scholarly journals Improving medication access within integrated treatment for individuals with co-occurring disorders in substance use treatment agencies

2021 ◽  
Vol 2 ◽  
pp. 263348952110336
Author(s):  
James H Ford ◽  
Arveen Kaur ◽  
Deepika Rao ◽  
Aaron Gilson ◽  
Daniel M Bolt ◽  
...  
Keyword(s):  
Substance Use ◽  
Implementation Strategy ◽  
Addiction Treatment ◽  
Implementation Strategies ◽  
Integrated Treatment ◽  
Psychotropic Medications ◽  
Control Group ◽  
Medication Access ◽  
Waitlist Control Group ◽  
Improve Access

Background The best approach to provide comprehensive care for individuals with co-occurring disorders (CODs) related to substance use and mental health is to address both disorders through an integrated treatment approach. However, only 25% of behavioral health agencies offer integrated care and <7% of individuals who need integrated treatment receive it. A project used a cluster-randomized waitlist control group design to evaluate the effectiveness of network for the improvement of addiction treatment (NIATx) implementation strategies to improve access to addiction and psychotropic medications. Methods This study represents a secondary analysis of data from the NIATx project. Forty-nine agencies were randomized to Cohort1 (active implementation group, receiving the NIATx strategy [ n = 25]) or Cohort2 (waitlist control group [ n = 24]). Data were collected at three time points (Baseline, Year1, and Year2). A two-level (patient within an agency) multinomial logistic regression model investigated the effects of implementation strategy condition on one of four medication outcomes: both medication types, only psychotropic medication, only addiction medication, or neither medication type. A per-protocol analysis included time, NIATx fidelity, and agency focus as predictors. Results The intent-to-treat analysis found a statistically significant change in access to addiction versus neither medication, but Cohort1 compared to Cohort2 at Year 1 showed no differences. Changes were associated with the experimental intervention and occurred in the transition from Year1 to Year2, where greater increases were seen for agencies in Cohort2 versus Cohort1. The per-protocol analysis showed increased access to both medications and addiction medications from pre- to post-intervention for agencies in both cohorts; however, differences in change between high- and low-implementation agencies were not significant. Conclusions Access to integrated services for people with CODs is a long-standing problem. NIATx implementation strategies had limited effectiveness in improving medication access for individuals with CODs. Implementation strategy adherence is associated with increased medication access. Plain language summary Individuals with co-occurring substance use and psychiatric disorders face significant challenges in receiving care. With only 25% of behavioral health organizations offering integrated substance use and mental health services, it is not surprising that only 7% of individuals with a co-occurring disorder (COD) receive integrated care. The use of implementation strategies including feedback reports, external coaching, and in-person learning can provide staff with the necessary skills to implement changes in their organization. In this study, staff in addiction treatment agencies provided comprehensive assessments and treatment plans that targeted patients’ CODs, using proven implementation strategies. Results found that the application of these strategies increased patient access to addiction medications and their access to both addiction and psychotropic medications for their CODs. Higher implementation strategy adherence appears to be associated with improved access to addiction medications or both addiction and psychotropic medications but not psychotropic medications exclusively. Implementation researchers and addiction treatment agencies have evidence that implementation strategies can be utilized to improve access to medications as part of integrated treatment for individuals with CODs. However, additional research is needed to understand how adherence and fidelity to the implementation strategies are associated with more significant improvements. In addition, the results from this study raise questions as to whether efforts to improve access to psychotropic medications or addiction and psychotropic medications take longer to implement in addiction treatment agencies that do not typically provide integrated treatment for individuals with CODs.

scholarly journals A Motion-Activated Video Game for Prevention of Substance Use Disorder Relapse in Youth: Pilot Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Lorien C Abroms ◽  
Marc Fishman ◽  
Hoa Vo ◽  
Shawn C Chiang ◽  
Victoria Somerville ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Video Game ◽  
Addiction Treatment ◽  
Intervention Group ◽  
Body Motion ◽  
Control Group ◽  
Inpatient Setting ◽  
Game Play ◽  
Treatment As Usual

BACKGROUND Body motion-activated video games are a promising strategy for promoting engagement in and adherence to addiction treatment among youth. OBJECTIVE This pilot randomized trial (N=80) investigated the feasibility of a body motion–activated video game prototype, Recovery Warrior 2.0, targeting relapse prevention in the context of a community inpatient care program for youth. METHODS Participants aged 15-25 years were recruited from an inpatient drug treatment program and randomized to receive treatment as usual (control) or game play with treatment as usual (intervention). Assessments were conducted at baseline, prior to discharge, and at 4 and 8 weeks postdischarge. RESULTS The provision of the game play intervention was found to be feasible in the inpatient setting. On an average, participants in the intervention group played for 36.6 minutes and on 3.6 different days. Participants in the intervention group mostly agreed that they would use the refusal skills taught by the game. Participants in the intervention group reported attending more outpatient counseling sessions than those in the control group (10.8 versus 4.8), but the difference was not significant (P=.32). The game had no effect on drug use at 4 or 8 weeks postdischarge, with the exception of a benefit reported at the 4-week follow-up among participants receiving treatment for marijuana addiction (P=.04). CONCLUSIONS Preliminary evidence indicates that a motion-activated video game for addiction recovery appears to be feasible and acceptable for youth within the context of inpatient treatment, but not outpatient treatment. With further development, such games hold promise as a tool for the treatment of youth substance use disorder. CLINICALTRIAL ClinicalTrials.gov NCT03957798; https://clinicaltrials.gov/show/NCT03957798 (Archived by WebCite at http://www.webcitation.org/78XU6ENB4)

Substance Use Disorders

2021 ◽  
pp. 96-111
Author(s):  
Faith Summersett Williams ◽  
Rebecca E. Ford-Paz ◽  
Jason Washburn
Keyword(s):  
Substance Use ◽  
Emotional Disorders ◽  
Substance Use Disorders ◽  
Addiction Treatment ◽  
Internalizing Disorders ◽  
Integrated Treatment ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Treatment Models ◽  
Parsimonious Model

The etiology of substance use disorders in adolescence has been traced in part to untreated or undertreated internalizing disorders. Integrated treatment for co-occurring psychopathology and substance use is highly recommended for this population. There has been increasing interest in transdiagnostic interventions that offer a more efficient, acceptable, and parsimonious model for clinicians to learn to treat substance use that co-occurs with other emotion-based disorders. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) overlaps with many of the treatment targets proposed in transdiagnostic treatment models for addictions and comorbid emotional disorders. This chapter provides a framework, based on the adolescent addiction treatment literature, to guide implementation of the UP-A with comorbid emotional and substance use disorders.

Solution-Focused Brief Therapy With Substance-Using Individuals

2016 ◽  
Vol 28 (4) ◽  
pp. 452-462 ◽  
Author(s):  
Johnny S. Kim ◽  
Jody Brook ◽  
Becci A. Akin
Keyword(s):  
Substance Use ◽  
Linear Models ◽  
Brief Therapy ◽  
Controlled Trial ◽  
Addiction Severity Index ◽  
Self Report ◽  
Effect Sizes ◽  
Control Group ◽  
Solution Focused Brief Therapy ◽  
Solution Focused

Objective: This study examined the effectiveness of solution-focused brief therapy (SFBT) intervention on substance abuse and trauma-related problems. Methods: A randomized controlled trial design was used to evaluate the effectiveness of SFBT in primary substance use treatment services for child welfare involved parents in outpatient treatment for substance use disorders. Mixed linear models were used to test within- and between-group changes using intent-to-treat analysis ( N = 64). Hedges’s g effect sizes were also calculated to examine magnitude of treatment effects. Results: Both groups decreased on the Addiction Severity Index-Self-Report and the Trauma Symptom Checklist-40. The between group effect sizes were not statistically significant on either measures, thus SFBT produced similar results as the research supported treatments the control group received. Conclusion: Results support the use of SFBT in treating substance use and trauma and provide an alternative approach that is more strengths based and less problem focused.

scholarly journals Developing implementation strategies to adopt Enhanced Recovery After Surgery (ERAS®) guidelines

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Jennifer Y Lam ◽  
Alexandra Howlett ◽  
Duncan McLuckie ◽  
Lori M Stephen ◽  
Scott D N Else ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Healthcare Providers ◽  
Implementation Strategies ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Care Pathways ◽  
Audit System ◽  
Local Contexts

Abstract Background Strong implementation strategies are critical to the success of Enhanced Recovery after Surgery (ERAS®) guidelines, though little documentation exists on effective strategies, especially in complex clinical situations and unfamiliar contexts. This study outlines the process taken to adopt a novel neonatal ERAS® guideline. Methods The implementation strategy was approached in a multi-pronged, concurrent but asynchronous fashion. Between September 2019 and January 2020, healthcare providers from various disciplines and different specialties as well as parents participated in the strategy. Multidisciplinary teams were created to consider existing literature and local contexts including potential facilitators and/or barriers. Task forces worked collaboratively to develop new care pathways. An audit system was developed to record outcomes and elicit feedback for revision. Results 32 healthcare providers representing 9 disciplines and 5 specialties as well as 8 parents participated. Care pathways and resources were created. Elements recommended for a successful implementation strategy included identification of champions, multidisciplinary stakeholder involvement, consideration of local contexts and insights, patient/family engagement, education, and creation of an audit system. Conclusion A multidisciplinary and structured process following principles of implementation science was used to develop an effective implementation strategy for initiating ERAS® guidelines.

scholarly journals Effectiveness of a short Yoga Nidra meditation on stress, sleep, and well-being in a large and diverse sample

2020 ◽  
Author(s):  
Esther N. Moszeik ◽  
Timo von Oertzen ◽  
Karl-Heinz Renner
Keyword(s):  
Structural Equation ◽  
Well Being ◽  
Equation Model ◽  
Future Research ◽  
Control Group ◽  
Core Element ◽  
Waitlist Control Group ◽  
Affective Components ◽  
Meditation Group ◽  
Yoga Nidra

Abstract Previous studies have shown that meditation-based interventions can have a significant impact on stress and well-being in various populations. To further extend these findings, an 11-min Yoga Nidra meditation that may especially be integrated in a busy daily schedule by people who can only afford short time for breaks was adapted and analyzed in an experimental online study design. The effects of this short meditation on stress, sleep, well-being and mindfulness were examined for the first time. The meditation was provided as audio file and carried out during a period of 30 days by the participants of the meditation group. A Structural Equation Model (SEM) was used to analyze the data with Full Information Maximum Likelihood (FIML) in order to cope with missing data. As expected, the meditation group (N = 341) showed lower stress, higher well-being and improved sleep quality after the intervention (very small to small effect sizes) compared with a waitlist control group (N = 430). It turned out that the meditation had a stronger impact on the reduction of negative affect than on the increase of positive affect and also a stronger effect on affective components of well-being. Mindfulness, as a core element of the meditation, increased during the study within the meditation group. All effects remained stable at follow-up six weeks later. Overall, a large, heterogeneous sample showed that already a very short dose of meditation can positively influence stress, sleep, and well-being. Future research should consider biological markers as well as active control groups.

scholarly journals Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016298 ◽  
Author(s):  
Janaka Lagoo ◽  
Steven R Lopushinsky ◽  
Alex B Haynes ◽  
Paul Bain ◽  
Helene Flageole ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Implementation Strategy ◽  
Citation Index ◽  
Improve Patient Safety ◽  
Implementation Strategies ◽  
Meaningful Use ◽  
Narrative Synthesis ◽  
Surgical Safety ◽  
Full Text Review

ObjectiveTo examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.Summary background dataSince the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.MethodsA broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.Results1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.ConclusionsA SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.

Aim: To determine the efficacy of health beliefs model –based intervention in changing the belief related to substance use among university student in Mosul city-Iraq.

2021 ◽  
Author(s):  
Arkan Bahlol Naji ◽  
Nasir Muwfaq Younis
Keyword(s):  
Substance Use ◽  
Health Beliefs ◽  
Undergraduate Student ◽  
Controlled Trial ◽  
University Student ◽  
Simple Random Sample ◽  
Control Group ◽  
Model Based ◽  
Engineering Sciences ◽  
And Control

Abstract Aim: To determine the efficacy of health beliefs model –based intervention in changing the belief related to substance use among university student in Mosul city-Iraq. Design: A randomized controlled trial. Methods: A probability (simple random sample) of (N=80) undergraduate student in different specialties would be selected. The study sample will be recruited from (4) colleges in the University of Mosul's Engineering, Sciences, Medicine and Education Colleges. The sample will be randomly assigned into experimental and control groups of (40) undergraduate student for each group. Such chosen is employed of pool of topics that have the criteria contain students who have using on (Smoking, Hookah, Drug abuse and Alcohol).For during from 25of October / 2019 till 1 of February/2021. Data is analyzed using the &quot;Statistical Package for Social Science&quot; (SPSS) software for Windows (V:26). Results: This finding indicated that before the intervention, mean scores for all concepts of HBM, add to Motivation, Control, and behaviors intensions of students they were almost equal. However, after the intervention were significantly different in the study group, while it was not significant in the control group. Conclusion:This study concluded that designing an HBM-based study could affect students' understanding and their behaviors in the field of substance abuse. Considering the positive correlation between construct of HBM, particularly in &quot;perceived benefits and perceived severity&quot; related to students’ beliefs. These beliefs implied a significant correlation with each other and with the attention to the prevention of addiction.

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