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NIH study suggests a link between cannabis use and higher levels of suicidal ideation, plan, and attempt. An analysis of survey data from more than 280,000 young adults ages 18-35 showed that cannabis (marijuana) use was associated with increased risks of thoughts of...
The current need for social distancing and isolation related to the COVID-19 pandemic has necessitated a quick expansion of the provision of mental health services via remote platforms. This tip sheet provides some tips for evaluating and treating suicidal individuals remotely via telehealth.
Controlled substances (CS) diversion in health systems can lead to serious patient safety issues, harm to the diverter, and significant liability risk to the organization. Diversion driven by addiction puts patients at risk of harm, including inadequate relief of pain, inaccurate documentation of their care in the medical record, exposure to infectious diseases from contaminated needles and drugs, and impaired healthcare worker (HCW) performance. In addition to patient harm, there are regulatory and legal risks to the organization, including fraudulent billing and liability for resulting damages, and decreased community confidence in the healthcare system. These guidelines provide a detailed and comprehensive framework to support organizations in developing their CS diversion prevention program (CSDPP) in order to protect patients, employees, the organization, and the community-at-large. Ultimately, each organization is responsible for developing a CSDPP that complies with applicable federal and state laws and regulations but also one that applies technology and diligent surveillance to routinely review process compliance and effectiveness, strengthen controls, and seek to proactively prevent diversion.
Change is not a concrete process, but rather, a fluid process. Individuals tend to move through different “stages of change” in the management of medical problems. These stages include: 1) precontemplation, 2) contemplation, 3) preparation, 4) action, and 5) maintenance.
Many randomized controlled trials in which motivational interviewing (MI) is a key intervention make no provision for the assessment of treatment fidelity. This methodological shortcoming makes it impossible to distinguish between high- and low-quality MI interventions, and, consequently, to know whether MI provision has contributed to any intervention effects. This article makes some practical recommendations for the collection, selection, coding and reporting of MI fidelity data, as measured using the Motivational Interviewing Treatment Integrity Code. We hope that researchers will consider these recommendations and include MI fidelity measures in future studies.
This guide contains a foreword and five chapters. The chapters stand alone and do not need to be read in order. Each chapter is designed to be brief and accessible to healthcare providers, healthcare system administrators, community members, policymakers, and others working to meet the needs of people at risk for, experiencing, or recovering from SMI and/or SUD.
The goal of this guide is to review the literature on the effectiveness of telehealth modalities for the treatment of SMI and SUD, distill the research into recommendations for practice, and provide examples of how practitioners use these practices in their programs.
To establish the reliability and validity of the Family CAGE (an acronym indicating Cut down on drinking; Annoyed by complaints about drinking; Guilty about drinking; had an Eye-opener first thing in the morning), a four-item instrument intended to assess family alcohol-related problems.
Family physicians spend substantial time counseling patients with psychiatric conditions, unhealthy behaviors, and medical adherence issues. Maintaining efficiency while providing counseling is a major challenge. There are several effective, structured counseling...
The common narrative is coronavirus disease 2019 happened, payment and policy barriers were quickly lowered, and voila, telemedicine, a technology for which adoption had been slow over the past decade, is, within a matter of months, in widespread and successful use. Fait accompli. On to this narrative has been grafted the hopes that telemedicine will solve other persistent problems, particularly in primary care.
This change guide is designed to assist primary care clinicians and leaders to integrate care for patients with unhealthy alcohol and/or other drug use into routine medical care. As behavioral health care is increasingly integrated into medical settings, especially primary care, the focus is often on depression and anxiety. Care for alcohol and/or other drugs is often omitted or minimized, likely reflecting: stigma, lack of workforce training/education, and the traditional separation of care for alcohol and other drugs from traditional health care (e.g., primary care, emergency care, and behavioral health, etc.). This guide expands on and updates the widely recognized model of Screening, Brief Intervention, and Referral to Treatment (SBIRT).
IBHA recommends that health systems, insurance plans, and others looking to measure progress toward integrating behavioral health in primary care use the 2017 PCPCH Standard 3.C.3 as the integration metric of choice. At the system level, IBHA concurs that measuring practice-level progress toward adopting excellent integrated care delivery models in the most meaningful way to affect system change.
Untreated drug and alcohol use contributes to tens of thousands of deaths every year and affects the lives of many more people. We have effective treatments, including medications for opioid and alcohol use disorders, that could prevent a significant number of these deaths, but they are not being utilized widely enough, and people who could benefit often do not even seek them out. One important reason is the stigma around those with addiction.
When two disorders or illnesses occur in the same person, simultaneously or sequentially, they are described as comorbid.
Comorbidity also implies that the illnesses interact, affecting the course and prognosis of both.1,2 This research report provides information on the state of the science in the comorbidity of substance use disorders with mental illness and physical health conditions.
This handout offers background information and tips for providers to keep in mind while using person-first language, as well as terms to avoid to reduce stigma and negative bias when discussing addiction. Although some language that may be considered stigmatizing is commonly used within social communities of people who struggle with substance use disorder (SUD), clinicians can show leadership in how language can destigmatize the disease of addiction.
Collaborative Care (CoCM) is a specific type of integrated care developed at the University of Washington that treats common mental health conditions such as depression and anxiety that require systematic follow-up due to their persistent nature. Based on principles of effective chronic illness care, Collaborative Care focuses on defined patient populations tracked in a registry, measurement-based practice, and treatment to target. Trained primary care providers and embedded behavioral health professionals provide evidence-based medication or psychosocial treatments, supported by regular psychiatric case consultation and treatment adjustment for patients who are not improving as expected.
Burnout is common in healthcare and has increased during the Covid 19 pandemic. This brief presentation defines burnout and it's consequences. Building resilience is a strategy to reduce and prevent burnout. The presentation defines resilience and provides tips in increase personal resilience and organizational resilience.
Adolescents are at the highest risk for experiencing health problems related to substance use. This resource provides an overview of screening adolescents for substance use disorders including assessments and tips.
This brief video provides an overview of fentanyl strip testing to identify the presence of fentanyl in unregulated drugs for people who use drugs (PWUD). It also includes a brief demo of how to use fentanyl test strip testing to detect the presence of fentanyl in their drug supply.
Testing for fentanyl test strips can identify the presence of fentanyl in unregulated drugs. They can be used to test injectable drugs, powders, and pills. Being aware if fentanyl is present allows people to implement appropriate harm reduction strategies to reduce the risk of an overdose.
Presented by Sari Frankel, DC Department of Behavioral Health.
Registries are important population health tools that allow organizations to collect, organize, aggregate, and utilize the information for a variety of purposes. Maintaining registries for certain disease states such as depression or diabetes provides easy access to results, identification of care gaps, and level of improvement and can lead to adjustments in care as needed. This Short Take video provides an introduction to registries and how to use them.
An online resource to provide broad access to resources to clarify best practices to support and improve the care for substance-exposed mothers and newborns. The toolkit includes resources to support screening, assessment, and level of care determination; treatment; transitions of care; and education.
The California Department of Health Care Services (DHCS) has implemented the California Medications for Addiction Treatment (MAT) Expansion Project to address the opioid epidemic throughout the state. This website serves as a separate yet complementary resource to the DHCS MAT Expansion Website and provides resources and information related to the four MAT Expansion Project initiatives operated by Health Management Associates.
The California MAT Expansion Project aims to increase access to MAT, reduce unmet treatment need, and reduce opioid overdose-related deaths through the provision of prevention, treatment, and recovery activities. The project focuses on individuals experiencing homelessness, youth, rural, and tribal populations with limited MAT access. The California MAT Expansion Project, composed of nearly 30 initiatives, is funded by grants from the Substance Abuse and Mental Health Services Administration (SAMHSA).
HMAedu.com is an educational resource specifically designed for training treatment teams about addiction, pain, and behavioral health. With over 25 hours of education through the lens of patient-centered care, users can explore topics of interest or follow the suggested curriculum path. Once a user signs in, the learning management system automatically loads modules that are pertinent to the user’s level of training. This automation allows for consistency in messaging to all providers without delivering information beyond the scope of practice. Each course starts with a TED Talks-style overview that is followed by patient-focused modules of 3-10 minutes each. Each module is traced for completion and can be reported back to the client and individual for tracking purposes.
This webinar focuses on effective strategies for engaging justice-involved populations and ways to support individuals transitioning to communities. The speakers shared case studies to illustrate the ways that providers have managed transitions of care and supported people. This session is approved by the American Academy of Family Physicians for up to 1 AMA Level 1 CME credit.
Healthcare systems are in the process of reforming themselves to better meet the needs of people with, or at risk of developing, chronic diseases and long-term conditions. One goal of these efforts is the coproduction of activated, informed, engaged, and motivated patients and citizens.
This brief webinar will review the basics of behavioral activation, distress tolerance skills, and problem-solving therapy to use in skills-based, time-limited treatment settings.
This brief video introduces the concept of brief interventions and review motivational interviewing and mindfulness. Presented by Dr. Lori Raney, Principal, Health Management Associates.
This brief video explains the process of enhanced referral to improve patient engagement and completion of the referral and improve provider relationships with referrals. Presented by Dr. Lori Raney, Principal, Health Management Associates.
This is a short reference guide to developing a structure to enhance the referral experience for providers and service recipients. It covers setting standards for partnership starting with your value proposition. It outlines the continuum of provider relationships from informal agreements through forming a business entity and finally provides initial guidance and further resources for establishing care compacts.
This document represents a collaboration between the American Psychiatric Association (APA) and the American Telemedicine Association (ATA) to create a consolidated update of the previous APA and ATA official documents and resources in telemental health to provide a...
There is a need for an organizing model that assists practices and policy-makers to prioritize the steps of integration implementation and the need for both technical assistance and funding for key program elements. In order to advance evidence-based integration of general health care in BH settings, clinics have become intensely interested in the underlying steps they can take to implement and advance specific general health practices.
Based on a targeted literature review and input from diverse stakeholders, the framework presented in this report seeks to provide BH clinics and other organizing entities, such as New York State's (NYS) Behavioral Health Care Collaboratives (BHCC) and Behavioral Health Independent Practice
Associations (IPA), with practical guidance using a continuum-based road map approach on the intentional and incremental steps to achieve and advance key subdomains of integrated care for community BH clinics.
What is less clear has been how to accomplish that at scale, given the varying types of primary care practices and, in particular, the resource limitations of small and medium-size practices and the complexity of the models that are currently the evidence-based standards for integrating medical and behavioral care. This framework seeks to fill that gap by delineating a series of steps that providers can take to move toward the integration of behavioral health services into their primary care practices.
This document contains information about assessing the need for treatment; initiating MAT; monitoring patient progress and adjusting treatment plan; deciding whether and when to end MAT.
The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening tool developed by the WHO to assess alcohol consumption, drinking behaviors, and alcohol-related problems.
Screening and brief intervention provides an opportunity for clinicians to intervene early and potentially enhance medical care by increasing awareness of the likely impact of substance use on a patient’s overall health.
This document consists of common questions and concerns about Medication Assisted Treatment for Ambivalent patients. This document can be used as a starting point to have conversations with your patients. In the end, the patient will be able to make an informed decision that’s in line with their values and hopes for recovery.
This question and answer document answers common questions and concerns that family members have about Medication Assisted Treatment (MAT). The purpose of this document is to assist providers in educating family members.
Patients can use this Early Recovery Handout to determine behaviors when cravings or urges arise or behaviors have changed. The document provides strategy to mitigate any behavioral outliers while keeping the patient on track from day to day.
This article reviews research findings in the following 7 areas: location of buprenorphine induction, combining buprenorphine with a benzodiazepine, relapse during buprenorphine treatment, requirements for counseling, uses of drug testing, use of other substances during buprenorphine treatment, and duration of buprenorphine treatment.
The Medication-Assisted Treatment Of Opioid Use Disorder pocket guide to provide guidance on how to assess the need for treatment, referring to higher levels of care if necessary and the approved frequency and route of administration for treatment of Opioid Use Disorder. In addition, a tool has been provided to determine clinical opiate withdrawal.
The Substance Abuse and Mental Health Services Administration provides guidance for substance use disorder treatment services during the COVID-19 pandemic. The document specifies when a medical emergency exists, 42 C.F.R Part 2 does not apply and any disclosure of medical information is temporarily exempt for purposes of medical treatment.
