Integrated Behavioral Health Training in Counselor Education: A Call to Action

The American healthcare system is beginning to adopt an integrated behavioral health model as a way to meet the ever-changing and holistic needs of patients by creating opportunities for collaboration among medical and behavioral health professionals. Professional counselors play a vital role in integrative behavioral health through their meaningful participation on interdisciplinary healthcare teams. Professional counselors are key to any interdisciplinary team because they embrace a biopsychosocial wellness perspective and have undergone clinical and academic training. However, many counseling programs do not specifically educate or train counselors in how to work in integrated care settings. As such, counselor educators must adapt to this evolving system of healthcare by providing students with didactic and experiential learning opportunities to promote competence and readiness to practice in this new wave of healthcare

Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions : a cluster randomised controlled implementation trial

Background Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these two research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services. Methods and findings This multicentre, single-blinded (data collection and analysis), three-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control; (2) dissemination of written evidence-based practice recommendations; and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters (n = 833 wards) were randomised to either control (n = 15), recommendation (n = 16), or knowledge broker (n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control β 18.11 [95% CI −8,721.81 to 8,758.02] p = 0.997; knowledge broker versus control β 1.24 [95% CI −6,992.60 to 6,995.07] p = 1.000; recommendation versus knowledge broker β −9.12 [95% CI −3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control β 0.01 [95% CI 0.74 to 0.75] p = 0.983; knowledge broker versus control β −0.12 [95% CI −0.54 to 0.30] p = 0.581; recommendation versus knowledge broker β −0.19 [−1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control β 2.19 [95% CI −1.36 to 5.74] p = 0.219; knowledge broker versus control β −0.55 [95% CI −1.16 to 0.06] p = 0.075; recommendation versus knowledge broker β −3.75 [95% CI −8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level sample due to the grouping of multiple geographically distinct hospitals to avoid contamination. Conclusions Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice. © 2021 Sarkies et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Identifying Predictors of Diagnostic Instability of Autism Spectrum Disorder and Global Developmental Delay In Toddlers

Although Autism Spectrum Disorder (ASD) is considered to be a lifelong condition, some toddlers experience diagnostic instability over time. In particular, some toddlers’ diagnosis changes between ASD and Global Developmental Delay (GDD). However, little is known about the subset of children who change diagnosis. In a total of 424 toddlers who either maintained or changed diagnosis, the current study identified predictors of change in diagnosis and severity in those who change from ASD to non-ASD (ASD-NON), ASD to GDD (ASD-GDD), non-ASD to ASD (NON-ASD), and GDD to ASD (GDD-ASD) between two years old and four years old. Initial ASD symptom severity and participation in intervention services were predictive of all transitions. Additionally, receptive language predicted ASD-NON transition and socioeconomic status predicted ASD-GDD transition. Implications for informing prognosis of children, identifying targets of intervention, refining of screening and diagnostic measures, and measuring change in severity regardless of categorical change are discussed

Interrogating Systems That Cause Disparities: Testing the Social-Ecological Model in Low- Versus High-Density African American Communities

This study utilized the four-level social-ecological model to provide a better understanding of the disparities in health-related outcomes in high- and low-density African American (AA) communities. The current research sought to understand the relationships between mental and physical health, social-economic factors, and physical environment within this community. The goal of this study was to understand the relationship between these indicators of health, to better inform health-care strategies. The results highlight the significant difference between high- and low-density AA communities and socio-economic factors, physical environment, poor physical days, and poor mental health days. Implications for behavioral health providers are explored

Experiences of School Counseling Trainees in a Primary Care Integrated Behavioral Health Care Practicum

Youth integrated behavioral healthcare (IBH) is a preferred method of service delivery, and school system expertise on these teams is imperative. In this descriptive phenomenological study, we sought to understand the experiences of five school counseling practicum students (SCITs) engaged in IBH in an urban children\u27s hospital. Phenomenological analysis resulted in five themes: (a) contributing school system knowledge, (b) expansion of professional identity through practical application, (c) collaborative interventions and techniques, (d) interprofessional supervision, and (e) program and setting challenges. Implications for counselor education and supervision, including IBH-specific training for SCITs, conclude

Antiracism Internship: Applying the Ecological Social Justice School Counseling Theory

This manuscript describes an empirically designed internship course that utilized the Ecological Social Justice School Counseling theory to teach internship students how to engage in antiracist practice to address social determinants of health in schools. The research reports on the eight school counseling internship students\u27 experiences, through five themes and 12 subthemes, highlighting the ways they increased awareness of SDOH, antiracist practice, and related constructs at their schools and with students including their action toward addressing SDOH, advocacy, barriers, and growth. Implications for counselor educators and site supervisors conclude

Utilization of the Social Determinants of Mental Health Framework with Older Adults for Assessment, Case Conceptualization, and Treatment Planning

This conceptual paper will aid counselors and mental health professionals in obtaining insight to utilizing a Social Determinants of Mental Health Framework with older adult clients. Further, the article incorporates the Multicultural and Social Justice Counseling Competencies to further contextualize the therapeutic alliance. The authors utilize the Social Determinants of Mental Health Framework to frame counseling assessment, case conceptualization, and treatment planning to improve the mental health outcomes of older adults. The article utilizes a specific case example to assess, conceptualize, and plan treatment for an older adult client contextualized in their environment

Evolving Clustered Random Networks

We propose a Markov chain simulation method to generate simple connected random graphs with a specified degree sequence and level of clustering. The networks generated by our algorithm are random in all other respects and can thus serve as generic models for studying the impacts of degree distributions and clustering on dynamical processes as well as null models for detecting other structural properties in empirical networks

Effectiveness of Early Antiretroviral Therapy Initiation to Improve Survival among HIV-Infected Adults with Tuberculosis: A Retrospective Cohort Study

Molly Franke, Megan Murray, and colleagues report that early cART reduces mortality among HIV-infected adults with tuberculosis and improves retention in care, regardless of CD4 count