Enhance Treatment Engagement Research Articles

Exemplar Hospital initiation trial to Enhance Treatment Engagement (EXHIT ENTRE): protocol for CTN-0098B a randomized implementation study to support hospitals in caring for patients with opioid use disorder

BackgroundHospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT.MethodsFour state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge.DiscussionInitiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals.Trial registrationNCT04921787.

275 Cultural Adaptation and Implementation of Cognitive Behavior Therapy in a Rural Mental Health Clinic of Puerto Rico

OBJECTIVES/GOALS: Culturally Centered Cognitive-Behavioral Therapy (CCCBT) is a therapeutic approach that acknowledges the effect of cultural values, beliefs, and norms on mental health. Study aims to develop a CCCBT for rural community by enhancing engagement, relevance, and outcomes through culturally tailored interventions, and evaluate its implementation. METHODS/STUDY POPULATION: Diverse mixed methods study with participants ages 18-65 from Partial Hospitalization Program in rural community located in Puerto Rico Mountain region. CCCBT intervention will have a span of 9 consecutive bi-weekly sessions. The study consists of 2 phases: 1. Evaluate intervention acceptability through focus groups (n=12) with repeated measures to learn about enhancing mental health outcomes, 2. Measure intervention effectiveness in reducing mild-moderate depression and anxiety symptoms using validated questionnaires (PHQ-9 and GAD-7) with a 100 participants from same region. Descriptive analysis for sociodemographic characteristics will be used to provide overview of participants characteristics. Qualitative analysis of focus groups will be obtained through feedback and content analysis. RESULTS/ANTICIPATED RESULTS: We anticipate high intervention acceptability through positive participant feedback and cultural relevance feedback from focal groups. We expect to find significant reduction in symptoms of depression and anxiety post-intervention, demonstrating the efficacy of CCCBT in Puerto Rican rural communities. These results will support the feasibility of implementing this approach, addressing mental health disparities, and enhancing treatment engagement and outcomes in underserved populations. The study will inform future research to refine and expand this intervention in rural communities of Hispanics and/or other rural underserved populations in the US. DISCUSSION/SIGNIFICANCE: This study’s success will advance culturally tailored mental health care in underserved rural Puerto Rican communities, reducing disparities and enhancing treatment relevance and engagement, with potential implications for improving mental health outcomes in similar populations in the US and worldwide.

EFFECTS OF GAMIFIED COGNITIVE TRAINING TO DETER THE PROGRESSION OF MILD COGNITIVE IMPAIRMENT

Abstract Mild cognitive impairment (MCI) is highly prevalent condition among older adults, and has a greater risk of progression to dementia. Even cognitive training has great efficacy to delay the onset of dementia, its time-limited offer by professional members reduces its availability. Whereas ‘gamification’ evolves as important concept to enhance treatment engagement, we developed an innovative Sudoku solving algorithm titled ‘T-code’ to assimilates the key domains of cognitive training on attention, logical and deductive reasoning. A single-blinded RCT randomized 288 older adults with MCI to receive the 24-week Sudoku Mind Activation and Revitalizing Training (SMART) Program (n=157) or the usual care (n = 131). A battery of cognitive assessments, the Memory Inventory for Chinese, the Short Form-36 were evaluated at baseline, immediately after the 12-week Sudoku training and after the 12-week home-based self-practice. Focus group interview was conducted to explore subjects’ experience and reasons for its therapeutic effects if any. The results indicated that participants in the SMART Program had greater improvements in global cognitive function, working memory, language, short- and long-term delay recalls, recognition memory, CTT 1 and subjective memory complaints immediately after the 12-week training than the control. These effects, together with executive function, were sustained till the end of the programme. The qualitative findings converged with the outcome evaluation, and improved self-confidence, more active life engagement, and enhanced mood status might sustain the cognitive benefits. This game-based cognitive training is a treatment option of high accessibility, availability and acceptance to prevent MCI from progressing to dementia.

96 Feasibility Trial of a Mobile Health Intervention for Dementia Caregivers

Objective:There are numerous adverse health outcomes associated with dementia caregiving, including increased stress and depression. Caregivers often face time-related, socioeconomic, geographic, and pandemic-related barriers to treatment. Thus, implementing mobile health (mHealth) interventions is one way of increasing caregivers’ access to supportive care. The objective of the current study was to collect data from a 3-month feasibility trial of a multicomponent mHealth intervention for dementia caregivers.Participants and Methods:40 community-dwelling dementia caregivers were randomized to receive the CARE-Well (Caregiver Assessment, Resources, and Education) App or internet links connected to caregiver education, support, and resources. Caregivers were encouraged to use the App or links at least 4 times per week for 3 months. The App consisted of self-assessments, caregiver and stress reduction education, behavior problem management, calendar reminders, and online social support. Caregivers completed measures of burden, depression, and desire to institutionalize at baseline and post-intervention. Feasibility data included App usage, retention and adherence rates, and treatment satisfaction. Data were analyzed via descriptive statistics.Results:Caregivers were mostly white (95%), female (68%), in their mid-60s, (M= 66.38, SD= 10.64), and well-educated (M= 15.52 years, SD= 2.26). Caregivers were mainly spouses (68%) or adult children (30%). Care recipients were diagnosed with mild (60%) or moderate (40%) dementia, with 80% diagnosed as having Alzheimer’s disease. Overall, the study had an 85% retention rate (80% for App group; 90% for links group). 58% of caregivers in the App group were considered high users, using the App >120 minutes over the course of 3 months (M= 362.42, SD= 432.68), and an average of 16.44 days (SD= 15.51). 15% of the sample was non-adherent due to time constraints, disinterest, and/or technology issues. Most participants (75%) using the App were mostly or very satisfied, about 87% would be likely or very likely to seek similar programs in the future, and 93% found the App mostly or very understandable. Groups did not significantly differ on clinical outcomes, although the study was not powered for an efficacy analysis. Within groups analysis revealed significant increases in depressive symptoms at post-treatment for caregivers in both groups.Conclusions:This study demonstrated initial feasibility of the CARE-Well App for dementia caregivers. App use was lower than expected, however, high satisfaction, ease of use, and willingness to use similar programs in the future were endorsed. Some caregivers did not complete the intervention due to caregiving responsibilities, general disinterest, and/or technology issues. Although the study was not designed to assess clinical outcomes, we found that both groups reported higher depressive symptoms at post-treatment. This finding was unexpected and might reflect pandemic-related stress, which has been shown to particularly impact dementia caregivers. Future studies should address the efficacy of multicomponent mHealth interventions for dementia caregivers and the effects of increased dose on clinical outcomes. mHealth interventions should be refined to cater to varying levels of technology literacy among caregivers, and further research should aim to better integrate interventions into caregivers’ routines to enhance treatment engagement.

The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial

BackgroundThere is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents’ inclusion in their adolescents’ obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents’ obesity treatment.MethodsParticipants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child’s weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up.DiscussionResults of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment.Trial registrationClinicaltrials.gov NCT03851796. Registered: February 22, 2019.

A Pilot Replication Study ofImplementing an Equine-Assisted Services Program Within a VA Residential Substance Use Disorder Treatment Program.

Veterans have high rates of substance use disorders and other mental health conditions including post-traumatic stress disorder. Effective treatments for these conditions exist; however, high attrition rates and residual symptoms after completing treatment are common. Complementary treatment approaches could enhance treatment engagement and/or response among this population. We previously reported a study of one such intervention, an equine-assisted learning, and psychotherapy incorporating horses intervention provided to veterans admitted to a Veterans Health Care Administration residential substance abuse treatment program. The first aim of this study was to replicate the previous study assessing the safety, feasibility, and preliminary outcomes of this intervention. The second aim was to examine the effect of participants attending multiple intervention sessions. Participants were 94 veterans who participated in one to six sessions of a 3-4-hour program consisting of both equine-assisted learning and psychotherapy incorporating horses. Pre- and post-session administration of the Positive and Negative Affect Scale, State-Trait Anxiety Inventory, and Craving Experience Questionnaire was utilized to assess changes in affect, anxiety, and craving. Wilcoxon signed-rank or paired two-tailed t-tests were utilized for pre- to post-session comparisons of the outcome measures for sessions 1-4. Generalized linear mixed-effects (GLME) models were constructed to determine the impact of dosage. GLME models were constructed to determine the impact of dosage. As with our previous study, the intervention was safe and feasible to utilize for this population. There were statistically significant pre- to post-session improvements, with medium-to-large effect sizes, for sessions 1-3 for negative affect and sessions 1 and 2 for positive affect, anxiety, and craving. The GLME models revealed no statistical significance for any of the predictors. Taken together, this study and our previous investigation of this equine-assisted services intervention suggest that it is safe and feasible to utilize for veterans admitted to a residential substance abuse treatment program and we have now found short-term benefits in two separate studies. Thus, a randomized controlled trial of this intervention is warranted to demonstrate cause and effect and determine whether longer-term benefits are associated with the intervention. The finding that there was no additional benefit from attendance at more than two intervention sessions suggests that dose-response relationship studies of equine-assisted services interventions for veterans are needed.

Potential Mechanisms of Action and Outcomes of Equine-Assisted Services for Veterans with a History of Trauma: A Narrative Review of the Literature.

Equine-assisted services (EASs) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing the desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as by contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein, as well as investigate suggested mechanisms of action.

0418 Racial disparities in patient engagement and treatment outcomes in digital cognitive behavioral therapy for insomnia

Abstract Introduction Cognitive behavioral therapy for insomnia (CBTI) is gold standard for insomnia care. However, recent data suggest Black CBTI patients may complete fewer sessions and experience poorer outcomes relative to white CBTI patients. The present study examined whether racial disparities in CBTI engagement mediated group differences in treatment outcomes on insomnia symptoms. Methods We conducted a secondary analysis of pretreatment and posttreatment data from 569 Black and white patients with clinical insomnia symptoms (Insomnia Severity Index [ISI] ≥ 15) who were randomized to digital CBTI in a large-scale RCT. Study outcomes included number of sessions completed (≥4 sessions considered an adequate dose) and insomnia symptoms (ISI). Results Black CBTI patients completed fewer CBTI session than white patients (M±SD: 2.81±2.36 vs 3.79±2.45; t(561)=4.06, p<.001). Consequently, Black patients were 1.53 times more likely than white patients to prematurely discontinue CBTI before receiving an adequate dose (premature discontinuation rates: 62.5% vs 40.7%, Χ2=19.28, p<.001). A multivariate linear regression showed that Black patients reported higher ISI scores than white patients after CBTI (b=1.28, p=.009) while controlling for pretreatment ISI (p=<.001). However, race became non-significant in the multivariate model (b=.55, p=.248) when sessions completed was entered as a predictor (b=-.60, p<.001). The PRODLIN method estimated the indirect to be αβ=2.27 with a 95% Confident Interval of 1.59 to 2.96, thereby supporting a significant mediation. We estimated that 55.5% of racial disparities in posttreatment ISI outcomes were mediated through group differences in number of sessions completed. Notably, posttreatment insomnia remission (ISI≤9) rates did not differ between Black and white patients (36.9% vs 39.6% remission, p=.613), whereas insomnia remission rates were nearly twice as high among CBTI patients who received an adequate dose relative to those who discontinued prematurely (46.7% vs 24.9% remission, Χ2=23.46, p<.001). Conclusion Black patients reported greater insomnia symptoms after CBTI relative to white patients, but these racial disparities in insomnia outcomes were largely attributable to lower rates of CBTI engagement among them. No racial disparities in CBTI outcomes were observed among those who completed ≥4 sessions. Enhancing treatment engagement among Black patients may improve dCBTI efficacy in this group. Support (if any) This RCT (NCT03322774) was supported by NIMH R01-MH122636.

Parent-child interaction therapy for children in foster care and children with posttraumatic stress: Exploring behavioral outcomes and graduation rates in a large state-wide sample

ObjectiveParent-Child Interaction Therapy (PCIT) is an evidence-based treatment to reduce child disruptive behaviors and has been used for children with co-occurring posttraumatic stress symptoms (PTS). However, many families are faced with barriers that interfere with treatment completion. Engagement and attrition issues remain a continuous concern for families accessing needed services for youth. Furthermore, these issues are exacerbated for children in foster care. MethodsThe present study explored differences in behavioral outcomes and graduation rates for children in foster care, (n = 206), non-foster care children with a history of trauma (n = 249), and non-foster care children without a history of trauma (n = 1,522) who participated in PCIT. Data was collected in community mental health agencies across the state of Oregon. ResultsThere was a significant decrease in caregiver reported disruptive behavior scores for all groups following PCIT. There were no significant differences found in graduation rates and average number of sessions attended between the groups; however, the graduation rate for this sample was low (17.8%). ConclusionsResults demonstrate that PCIT can be similarly effective in reducing problematic behaviors for children placed in foster care when compared to children not in foster care. Practical Implications: Given the low graduation rate, is imperative that we continue to investigate strategies to enhance treatment engagement and reduce barriers to services.

Treatment engagement in first-episode schizophrenia: Associations between intrinsic motivation and attendance during cognitive training and an aerobic exercise program

Systematic cognitive training and aerobic exercise programs have emerged as promising interventions to improve cognitive deficits in first-episode schizophrenia, with successful outcomes closely linked with greater treatment engagement (e.g., higher attendance and homework completion rates). Unfortunately, treatment disengagement from these services remains a persistent issue. Intrinsic motivation, or the willingness to exert effort because a task is inherently interesting or meaningful, has emerged as a promising malleable personal factor to enhance treatment engagement. This study investigated whether early task-specific intrinsic motivation and its domains (e.g., interest, perceived competence, and value) predicted treatment engagement within the context of intensive cognitive training and aerobic exercise interventions over a 6-month period. Thirty-nine participants with first-episode schizophrenia were administered baseline measures of task-specific intrinsic motivation inventories, one for cognitive training and one for exercise, and completed a 6-month randomized clinical trial comparing a neuroplasticity-based cognitive training plus aerobic exercise program against the same cognitive training alone. Results indicated that higher baseline scores of intrinsic motivation for cognitive training, specifically early perceptions of task interest and value, were predictive of greater cognitive training and exercise group attendance. Scores for exercise-specific intrinsic motivation were generally unrelated to indices of exercise participation, with the exception that the gain over time in perceived choice for exercise was linked with greater exercise homework completion and a similar directional tendency for greater in-clinic exercise attendance. This study provides support for monitoring and enhancing motivation early during service delivery to maximize engagement and the likelihood of successful treatment outcomes.

Military veterans’ motivation and barriers to outdoor recreation participation

ABSTRACT Outdoor activity benefits veterans’ sense of well-being, coping skills and affective experience while improving physical and mental health. Understanding military veterans’ motivation for and barriers to outdoor recreation allows healthcare providers to design interventions that help veterans achieve their healthcare objectives through outdoor activity, which may enhance treatment engagement and clinical outcomes. Veterans were surveyed about their reasons for and barriers to participation in outdoor recreational activities. Veterans’ motivations for engaging in their preferred outdoor activities were: 1. keep fit and healthy, 2. meet new people, 3. learn something new, 4. feel in harmony with nature, and 5. achieve spiritual fulfilment. Veterans with mobility challenges more frequently pursued outdoor activities when it was important for them to keep fit and healthy. Veterans without mobility challenges more frequently pursued outdoor activities when it was important for them to: 1. experience challenge and excitement, 2. meet new people, 3. learn something new, 4. feel harmony with nature, and 5. achieve spiritual fulfilment. The most common barriers to outdoor recreation were health problems, crowded facilities, family time, and feeling too tired. Veterans’ motivations for outdoor recreation were stronger drivers of their actual outdoor recreation participation than barriers to that activity.

Cultural and Telehealth Considerations for Trauma‐Focused Treatment Among Latinx Youth: Case Reports and Clinical Recommendations to Enhance Treatment Engagement

Given that trauma exposure among youth, particularly those from communities of color, is high, there is a dire need to improve trauma-focused treatment for young people of color. Growing research has documented that integrating cultural and telehealth considerations into trauma-focused treatment can enhance treatment engagement and lead to positive treatment outcomes. Therefore, the purpose of this paper is to demonstrate how to incorporate cultural and telehealth considerations concurrently to enhance treatment engagement for Latinx youth and their caregivers. Specifically, we describe the process of delivering Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to three trauma-exposed Latinx youths through the use of telehealth technology. Clinical recommendations are discussed to improve treatment engagement of Latinx youth and other young people of color.

Sleep disorder symptoms and massed delivery of prolonged exposure for posttraumatic stress disorder: Nodding off but not missing out.

The impact of disrupted sleep on the effectiveness of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) is not well understood. Researchers have suggested that comorbid sleep disorders contribute to nonresponse by impairing therapeutic mechanisms such as emotional processing of trauma memories and extinction in cued fear conditioning. Several studies indicate daytime sleepiness, insomnia, and nightmares are correlated with PTSD symptom severity. However, a recent randomized controlled trial found that these sleep disorder symptoms did not affect PTSD symptom change over the course of massed PE (i.e., daily sessions across 2 weeks). The current study used an ecologically valid clinical sample to examine whether daytime sleepiness, insomnia, and nightmares interfere with the slope of symptom change in massed PE. Results indicate that all 3 sleep disorder symptoms correlate with PTSD symptom severity on the first day of treatment but were not associated with symptom change. These findings are consistent with the expectation that the daily structure of massed PE may enhance treatment engagement in patients who are typically drowsy or not well-rested, thus facilitating fear extinction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Factors contributing to PTSD treatment dropout in veterans returning from the wars in Iraq and Afghanistan: A systematic review.

Although treatment effectiveness among evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) has been well established, treatment dropout among veterans continues to be a concern within these treatments. Due to the uniqueness of the Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veteran cohort, this article reviewed the literature examining factors contributing to treatment dropout from EBPs for PTSD among OEF/OIF/OND veterans. We conducted a systematic review of the published literature using PsycINFO, PubMed, and PTSDpubs with a restriction on year of publication beginning in 2007, following the first VA national initiative to roll-out EBPs for PTSD, through May 1st, 2020. Articles were retained if treatment dropout for EBPs was examined among OEF/OIF/OND veterans with PTSD, which yielded a total of 26 manuscripts. Common themes associated with treatment dropout were identified, including demographic, psychological, cognitive, practical, and treatment-related factors. Specifically, younger age, concurrent substance use, and practical concerns (e.g., balancing multiple life roles) emerged as factors that consistently contributed to treatment dropout. Other findings were mixed (e.g., pretreatment symptom severity and presence of traumatic brain injury). While factors contributing to dropout are complex and interact uniquely for each veteran, improved understanding of these factors in combination with innovative strategies for treating OEF/OIF/OND veterans utilizing EBPs is needed to enhance treatment engagement, retention, and outcomes. Implications for these factors are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Intranasal Oxytocin for Stimulant Use Disorder Among Male Veterans Enrolled in an Opioid Treatment Program: A Randomized Controlled Trial.

The increasing prevalence of illicit stimulant use among those in opioid treatment programs poses a significant risk to public health, stimulant users have the lowest rate of retention and poorest outcomes among those in addiction treatment, and current treatment options are limited. Oxytocin administration has shown promise in reducing addiction-related behavior and enhancing salience to social cues. We conducted a randomized, double-blind, placebo-controlled clinical trial of intranasal oxytocin administered twice daily for 6 weeks to male Veterans with stimulant use disorder who were also receiving opioid agonist therapy and counseling (n = 42). There was no significant effect of oxytocin on stimulant use, stimulant craving, or therapeutic alliance over 6 weeks. However, participants receiving oxytocin (vs. placebo) attended significantly more daily opioid agonist therapy dispensing visits. This replicated previous work suggesting that oxytocin may enhance treatment engagement among individuals with stimulant and opioid use disorders, which would address a significant barrier to effective care.

Safety Planning for Suicidality in Autism: Obstacles, Potential Solutions, and Future Directions.

Safety Planning for Suicidality in Autism: Obstacles, Potential Solutions, and Future Directions.

70.6 BRINGING SUBSTANCE SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) TO THE HOSPITAL FLOOR

This brief presentation will describe psychiatric consultation-liaison (CL) procedures for evaluating substance use disorders in medically hospitalized adolescents and the limitations of current procedures for referring such youth to specialized substance treatment. The Teen Recovery Program at Children’s Health is designed to provide specialized services for adolescents with mental health diagnoses and problematic substance use. Established collaboration between medical providers at Children’s Medical Center Hospital in Dallas and the Teen Recovery Program allows for inpatient evaluation of medically hospitalized substance-involved youth on the psychiatry CL service. David Atkinson, MD, will discuss current challenges associated with substance treatment referral and engagement. He will also consider ways in which the Screening, Brief Intervention, and Referral for Brief Consultative Evaluation (SBIRE) model may be adapted to enhance treatment engagement in the Teen Recovery Program at Children’s Health providing specialized services for adolescents with co-occurring mental illness and substance use disorders. Dr. Atkinson will present data on the current rates of substance treatment engagement among medically hospitalized youth with problematic substance use referred to the Teen Recovery Program. He will also discuss how the SBIRE model may be adapted in this setting to enhance substance treatment engagement compared to poor rates of treatment engagement using a more conventional Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol used currently. The SBIRE model may be modified or adapted to increase substance treatment engagement among medically hospitalized youth referred to a subspecialty substance treatment program.

Suicide attempt survivors' recommendations for improving mental health treatment for attempt survivors.

Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors' experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and synthesize suicide attempt survivors' recommendations for how to enhance mental health treatment experiences for attempt survivors. A sample of 329 suicide attempt survivors (81.5% female, 86.0% White/Caucasian, mean age = 35.07 ± 12.18 years) provided responses to an open-ended self-report survey question probing how treatment might be improved for suicide attempt survivors. Responses were analyzed utilizing both qualitative and quantitative techniques. Analyses identified four broad areas in which mental health treatment experiences might be improved for attempt survivors: (a) provider interactions (e.g., by reducing stigma of suicidality, expressing empathy, and using active listening), (b) intake and treatment planning (e.g., by providing a range of treatment options, including nonmedication treatments, and conducting a thorough assessment), (c) treatment delivery (e.g., by addressing root problems, bolstering coping skills, and using trauma-informed care), and (d) structural issues (e.g., by improving access to care and continuity of care). Findings highlight numerous avenues by which health providers might be able to facilitate more positive mental health treatment experiences for suicide attempt survivors. Research is needed to test whether implementing the recommendations offered by attempt survivors in this study might lead to enhanced treatment engagement, retention, and outcomes among suicide attempt survivors at large. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Multidimensional Examination of the Measurement of Treatment Engagement: Implications for Children’s Mental Health Services and Research

ABSTRACT Objective: The gap between rates of children’s mental health problems and their participation in services highlights the need to address concerns related to engagement in mental health services more effectively. To identify, understand, and resolve engagement concerns appropriately requires effective measurement. In this study, we employed a multidimensional conceptual framework of engagement to examine the measurement of engagement in intervention studies focused on improving children’s and/or families’ engagement in services. Method: We coded 52 randomized controlled trials (RCTs) of interventions designed to enhance treatment engagement published between 1974 and 2019 to examine what engagement constructs have been measured, how these constructs have been measured, who has provided information about engagement, and when and why engagement measures have been administered. Results: Attendance was measured in 94.2% of studies, and 59.6% of studies measured only attendance. Furthermore, most studies (61.5%) measured only one engagement dimension. One hundred twelve unique indicators of treatment engagement were used (61.6% measuring attendance). Infrequent measurement of youth (19.2% of studies) or caregiver (26.9%) perspectives was apparent. About half (54.7%) of measures were completed on one occasion, with 53.7% of measures completed after treatment was concluded. Conclusions: Results highlight how the field’s measurement of engagement has focused narrowly on attendance and on interventions that improve attendance. We consider promising new directions for capturing the multidimensional, dynamic, and subjective aspects of engagement, and for leveraging measurement in research and practice settings to feasibly and effectively identify, monitor, and address engagement challenges.

Understanding the illness representations of young people with anxiety and depression: A qualitative study.

Many young people with anxiety or depression drop out of treatment early, and/or leave treatment without showing measurably improved symptom levels. To enhance treatment engagement and effectiveness, it is critical to better understand how young people's perceptions of the symptoms, causes, consequences, treatability, and course of their anxiety and depression influence engagement. This study aimed to provide a qualitative account of illness perceptions among youth with anxiety and depression by applying the Common Sense Model of Self-Regulation (CSM), which was developed in physical health contexts. Semi-structured interviews were conducted with 26 young people (aged 16-24, 73% female) with a history of anxiety and/or depression. Interviews were analysed using a combination of theory- and data-driven analysis techniques, consisting primarily of deductive thematic analysis. The five themes broadly mapped onto the dimensions of the CSM, suggesting parallels in how mental and physical health problems are perceived. Anxiety and depression were viewed as non-linear, relapsing and remitting, but lifelong conditions, with a fluctuating and complex path to recovery and coping. Youth described pervasive negative impacts on their lives, but also described some positive aspects. Better understanding of young people's illness beliefs has the potential to open a range of intervention possibilities by prioritizing young people's illness perceptions over the clinician's understanding and the supposed objective condition severity and trajectory. Although this study supported a common structure of illness beliefs, the content of these beliefs was idiosyncratic and specific to anxiety and depression, suggesting the need to develop a valid tool to measure illness perceptions in this group. Our findings suggest that illness perceptions are complex, highly idiosyncratic, and specific to youth anxiety and depression. Given the complexity of these beliefs and the known association with important treatment- and health-related outcomes, it is important that clinical formulation incorporates young people's illness belief models, including their perceptions of symptoms, cause, timeline to recovery, consequences, and personal and treatment control. To increase help-seeking, treatment engagement and adaptive coping strategies, therapy should work to a shared understanding of illness beliefs. Increasing congruence between the belief models of young people, families, and clinicians may serve to improve treatment benefits and address the unmet mental health needs of young people.