Counselor-provided SBIRT for hospitalized adults with substance misuse or disordered use: evaluating hospital utilization outcomes and economic cost

The misuse and disordered use of alcohol and illicit drugs in the United States creates serious consequences for people and their families and communities, such as severe physical health issues (Substance Abuse and Mental Health Administration [SAMHSA], 2017a) and costs to society approaching $440 billion annually (National Institute on Drug Abuse [NIDA], 2018). Yet, few people receive the treatment they need (Grant et al., 2015; Grant et al., 2016). Instead, they overuse hospital stays and emergency care, among the most expensive medical services (Bernardino, Baird, Liu, & Merchant, 2015; Hankin, Daugherty, Bethea, & Haley, 2013). White and Kelly’s (2011) Addiction Recovery Management theoretical framework suggests that the historical partitioning of medical and mental health care hinders detection, intervention, coordination of services, and recovery from substance misuse and disordered use. Given that most U.S. citizens see a physician at least once per year (Sacks et al., 2016), a technique developed for medical settings is Screening, Brief Intervention, and Referral to Treatment (SBIRT) (SAMHSA, 2013). SBIRT by medical providers is effective for helping patients of clinics and emergency departments reduce alcohol misuse (Jonas et al., 2012; Schmidt et al., 2015), but not effective for patients with disordered alcohol use (Mdege & Watson, 2013; Schmidt et al., 2015), patients with drug use (Saitz et al., 2014), or patients admitted to medical hospitals (Mdege & Watson, 2013). Recent efforts to integrate medical and mental health care practices have incorporated SBIRT conducted by mental health professionals (Collaborative Family Health Association [CFHA], 2017). Outcomes from early investigations show promise for populations and settings not responsive to SBIRT by medical providers (Barbosa et al., 2017; Watkins et al., 2017). Professional counseling, in particular, aligns with SBIRT’s goals and guidelines (Babor & Higgins-Biddle, 2001; CACREP, 2015). Counselors endeavor to build therapeutic alliances with clients; in specialty treatment settings, this alliance predicts positive outcomes (Barber et al., 2001; Crits-Christoph, Johnson, Gibbons, & Gallop, 2013; Van Horn et al., 2015; Watts, O'Sullivan, & Chatters, 2018). Early results for counselor-provided SBIRT in an integrated care setting suggest efficacy for reducing substance use (Veach et al., 2018). This study extended the work of Veach et al. (2018) by determining if counselor provided SBIRT in integrated care settings is an effective treatment intervention, guided by Simpson’s (2004) Texas Christian University Treatment Model theoretical framework associating patient, program, and treatment factors with outcomes. The study tested three hypotheses. The first hypothesis predicted that interventions for hospitalized patients with alcohol or illicit drug misuse or disordered use were associated with fewer subsequent hospitalizations and emergency department visits. The findings were not significant but did trend in a supportive direction. The second hypothesis was that these outcomes differed by substance use type (alcohol or illicit drugs), substance use severity, and hospital clinical service unit. Significant results were found for all three covariates, including significance for counselor-provided SBIRT and alcohol use. The third hypothesis, given the substantial financial burden of substance misuse and disordered use on health care systems, predicted that counselor-provided SBIRT interventions reduced economic costs from the health system perspective. The findings supported the third hypothesis with significance, but with caution relative to inconsistency in the results. Given these findings, health system administrators, physicians, and community leaders may support integrating professional counselors into hospital units and other medical settings, raising the likelihood that people who need help with their substance misuse or disordered use actually receive it

Trends in malaria morbidity among health care-seeking children under age five in Mopti and Sévaré, Mali between 1998 and 2006

<p>Abstract</p> <p>Background</p> <p>In Mali, malaria is the leading cause of death and the primary cause of outpatient visits for children under five. The twin towns of Mopti and Sévaré have historically had high under-five mortality. This paper investigates the changing malaria burden in children under five in these two towns for the years 1998-2006, and the likely contribution of previous interventions aimed at reducing malaria.</p> <p>Methods</p> <p>A retrospective analysis of daily outpatient consultation records from urban community health centres (CSCOMs) located in Mopti and Sévaré for the years 1998-2006 was conducted. Risk factors for a diagnosis of presumptive malaria, using logistic regression and trends in presumptive malaria diagnostic rates, were assessed using multilevel analysis.</p> <p>Results</p> <p>Between 1998-2006, presumptive malaria accounted for 33.8% of all recorded consultation diagnoses (10,123 out of 29,915). The monthly presumptive malaria diagnostic rate for children under five decreased by 66% (average of 8 diagnoses per month per 1,000 children in 1998 to 2.7 diagnoses per month in 2006). The multi-level analysis related 37% of this decrease to the distribution of bed net treatment kits initiated in May of 2001. Children of the Fulani (Peuhl) ethnicity had significantly lower odds of a presumptive malaria diagnosis when compared to children of other ethnic groups.</p> <p>Conclusions</p> <p>Presumptive malaria diagnostic rates have decreased between 1998-2006 among health care-seeking children under five in Mopti and Sévaré. A bed net treatment kit intervention conducted in 2001 is likely to have contributed to this decline. The results corroborate previous findings that suggest that the Fulani ethnicity is protective against malaria. The findings are useful to encourage dialogue around the urban malaria situation in Mali, particularly in the context of achieving the target of reducing malaria morbidity in children younger than five by 50% by 2011 as compared to levels in 2000.</p

A longitudinal study of the self-concepts and experiential components of self-worth and affect across adolescence

Classic theories depict adolescence as a period of emotional "storm and stress". Empirical evidence, mostly from cross-sectional studies, suggests that emotional development presents a mixture of continuity, swings, and resilience. We examined longitudinally the average grade trends in components of self-concept and experiential components of self-worth and affect across adolescence. We followed 1,165 6th through 12th graders for 4 years using a 3-wave, accelerated longitudinal design. Participants completed self-concept scales (global self-esteem and locus of control), and the Experience Sampling Method, which provided daily self- reports on self-worth (living up to one’s own expectations, to the expectations of others, feeling successful, and feeling in control of the situation) and affect (feeling good about oneself and feeling happy). Multilevel modeling indicated that both self-esteem and locus of control grow linearly over time. Self-worth components of experience showed a concave-up trend bottoming around Grade 10, suggesting a pubertal swing and partial readjustment by the end of adolescence. Affect declined quadratically across adolescence. Compared to White students, less positive grade trends were found for Hispanics, Asian Americans, and adolescents from nontraditional families. A mixed pattern emerged for African Americans. Behind the stable growth of components of self-concept, adolescents experience a certain degree of discontinuity as to how they evaluate their capability to meet everyday life demands and their affect declines. The modifications in grade trends due to ethnicity and family structure call for studies on the possible influence exercised by family processes and school environments

Well-Being of Family Caregivers of Persons with Late-Stage Huntington\u27s Disease: Lessons in Stress and Coping

The utility of a stress-process model in predicting health and quality-of-life outcomes for family caregivers of persons with Huntington\u27s disease (HD) was tested. HD is an inherited neurodegenerative disease that poses particular challenges to patients and families. Seventeen family caregivers were interviewed and completed scales measuring stressors, appraisals, protective factors, and outcomes. No direct relationship between stress and caregiver well-being was found; the impact of stressors was mediated by appraisals and protective factors. Bivariate correlation analysis revealed significant positive relationships between satisfaction with emotionally supportive communication and life satisfaction. Significant positive correlations were found between positive appraisals of the benefits of the caregiving experience and life satisfaction and health. Mastery was significantly positively correlated with life satisfaction and negatively correlated with depressive symptoms; similar results were found between spirituality and outcome measures. Caregivers\u27 interpretations appeared to have a more significant impact on well-being than did objective characteristics of the experience

The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans

Objectives: To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions. Methods: Participants will include up to 343 Veterans with chronic pain due to a broad range of etiologies, randomly assigned to one of three 8-week manualized in-person group treatments: (1) Hypnosis (HYP), (2) Mindfulness Meditation (MM), or (3) Education Control (EDU). Projected outcomes: The primary aim of the study is to compare the effectiveness of HYP and MM to EDU on average pain intensity measured pre- and post-treatment. Additional study aims will explore the effectiveness of HYP and MM compared to EDU on secondary outcomes (i.e., pain interference, sleep, depression, anxiety and PTSD), and the maintenance of effects at 3- and 6-months post-treatment. Participants will have electroencephalogram (EEG) assessments at pre- and post-treatment to determine if the power of specific brain oscillations moderate the effectiveness of HYP and MM (Study Aim 2) and examine brain oscillations as possible mediators of treatment effects (exploratory aim). Additional planned exploratory analyses will be performed to identify possible treatment mediators (i.e., pain acceptance, catastrophizing, mindfulness) and moderators (e.g., hypnotizability, treatment expectations, pain type, cognitive function). Setting: The study treatments will be administered at a large Veterans Affairs Medical Center in the northwest United States. The treatments will be integrated within clinical infrastructure and delivered by licensed and credentialed health care professionals