Mental Health Services Administration Research Articles

New grants: Residential SUD treatment for pregnant women

Last month the Substance Abuse and Mental Health Services Administration (SAMHSA) announced funding opportunities for grants for substance use disorder (SUD) treatment and recovery among pregnant and postpartum women.

Implementing a Trauma-Informed Approach at a Student-Run Clinic for Individuals Seeking Asylum.

Health care professionals complete forensic medical evaluations (FMEs) to corroborate evidence of persecution among individuals seeking asylum. Many FMEs are conducted at student-run clinics for individuals seeking asylum (or student-run asylum clinics; SRACs). Trauma-informed care (TIC) recognizes that trauma is pervasive and seeks to mitigate reexposure to trauma in health care interactions. Given that FMEs involve recalling trauma, TIC is an ideal model for supporting the individuals involved in an FME. The authors operationalized TIC principles in an SRAC model (the Human Rights Cooperative) at the University of California, San Francisco. Between April 2019 and April 2022, the SRAC provided 3 to 10 pro bono FMEs per month, as well as community referrals for individuals seeking asylum, clinician and medical student training on FMEs and TIC, and research on FMEs. This report describes the SRAC operations, organized by the 10 implementation domains of the Substance Abuse and Mental Health Services Administration guidance to organizations for implementing a trauma-informed approach. Between April 2019 and April 2022, the SRAC completed 160 FMEs. Sixty-nine clinicians performed FMEs, and 119 first-year medical students participated in the accompanying elective. Qualitative survey responses by clinicians, lawyers, students, and clients (individuals seeking asylum) highlighted the trauma-informed principles of safety; trustworthiness and transparency; empowerment, voice, and choice; peer support; collaboration and mutuality; and cultural, historical, and gender issues. All students who acted as leaders sustained their engagement with the SRAC over time. Future research should use validated tools to assess secondary trauma and resilience within SRACs. The SRAC concept, which engages medical students and experienced clinicians in learning skills that can be used in the pursuit of health justice and equity, should be expanded and supported in U.S. medical schools across the country, which is facing unprecedented levels of migration.

Peer Support Specialists Can Play Important Role in Patients’ Lives

Peer Support Specialists Can Play Important Role in Patients’ Lives

NSDUH: More consumers reporting SUD, mental health problems

In January, the Substance Abuse and Mental Health Services Administration (SAMHSA) released its 2021 National Survey on Drug Use and Health (NSDUH) data.

SAMHSA names new director of 988 crisis coordinating office

The Substance Abuse and Mental Health Services Administration (SAMHSA) has named Monica S. Johnson, M.A., LPC as the new director of SAMHSA's 988 & Behavioral Health Crisis Coordinating Office. Johnson has worked in the behavioral health field for 26 years and most recently served as the interim commissioner for the Georgia Department of Behavioral Health and Developmental Disabilities DBHDD). Prior to that role, she served in other positions for DBHDD, including as division director of the agency's division of behavioral health, community mental health director, and child and adolescent mental health director.

AATOD's Parrino focusing on the star: Part 8 NPRM

With all of the buzz swirling about buprenorphine — the victory of eliminating the X‐waiver claimed by Congress, the White House, the American Society of Addiction Medicine, the U.S. Department of Health and Human Services, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Drug Enforcement Administration, and on and on — what is the main organization dedicated to the treatment of opioid use disorder (OUD) with methadone (and buprenorphine), i.e., the American Association for the Treatment of Opioid Dependence (AATOD), up to? AATOD is looking carefully at, and responding to, the Part 8 Notice of Proposed Rulemaking (NPRM), which makes methadone treatment much more accessible and flexible than it was.

Diversity workforce report one of newly released SMHA profiles

Data from the federal Health Resources and Services Administration (HRSA) and Substance Abuse and Mental Health Services Administration (SAMHSA)‐funded Behavioral Health Workforce Research Center at the University of Michigan indicate that improvements can be made to increase the diversity of the behavioral health workforce, according to a new report, one of 10 released this month by NRI, Analytics Improving Behavioral Health.

Racial disparities in a community-based addiction reduction (CARE) program for women of reproductive age with substance use disorder

Background and Objective: In 2018, 51% of the 63 pregnancy-associated deaths of women in Indiana were attributed to substance use disorder (SUD), with Black women being disproportionately affected. To address the need for more effective SUD treatment interventions, the community-based addiction reduction (CARE) program connects women of child-bearing ages with SUD with addiction recovery coaches (ARCs) to provide personalized supports throughout recovery. To identify program characteristics that influence the retention of women of color in the program, quantitative analysis of CARE survey data and qualitative analysis of CARE ARC narrative entries of participant encounters were performed.
 Project Methods: 251 women were enrolled in the CARE program. Chi-square/T-tests compared survey responses by race for treatment status, treatment motivation scales, and retention in the program at intake, 2-, 6-, 9-, and 12-month follow ups. Qualitative analysis of ARC narrative entries was conducted following thematic analysis and crystallization immersion analytic methods based on the grounded theory.
 Results: Statistical analyses revealed White compared with Black women in the CARE program were significantly more likely to be in treatment at intake (p<.001) and more motivated to engage in recovery treatment (p<.001). Despite these differences, Black women were retained longer in the CARE Program at 2- (p<.006), 6- (p<.011) and 9-(p<.004) months. The ARC narrative entries were initially coded and emergent themes mapped well to the four types of supports provided by peer recovery coaches as outlined by the Substance Abuse and Mental Health Services Administration: emotional, instrumental, informational, and affiliational. Qualitative analysis of ARC narrative entries by race are currently underway.
 Conclusion and Potential Impact: The inclusion of ARCs as integral members of SUD recovery programs may preferentially provide Black women with SUD the opportunity to build more trusting relationships with these peer coaches, thereby increasing their participation and retention in SUD-related treatment.

Understanding Ohio X-Waivered Advanced Practice Registered Nurses' Rate of Naltrexone Prescription for Alcohol Use Disordered Patients.

Alcohol use disorder (AUD) is overrepresented within the United States. Naltrexone, a recommended treatment for AUD, is underutilized. However, the prescribing behaviors of advanced practice registered nurses (APRNs) regarding naltrexone for AUD patients have not been studied. The purpose of our study was to explore the prescriptive practices of a sample of APRNs. To describe and analyze survey responses of a sample of Ohio APRNs with training in medication for addiction treatment (MAT) for substance use disorders (as evidenced by DEA x-waiver receipt) regarding prescribing practices of naltrexone for AUD patients. Public information collected from the first author's Nursing Board (list of APRNs in Ohio) was checked against the public information of x-waivered providers nationally from the Substance Abuse and Mental Health Services Administration's (SAMHSA) website. This generated a potential sample size of 824 APRNs, all of whom were sent email solicitations to complete a Qualtrics survey. After 3 weeks, 55 surveys were completed, and the data were analyzed. Descriptive statistics were generated as well as a logistic regression with five potential predictor variables against the outcome variable (defined as use of naltrexone for AUD patients). Years practicing as an APRN was found to negatively predict naltrexone prescribing behavior for AUD patients. Practice setting and work experience with an addiction specialist physician were not found to predict naltrexone prescribing behavior for AUD patients. Implications for further study were discussed, with emphasis on regulatory variance between states.

Mixed Methods Evaluation of State Targeted Response to the Opioid Crisis in Ohio

Background: In 2017, the Substance Abuse and Mental Health Services Administration awarded State Targeted Response (STR) grants through the 21st Century Cures Act to help states address the opioid crisis. While there are publications that discuss how each state allocated their STR grant awards, there is a paucity of evaluations illustrating the impact of STR grant activities on clients of opioid use disorder (OUD) treatment, family members of persons living with OUD, community professionals whose work involves addressing OUD, as well as impacts on local communities. This longitudinal qualitative study assessed the impact of STR grant-funded projects on communities in Ohio particularly hard hit by the opioid epidemic. Methods: Data were collected through a mixed research methodology from November 2017 through April 2019. Epidemiologists conducted focus groups and administered surveys in 4 geographically different areas of the state. Study objectives included assessments of community messaging related to opioids, level of perceived stigma for OUD, knowledge of available services and processes for accessing them, and perception of community treatment service needs. Results: A total of 940 respondents participated in 3 cycles (6 months each) of focus groups. Key findings included increased naloxone knowledge and experience, increased proportion of persons living with OUD receiving medication-assisted treatment (MAT), and a 2.5 time increase in the number of reported positive observations of community change. While the level of perceived stigma for OUD remained consistent (moderate) throughout the study, respondents throughout cycles observed an increasing number of community approaches, such as public awareness campaigns and recovery rallies, to impart knowledge, change attitudes, and reduce stigma. Conclusion: Evaluations of STR funded activities and programs could help illustrate the value that additional funding might have over time in reducing stigma related to OUD and increasing knowledge of available treatment services in communities.

Congress Passes Spending Bill With Several APA Priorities

Back to table of contents Previous article Next article Government & LegalFull AccessCongress Passes Spending Bill With Several APA PrioritiesKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:20 Jan 2023https://doi.org/10.1176/appi.pn.2023.02.2.43AbstractThe $1.7 trillion omnibus package includes many provisions for which APA heavily advocated, including new investments in the psychiatric workforce, collaborative care, and mental health parity.dkfieldingIn December, Congress passed the Consolidated Appropriations Act of 2023 (HR 2617), a massive spending bill that will keep the U.S. government funded through September.The package, which President Joe Biden signed on December 29, includes numerous APA priorities for which it has advocated heavily. They include APA initiatives focused on encouraging implementation of the evidence-based Collaborative Care Model (CoCM), enforcing mental health parity, and bolstering the psychiatric workforce.“These accomplishments as well as many others in the legislation are a great victory for psychiatry and the patients we serve and could not have been achieved without the active engagement of APA members and the dedication of APA staff,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A.Some of the APA priorities in the package include the following:Collaborative care: The package includes grants and technical assistance to implement the CoCM in primary care settings for the prevention of mental and substance use disorders (SUD) and early intervention for treatment.Mental health parity: Grants for state insurance agencies were included in the package to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and ensure that insurers are complying with the federal parity law. The spending package also eliminates the parity opt-out for non-federal governmental health plans.Workforce: The package made significant investments in the medical workforce with the creation of 200 new graduate medical education (GME) residency slots, half of which are designated specifically for psychiatry or psychiatric subspecialties.Telehealth: The package extends the current Medicare telehealth flexibilities instituted due to the ongoing public health emergency. It delays the implementation of the in-person requirement for telehealth services for mental health until December 31, 2024.APA’s members and staff have initiated many of these provisions and actively advocated for them. In May 2022, in her role at the time as incoming APA President, Rebecca Brendel, M.D., J.D., provided expert testimony to the Subcommittee on Health of the House Committee on Energy and Commerce. She spoke about numerous bills that would bolster the nation’s mental health system, explaining that many insurers are not in compliance with MHPAEA and that Congressional action is needed. She also emphasized the importance of integrating mental and physical health care to enhance access and the need of primary care offices for support so they can implement the CoCM (“Incoming APA President Testifies Before House Subcommittee”).In addition, APA members and staff engaged congressional offices and deployed a strong grassroots push to encourage congressional action addressing the psychiatry workforce shortage, resulting in the 100 new GME slots reserved for psychiatry. Congress has increased the number of GME slots only twice over the last 25 years.Other APA-supported provisions within the spending package include investments in health equity. The package increased the authorizations and funding for programs to improve maternal health and for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Minority Fellowship Program, a program in which APA participates.Additionally, the package increases funding for critical mental health and SUD programs under SAMHSA; the Centers for Disease Control and Prevention; and the National Institutes of Health, including the National Institute on Minority Health and Health Disparities.In a statement applauding the package’s passage, APA also emphasized the need for continued work. Congress did not entirely eliminate a cut in Medicare payments for physicians imposed by the Centers for Medicare and Medicaid Services. The cut, which went into effect January 1, was originally slated to be 4.5%, but Congress adjusted it down to 2%. “This runs counter to the need to improve access to care for patients, and we urge Congress to revisit this continuing challenge as soon as possible in the new year,” APA’s statement reads.“Improving mental health care is critically important for families across the country,” said Sen. Ron Wyden (D-Ore.). “I was proud to fight for measures that will bring more mental health providers into the workforce and boost access through innovations like telehealth. There’s still more work to do, but the accomplishments in this legislation are a promising start for Americans that need mental health care.” ■APA Statement on Mental Health Provisions in Federal End-of-Year Spending Package ISSUES NewArchived

In Case You Haven't Heard…

From the what's in a name department … If you're used to seeing Substance Abuse Prevention and Treatment block grant, sometimes referred to as the Substance Abuse Block Grant, the omnibus bill late last December got rid of the nomenclature. What for years we have called SAPT BG or SABG is now called the SUPTRS (Substance Use Prevention, Treatment, and Recovery Services) Block Grant. This is new language designed to get “abuse” out of the name. Interestingly, the agency still in charge of the grant, the Substance Abuse and Mental Health Services Administration (SAMHSA), has not had a name change yet. (Senior media advisor Chris Garrett told us: “SAMHSA appreciates that the FY23 Omnibus made changes to several programs to remove the stigmatizing and inaccurate use of the word ‘abuse.’ We look forwarding to continuing to work with Congress to eliminate the use of the word in other places in the statute in the future.” Our comment on this – SAMHSA employs people with the most open, non‐stigmatizing views toward substance use – than any other federal agency.) Also interestingly, really, preventing all substance use? And one more interesting fact: There is no recovery set‐aside in the block grant, which is the money that groups wanted. States, of course, are free to put their block grant money — whatever it's called — wherever the block grant authorization allows.

Physicians’ experiences with buprenorphine: A qualitative study of motivations for becoming X waivered and barriers to and facilitators of prescribing the medication for opioid use disorder

IntroductionBuprenorphine can only be prescribed for opioid use disorder (OUD) by providers with a Controlled Substance Act waiver (X waiver) from the Substance Abuse and Mental Health Services Administration. This study examines what motivates physicians to become X waivered, as well as what facilitates and hinders physicians’ abilities to prescribe buprenorphine to people with OUD. MethodsThis is a qualitative study of physicians in Birmingham, Alabama. We recruited physicians from the University of Alabama at Birmingham and Cahaba Medical Care to participate in semi-structured interviews and used a Framework-guided Rapid Qualitative Analysis technique to analyze the transcripts for themes aligned with the Social Cognitive Theory. ResultsA total of 27 physicians were interviewed between December 15th, 2021 and July 21st, 2022. The vast majority reported seeking to obtain an X waiver when their employers encouraged or mandated it. Most providers reported being eager to become waivered when first asked by their employers, while a few described some hesitancies. Essentially all participants agreed that having mentors is important when first prescribing buprenorphine and that support from social workers and counselors is needed. Most physicians discussed how stigma, administrative barriers, and a lack of community resources hinder buprenorphine prescription. ConclusionsOur findings suggest that employers are effective in encouraging X waiver certification and mentors and allied health professionals are important in ensuring providers continue buprenorphine prescription. Additionally, it is critical to address challenges to successful buprenorphine prescription, like stigma and administrative barriers.

NSDUH: More consumers reporting SUD, mental health problems

Last week, the Substance Abuse and Mental Health Services Administration (SAMHSA) released its 2021 National Survey on Drug Use and Health (NSDUH) data.

Creating a parallel process: A new methodological framework for conducting Trauma-Informed Evaluation and Research (TIER) in mental health settings

New understandings of the pervasiveness of adverse childhood experiences and their attendant negative impact over the life course has led to a focus on the provision of Trauma-Informed Care (TIC) in mental health treatment. The Substance Abuse and Mental Health Services Administration operationalizes TIC through six key principles: 1) safety, 2) transparency and trustworthiness, 3) peer support, 4) collaboration, 5) empowerment and, 6) sensitivity to cultural, gender, and historical issues (SAMSHA, 2014). However, there has been little attention paid to how these principles should be operationalized in the context of evaluation. This methodological article first identifies the need for evaluation of TIC programs to mirror the core principles of TIC and then offers specific strategies for conducting research and evaluation in accordance with them. The goal of this work is to define a set of principles for research and evaluation that utilizes the process to reinforce key tenets of TIC and enhance trauma treatment.

More on the funding additions for SUD treatment and prevention

The “omnibus” spending bill, passed by Congress and signed by President Biden last month (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33651), has too many important additions for substance use disorder (SUD) prevention and treatment to occupy even a few issues, so we will be shedding more light on what the law contains in coming weeks. The Substance Abuse and Mental Health Services Administration (SAMHSA) will be undergoing bigger changes than it has in more than two decades.

Racial Differences in Retention in a Community-based Addiction Reduction Program Implemented by Peer Recovery Coaches for Women of Reproductive Age.

To identify program characteristics that influence the retention of women of reproductive age in the Community-based Addiction Reduction program (CARE), mixed-method analyses of CARE survey data and CARE Peer Recovery Coach (PRC) narrative entries of participant encounters were performed. About 251 women were enrolled in this prospective community-based implementation science intervention. We compared survey responses by race for treatment status, treatment motivation scales, and retention in the program at intake, 2-, 6-, 9-, and 12-month follow ups using Chi-square/T-tests. Qualitative analysis of PRC narrative entries was conducted following thematic analysis and crystallization immersion analytic methods. White compared with Black women in CARE were significantly more likely to be in treatment at intake (P < .001) and more motivated to engage in recovery treatment (P < .001). However, Black women were retained longer in CARE at 2- (P < .006), 6- (P < .011), and 9- (P < .004) months. PRC narrative entries were coded, and emergent themes mapped well to the 4 types of supports provided by PRC as outlined by the Substance Abuse and Mental Health Services Administration: emotional, instrumental, informational, and affiliational. Analysis of narrative entries by race revealed that Black women were given more detailed information, communications with PRC were more encouraging and proactive in identifying and meeting needs, and PRC took a more hands-on approach when assisting and linking to resources. The inclusion of PRC as integral members of SUD recovery programs may preferentially provide Black women with SUD the opportunity to build more trusting relationships with these peer coaches, thereby increasing their participation and retention.

After 988’s Launch, Experts Emphasize More Work Needed

After 988’s Launch, Experts Emphasize More Work Needed

Trauma-informed and affirmative mental health practices with LGBTQ+ clients.

People with diverse sexual orientations, gender identities, and gender expression are at greater risk for trauma, discrimination, and victimization than heterosexual and cisgender populations. Trauma-informed care (TIC) provides a framework for providing lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ +) mental health services. Substance Abuse and Mental Health Services Administration (SAMHSA)'s principles of TIC guide practitioners to create safety, trust, transparency, collaboration, and empowerment in helping relationships, and to ensure that services have cultural and gender relevance. This article first explores the role of trauma in contributing to behavioral health concerns presented by LGBTQ + clients. The application of TIC to mental health counseling and social services for LGBTQ + clients will then be described, with specific suggestions for translating TIC principles into affirmative practice. Through the lens of trauma, clinicians can improve clinical case conceptualization and effective treatment strategies for LGBTQ + clients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Team approach for nonmedical opioid use

Team approach for nonmedical opioid use