to uncontrollable aversive stimuli decreases approach motivation by inducing a state of perceived uncontrollability. Accordingly, the present study examined the effect of perceived uncontrollability (i.e., learned helplessness) on PFTA. EEG data were collected from 74 participants (mean age = 19.21 years; 40 females) exposed to either Controllable (n = 26) or Uncontrollable (n = 25) aversive noise bursts, or a No-Noise Condition (n = 23). In line with prediction, individuals exposed to uncontrollable aversive noise bursts displayed a significant decrease in PFTA, reflecting reduced approach motivation, relative to both individuals exposed to controllable noise bursts or the No-Noise Condition. There was no relationship between perceived uncontrollability and frontal EEG alpha asymmetry, another commonly used neurophysiological index of approach motivation. Results have implications for understanding the neurophysiology of approach motivation and establishing PFTA as a neurophysiological index of approach-related tendencies.

Assessing and conceptualizing frontal EEG asymmetry: An updated primer on recording, processing, analyzing, and interpreting frontal alpha asymmetry.

Frontal electroencephalographic (EEG) alpha asymmetry is widely researched in studies of emotion, motivation, and psychopathology, yet it is a metric that has been quantified and analyzed using diverse procedures, and diversity in procedures muddles cross-study interpretation. The aim of this article is to provide an updated tutorial for EEG alpha asymmetry recording, processing, analysis, and interpretation, with an eye towards improving consistency of results across studies. First, a brief background in alpha asymmetry findings is provided. Then, some guidelines for recording, processing, and analyzing alpha asymmetry are presented with an emphasis on the creation of asymmetry scores, referencing choices, and artifact removal. Processing steps are explained in detail, and references to MATLAB-based toolboxes that are helpful for creating and investigating alpha asymmetry are noted. Then, conceptual challenges and interpretative issues are reviewed, including a discussion of alpha asymmetry as a mediator/moderator of emotion and psychopathology. Finally, the effects of two automated component-based artifact correction algorithms-MARA and ADJUST-on frontal alpha asymmetry are evaluated.

Frontal EEG Asymmetry as a Promising Marker of Depression Vulnerability: Summary and Methodological Considerations.

Frontal EEG asymmetry is a promising neurophysiological marker of depression risk. It predicts emotional response and negative affect hours to years later. Yet, inconsistencies in the literature may be due to differing methodological approaches between research groups. Within the past two years, a number of studies have shown this line of research may be strengthened by augmenting resting assessments with emotionally evocative tasks, utilizing optimal recording montages, and taking an integrative neuroscience approach that links frontal asymmetry to other indices of neural function. This review will focus on recent work in frontal asymmetry and depression with a particular focus on promising future directions and methodological considerations that may increase consistency between research groups.