Response to Kelley & Incze: there is certainly more work to do for the OUD-COS

No description supplie

Early Life Stress and Childhood Aggression: Mediating and Moderating Effects of Child Callousness and Stress Reactivity

Early life stress (ELS) has been implicated in the development of aggression, though the exact mechanisms remain unknown. This study tested associations between ELS, callousness, and stress reactivity in the prediction of school-age and persistent early childhood aggression. A longitudinal sample of 185 mother–child dyads completed a lab visit and mothers completed an online follow-up when children were preschool-aged and school-aged, respectively. Physiological and behavioral measures of stress reactivity were collected during the preschool period. Ratings of child aggressive behavior, ELS, and callousness were collected as well. The results suggested that ELS was related to measures of both school-age and persistent early childhood aggression, and that callousness had a mediating role in this process. Cortisol reactivity also moderated the association between ELS and persistent childhood aggression, such that the ELS–aggression relationship was stronger among children who had higher levels of cortisol reactivity during the preschool period. Clinical implications are discussed

Ethical challenges in developing drugs for psychiatric disorders

As the classification of mental disorders advances towards a disease model as promoted by the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC), there is hope that a more thorough neurobiological understanding of mental illness may allow clinicians and researchers to determine treatment efficacy with less diagnostic variability. This paradigm shift has presented a variety of ethical issues to be considered in the development of psychiatric drugs. These challenges are not limited to informed consent practices, industry funding, and placebo use. The consideration for alternative research models and quality of research design also present ethical challenges in the development of psychiatric drugs. The imperatives to create valid and sound research that justify the human time, cost, risk and use of limited resources must also be considered. Clinical innovation, and consideration for special populations are also important aspects to take into account. Based on the breadth of these ethical concerns, it is particularly important that scientific questions regarding the development of psychiatric drugs be answered collaboratively by a variety of stakeholders. As the field expands, new ethical considerations will be raised with increased focus on genetic markers, personalized medicine, patient-centered outcomes research, and tension over funding. We suggest that innovation in trial design is necessary to better reflect practices in clinical settings and that there must be an emphasized focus on expanding the transparency of consent processes, regard for suicidality, and care in working with special populations to support the goal of developing sound psychiatric drug therapies

The Substance Use Intervention Team: A Preliminary Analysis of a Population-level Strategy to Address the Opioid Crisis at an Academic Health Center

Objective:In 2017, an academic health center in Chicago launched the multidisciplinary Substance Use Intervention Team (SUIT) to address opioid misuse across 18 inpatient units and in a new outpatient addiction medicine clinic. This report assesses the first 5 months of implementation and associations with patient health and healthcare utilization. Methods: Patient demographic and screening data were extracted from the administrative data warehouse of the electronic health record (EHR) infrastructure. Distribution of sample characteristics for positive initial screens for opioid misuse was tested against those of all patients screened using a 2-tailed test of proportions (P < 0.05). A second analysis compared length of stay and 30-day readmissions within a cohort of patients with a secondary diagnosis of substance use disorder. Results: Between November, 2017 and March, 2018, 76% of 15,054 unique patients were screened, 578 had positive scores on the Alcohol Use Disorders Identification Test and Drug Abuse Screening Test, 131 had positive scores for opioid misuse, and 52 patients initiated medication treatment. Patients with a secondary diagnosis of substance use disorder who received a SUIT consult (n = 161), compared with those who did not (n = 612), had a shorter average length of stay (5.91 vs 6.73 days) and lower 30-day readmission rate (13.6% vs 15.7%).Conclusion:Leveraging the EHR to conduct standardized screenings and treatment has helped identify an at-risk population - disproportionately younger, black, and male - and treat new cases of opioid and substance misuse. The intervention indicates trends toward a shortened length of stay, reduced 30-day readmissions, and has linked patients to outpatient care

An Implementation of a Community-Engaged, Group-Level Mental Health Pilot for Black and Latina Transgender Women.

The primary aim is to assess the implementation of an eight-session, group therapy pilot for Black and Latina transgender women in Chicago in terms of implementation outcomes regarding intervention effectiveness, acceptability, appropriateness, and feasibility. The Exploration Preparation Implementation Sustainment (EPIS) framework guided implementation processes, including community engagement as an implementation strategy, and an implementation taxonomy was used to evaluate outcomes of acceptability, appropriateness, and feasibility, in addition to intervention effectiveness regarding anxiety and community connectedness. Two rounds of the pilot were completed in 2020, during the COVID-19 pandemic, at a community-based organization serving LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth on Chicago's West Side. Participants (N = 14) completed a baseline and postintervention assessment and evaluations after each of eight intervention modules. Descriptive statistics show improvement across measures of anxiety and community connectedness, and high mean scores across domains of acceptability, appropriateness, and feasibility. Pilot findings indicate intervention effectiveness, acceptability, appropriateness, and feasibility to address mental health and social support of Black and Latina transgender women. Additional resources are needed for transgender community-engaged mental health programs and research to establish core and adaptable intervention elements, scaled-up evidence for clinical effectiveness, and, most importantly, to improve mental health outcomes and the sustainability of such interventions

A mobile phone–based intervention to improve mental health among homeless young adults: Pilot feasibility trial

Background: Youth homelessness is a substantial issue, and many youths experiencing homelessness have mental health issues as both a cause and consequence of homelessness. These youths face many barriers to receiving traditional mental health services, and as a result, only a few youths experiencing homelessness receive any form of mental health care. Objective: This project aimed to develop and determine the feasibility and acceptability of engaging young adults (ie, individuals aged 18-24 years) experiencing homelessness in a remotely delivered mental health intervention. This intervention provided brief emotional support and coping skills, drawing from cognitive behavioral principles as an introduction into psychosocial support. The intervention was piloted in a homeless shelter network. Methods: A total of 35 young adults experiencing homelessness participated in a single-arm feasibility pilot trial. Participants received a mobile phone, a service and data plan, and 1 month of support from a coach consisting of up to 3 brief phone sessions, text messaging, and mobile mental health apps. We evaluated feasibility by looking at completion of sessions as well as the overall program and acceptability with satisfaction ratings. We also collected clinical symptoms at baseline and the end of the 1-month support period. We used validity items to identify participants who might be responding inappropriately and thus only report satisfaction ratings and clinical outcomes from valid responses. Results: Most participants (20/35, 57%) completed all 3 of their phone sessions, with an average of 2.09 sessions (SD 1.22) completed by each participant. Participants sent an average of 15.06 text messages (SD 12.62) and received an average of 19.34 messages (SD 12.70). We found higher rates of satisfaction among the participants with valid responses, with 100% (23/23) of such participants indicating that they would recommend participation to someone else and 52% (12/23) reporting that they were very or extremely satisfied with their participation. We found very little change from pre- to posttreatment on measures of depression (d=0.27), post-traumatic stress disorder (d=0.17), and emotion regulation (d=0.10). Conclusions: This study demonstrated that it was feasible to engage homeless young adults in mental health services in this technology-based intervention with high rates of satisfaction. We did not find changes in clinical outcomes; however, we had a small sample size and a brief intervention. Technology might be an important avenue to reach young adults experiencing homelessness, but additional work could explore proper interventions to deliver with such a platform

A Technology-Enhanced Intervention for Violence and Substance Use Prevention Among Young Black Men: Protocol for Adaptation and Pilot Testing

BACKGROUND: Black boys and men from disinvested communities are disproportionately survivors and perpetrators of youth violence. Those presenting to emergency departments with firearm-related injuries also report recent substance use. However, young Black men face several critical individual and systemic barriers to accessing trauma-focused prevention programs. These barriers contribute to service avoidance, the exacerbation of violence recidivism, substance use relapse, and a revolving-door approach to prevention. In addition, young Black men are known to be digital natives. Therefore, technology-enhanced interventions offer a pragmatic and promising opportunity to mitigate these barriers, provide vital life skills for self-led behavior change, and boost service engagement with vital community resources. OBJECTIVE: The study aims to systematically adapt and pilot-test Boosting Violence-Related Outcomes Using Technology for Empowerment, Risk Reduction, and Life Skills Preparation in Youth Based on Acceptance and Commitment Therapy (BrotherlyACT), a culturally congruent, trauma-focused digital psychoeducational and service-engagement tool tailored to young Black men aged 15-24 years. BrotherlyACT will incorporate microlearning modules, interactive safety planning tools for risk assessment, goal-setting, mindfulness practice, and a service-engagement conversational agent or chatbot to connect young Black men to relevant services. METHODS: The development of BrotherlyACT will occur in 3 phases. In phase 1, we will qualitatively investigate barriers and facilitators influencing young Black men's willingness to use violence and substance use prevention services with 15-30 young Black men (aged 15-24 years) who report perpetrating violence and substance use in the past year and 10 service providers (aged >18 years; any gender; including health care providers, street outreach workers, social workers, violence interrupters, community advocates, and school staff). Both groups will be recruited from community and pediatric emergency settings. In phase 2, a steering group of topic experts (n=3-5) and a youth and community advisory board comprising young Black men (n=8-12) and service providers (n=5-10) will be involved in participatory design, alpha testing, and beta testing sessions to develop, refine, and adapt BrotherlyACT based on an existing skills-based program (Achieving Change Through Values-Based Behavior). We will use user-centered design principles and the Assessment, Decision, Administration, Production, Topical, Experts, Integration, Training, and Testing framework to guide this adaptation process (phase 2). In phase 3, a total of 60 young Black men will pilot-test the adapted BrotherlyACT over 10 weeks in a single-group, pretest-posttest design to determine its feasibility and implementation outcomes. RESULTS: Phase 1 data collection began in September 2021. Phases 2 and 3 are scheduled to start in June 2023 and end in September 2024. CONCLUSIONS: The development and testing of BrotherlyACT is a crucial first step in expanding an evidence-based psychoeducational and service-mediating intervention for young Black men involved in violence. This colocation of services shifts the current prevention strategy from telling them why to change to teaching them how. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/43842

Publicly available machine learning models for identifying opioid misuse from the clinical notes of hospitalized patients

Background: Automated de-identification methods for removing protected health information (PHI) from the source notes of the electronic health record (EHR) rely on building systems to recognize mentions of PHI in text, but they remain inadequate at ensuring perfect PHI removal. As an alternative to relying on de-identification systems, we propose the following solutions: (1) Mapping the corpus of documents to standardized medical vocabulary (concept unique identifier [CUI] codes mapped from the Unified Medical Language System) thus eliminating PHI as inputs to a machine learning model; and (2) training character-based machine learning models that obviate the need for a dictionary containing input words/n-grams. We aim to test the performance of models with and without PHI in a use-case for an opioid misuse classifier. Methods: An observational cohort sampled from adult hospital inpatient encounters at a health system between 2007 and 2017. A case-control stratified sampling (n = 1000) was performed to build an annotated dataset for a reference standard of cases and non-cases of opioid misuse. Models for training and testing included CUI codes, character-based, and n-gram features. Models applied were machine learning with neural network and logistic regression as well as expert consensus with a rule-based model for opioid misuse. The area under the receiver operating characteristic curves (AUROC) were compared between models for discrimination. The Hosmer-Lemeshow test and visual plots measured model fit and calibration. Results: Machine learning models with CUI codes performed similarly to n-gram models with PHI. The top performing models with AUROCs > 0.90 included CUI codes as inputs to a convolutional neural network, max pooling network, and logistic regression model. The top calibrated models with the best model fit were the CUI-based convolutional neural network and max pooling network. The top weighted CUI codes in logistic regression has the related terms 'Heroin' and 'Victim of abuse'. Conclusions: We demonstrate good test characteristics for an opioid misuse computable phenotype that is void of any PHI and performs similarly to models that use PHI. Herein we share a PHI-free, trained opioid misuse classifier for other researchers and health systems to use and benchmark to overcome privacy and security concerns

A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: Implications for practice

Background: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice. Methods: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors. Results: Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models. Conclusions: Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment. Clinical trial registration: not applicable

Building a statewide network of MOUD expertise using tiered ECHO® mentoring opportunities

BACKGROUND: Expanding access to workforce training for opioid use disorder (OUD) treatment continues to be a priority. This study explored the use of tiered mentoring opportunities within an ECHO® model to expand treatment capacity and develop a statewide network of medications for OUD (MOUD) expertise. ECHO® engages participants in a virtual community to learn best practices through case-based learning and interactions with experts. METHODS: We studied two incentivized Illinois MOUD ECHO® training programs by examining aggregate demographic and prescribing data across eight training cohorts (n = 199 participants). Participants (n = 51) in the last two cohorts were evaluated with expanded pre- and post-training surveys. Qualitative interviews were completed with a subset (n = 13) to examine effects observed in the survey data. RESULTS: For the whole group, we found a geographic expansion of the participants' prescribing capacity that reached into rural and other underserved areas in Illinois. Participants in the last two cohorts reported both increased self-efficacy for OUD treatment and increased connectedness to the addiction treatment community in Illinois. Participants who progressed through the tiered mentorship roles were found to exhibit stepwise increases in reported self-efficacy and connectedness measures. CONCLUSION: An incentivized ECHO® program yielded substantive outcomes in terms of increased prescribing capacity across the state. The use of tiered mentoring opportunities enabled participants to develop MOUD expertise and support novice providers in a growing statewide network. There is potential to train professionals to a high level of expertise when the ECHO® model is combined with a mentorship pathway