Scaling Up Implementation Support for Violence Prevention and Resilience Promotion in the Air Force.

Closing the gap between research and practice requires that organizations can consistently incorporate new ideas and best practices. The Department of the Air Force (DAF) Integrated Resilience Directorate is leading a coordinated effort to increase the adoption of evidence-based violence prevention and resilience promotion programs across the entire Department. To support this effort, DAF is using Getting To Outcomes (GTO), an evidence-based implementation support that helps organizations plan, implement, and self-evaluate programs. Thus, the DAF is not only scaling up prevention programs but is also embarking on the largest scale-up of GTO to date. The study team trained personnel from every Air Force installation across the world to use GTO for their programs. Quantitative findings from training questionnaires and ratings of implementation plans as well as qualitative results from resilience personnel interviews suggest some lessons learned for scaling up implementation support. This study builds on established implementation science frameworks for scaling up interventions by identifying critical tasks and unique supports needed to scale up evidence-based prevention. Results suggest GTO helped DAF scale-up prevention across the Department, and that establishing leadership buy-in, simplifying evidence-based program selection and adaptation, monitoring implementation and outcomes, and creating dedicated prevention practitioner roles are critical tasks to support scale-up of evidence-based prevention. Unique supports needed to scale-up evidence-based prevention include multitiered learning systems; integrated tools that improve access to data and evolving evidence; prevention personnel with skills in program management, adaptation, and evaluation; timely crosscutting data; continuous learning to support sustainability; and leadership buy-in.

Improving Mental Health Guardianship: From Prevention to Treatment.

OBJECTIVE: The authors sought to identify the most promising strategies for improving the mental health guardianship process in Los Angeles County for adults with mental illness who are gravely disabled. METHODS: In May and June 2019, 56 experts, working in hospitals or outpatient facilities or representing legal, advocacy, policy, or forensic organizations, participated in an online modified-Delphi panel, rating the ethical appropriateness, impact on care quality, efficiency, and feasibility of nine strategies for improvement of mental health guardianship. Agreement was determined with the RAND/UCLA appropriateness method, and comments were thematically analyzed. RESULTS: The strategy ranked highest by the participating experts was improving the administrative functioning and judicial processes of entities involved in mental health guardianship proceedings-it was the only strategy that achieved agreement among panelists and was rated highly on all four criteria. Other preferred strategies were enhancing the ability of assertive outpatient mental health teams to serve individuals before they experience a crisis and expanding the continuum of unlocked residential treatment settings. CONCLUSIONS: Opportunities exist to improve all stages of the mental health guardianship process. Experts favored strategies that streamline administrative processes, facilitate community integration into treatment, and ensure fidelity to best practices. Improving the mental health guardianship process has the potential to speed up delivery of services, better manage resources, and increase access to treatment for individuals with mental illness who are gravely disabled.

Contact With Persons With Mental Illness and Willingness to Live Next Door to Them: Two Waves of a California Survey of Adults.

OBJECTIVE: This study sought to extend findings from previous studies of the association between having had interpersonal contact with individuals with mental illness and the desire to avoid contact with them (i.e., social distance). METHODS: The authors used a longitudinal design with a representative sample of 1,057 California adults who completed a survey in 2013 (wave 1) and 2014 (wave 2). Bivariable and multivariable logistic regression analyses were used to test whether demographic characteristics and changes in past-year contact with individuals with mental illness affected perceptions of the dangerousness of individuals with mental illness and willingness to move next door to someone with mental illness. RESULTS: An increase in contact with someone with mental illness between the two waves was associated with a decrease in unwillingness to move nearby a person with mental illness, even after the analysis accounted for contact and unwillingness at wave 1 (odds ratio [OR]=0.51, 95% confidence interval [CI]=0.31-0.84). Wave 1 beliefs that persons with mental illness are dangerous were associated with unwillingness to move nearby (OR=3.81, 95% CI=2.29-6.35) but changes in beliefs about dangerousness were not (OR=0.71, 95% CI=0.42-1.19). CONCLUSIONS: Increased naturally occurring contact with individuals with mental illness appears to decrease unwillingness to move near a person with mental illness for as long as 1 year after the contact. Housing and services that aim to integrate individuals with mental illness into the community should consider strategies that include contact with individuals with mental illness to counter community opposition.

State medical marijuana laws, cannabis use and cannabis use disorder among adults with elevated psychological distress.

BACKGROUND: Cannabis use and cannabis use disorder are more prevalent in U.S. states with medical marijuana laws (MMLs), as well as among individuals with elevated psychological distress. We investigated whether adults with moderate and serious psychological distress experienced greater levels of cannabis use and/or disorder in states with MMLs compared to states without MMLs. METHODS: National Survey of Drug Use and Health data (2013-2017) were used to compare past-month cannabis use, daily cannabis use, and cannabis use disorder prevalence among adults with moderate and serious psychological distress in states with versus without MMLs. We executed pooled multivariable logistic regression analyses to test main effects of distress, MMLs and their interaction, after adjustment. RESULTS: Compared to states without MMLs, states with MMLs had higher adjusted prevalence of past-month use (11.1 % vs. 6.8 %), daily use (4.0 % vs. 2.2 %), and disorder (1.7 % vs. 1.2 %). Adults with moderate and serious psychological distress had greater adjusted odds of any use (AORs of 1.72 and 2.22, respectively) and of disorder (AORs of 2.17 and 2.94, respectively), compared to those with no/mild distress. We did not find evidence of an interaction between MMLs and distress category for any outcome. CONCLUSIONS: Associations between elevated distress and cannabis use patterns are no greater in states with MML. However, cannabis use is more prevalent in MML states. Thus, higher base rates of cannabis use and disorder among adults with elevated distress are proportionally magnified in these states.

Relationship between Provider Stigma and Predictors of Staff Turnover among Addiction Treatment Providers.

To further our knowledge about feasible targets for improving quality of addiction treatment services, the current study provides preliminary assessment of the relationship between provider stigma and indicators of staff turnover. As predicted, results suggest that higher provider stigma was significantly related to lower ratings of job satisfaction and workplace climate. However, provider stigma was not significantly related to burnout. Our preliminary findings, if replicated, suggest the importance of considering provider stigma as a risk factor for future staff turnover and job dissatisfaction. Promising provider stigma interventions do exist and offer viable opportunity for improving quality of addiction treatment.

California's historic effort to reduce the stigma of mental illness: the Mental Health Services Act.

In a historic effort to reduce the stigma of mental illness, California voters approved the Mental Health Services Act in 2004. The law funds a comprehensive statewide prevention initiative that places stigma and discrimination reduction at its center, with 25 projects providing interventions at the institutional, societal, and individual levels. Stakeholders selected specific strategies from the research-based California Strategic Plan on Reducing Stigma and Discrimination. Strategies range from social marketing to increase public knowledge to capacity building at the local level, including training that emphasizes participation by consumers of mental health services and cultural competence. Collectively, these strategies aim to foster permanent change in the public perception of mental illness and in the individual experience of stigma. We examined the context, planning, programming, and evaluation of this effort.