Background: Collaborative documentation is a behavioral health practice involving shared writing of clinical visit notes by providers and consumers. Despite widespread dissemination of collaborative documentation, research on its effectiveness or impact on person-centered care has been limited. Principles of person-centered care planning, a recovery-based approach to service planning that operationalizes person-centered care, can inform measurement of person-centeredness within clinical documentation. Objective: This study uses the clinical informatics approach of Natural Language Processing to examine the impact of collaborative documentation on person-centeredness in clinical visit notes. Using a dictionary-based approach, this study conducts textual analysis of clinic notes from a community mental health center before and after staff were trained in collaborative documentation. Methods: This study used visit notes (n = 1,981) from 10 providers in a community mental health center 6 months pre-and-post training in collaborative documentation. Linguistic Inquiry and Word Count (LWIC)-22 was used to assess all notes using the LWIC dictionary that categorizes over 5000 linguistic and psychological words. Twelve LWIC categories were selected and mapped onto person-centered care planning principles through consensus of three domain experts. The LWIC-22 contextualizer was used to extract sentence fragments from notes corresponding to LWIC categories. Then, fixed-effects modelling was used to identify differences in notes pre-and-post collaborative documentation training while accounting for nesting within provider. Results: Sentence fragments identified by the contextualizing process illustrated how visit notes demonstrated person-centered care. The fixed effects analysis found a significant positive shift towards person-centeredness was observed in six of the selected LIWC categories post collaborative documentation. Specifically, there was a notable increase in words associated with achievement (β= 0.774, p<.001), power (β= 0.831, p<.001), money (β= 0.204, p<.001), physical health (β= 0.427, p=.027), while leisure words decreased (β= -0.135, p<.01). Conclusions: By using a dictionary-based approach, the study identified how collaborative documentation might influence the integration of person-centered care principles within clinical notes. Although the results were mixed, the findings highlight the potential effectiveness of collaborative documentation in enhancing person-centeredness in clinic notes. By leveraging natural language processing techniques, this research illuminated the value of narrative clinical notes in assessing the quality of care in behavioral health contexts. These findings underscore the promise of NLP for quality assurance in healthcare settings and emphasize the need for refining algorithms to more accurately measure person-centered care.person-centered care, mental health services, collaborative documentation, clinical notes; collaborative documentation; natural language processing

Objective: Increasing service user involvement and collaboration with providers has become an important facet of the recovery movement. This study explored perspectives on the implementation and delivery of an intervention (Just Do You [JDY]) designed to improve treatment engagement among marginalized young adults diagnosed with serious mental illnesses. Method: Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted in-depth interviews (N = 11) with nine participants that included agency leaders, clinical providers, and researchers involved with the planning, delivery, and evaluation of JDY. We used grounded theory coding techniques and constant comparison to develop themes that capture the data on implementation and collaboration related to the delivery of JDY. Results: Two broad themes emerged: (a) collaboration between the clinician and person with lived experience and (b) collaborative culture within and between organizations. Findings capture how collaboration occurred between providers within the clinical encounter (e.g., combined strengths of clinicians and peers) and within and between organizations, clustering around several CFIR domains (e.g., inner setting, process, characteristics of individuals, intervention characteristics). Findings speak to the importance of a "culture of collaboration" in which collaboration is occurring across multiple levels of an organization to support the delivery and implementation of JDY. Conclusions and Implications for Practice: JDY can complement other collaborative approaches given its focus on improving initial engagement. Findings point to the perceived benefits of interventions that are facilitated by a clinician and a person with lived experience along with how their combined expertise can support recovery.

Despite a wealth of evidence-based messaging on youth alcohol and drug prevention, there remains a dearth of research on how to construct and deliver these messages effectively. Communication science is useful for increasing the efficacy of these messages in reducing substance use risk among youth. This study explores the perspectives of youth and youth-serving providers to identify theory-informed substance use prevention messages and strategies and how the content and delivery of prevention messages evolved during the COVID-19 pandemic. This is a secondary analysis of qualitative data derived from focus groups with 53 youth ages 13 to 18 years and 18 youth-serving providers conducted in the USA between 2021 and 2022. The results describe theory-informed strategies that are important to consider when constructing effective substance use prevention messaging for youth, including preferences around key communication framework constructs, including sources, content, channels, and context. An element that emerged across the communication constructs was the saliency of “connection” in youth substance use prevention messaging content. Findings point to the need to further explore connection related to having shared experiences and the extent to which these dimensions are critical ingredients to effective substance use prevention.

Peer support workers (PSW) improve outcomes for people with behavioral health needs, but integrating PSWs into routine behavioral healthcare has been challenging. Certified Community Health Centers (CCBHC), a new comprehensive care model, provides new opportunities to increase access to PSWs. The present study examines whether PSW utilization changed following one organization’s transition to a CCBHC. Administrative data from a large behavioral health organization was used to examine changes in peer delivered services before and after CCBHC implementation. Chi-square analyses examined changes in the number of visits delivered by peers. Logistic regression examined differences in the likelihood of accessing PSW services during pre and post timepoints. Following CCHC implementation, the overall number of PSW visits delivered within substance use and transition age youth programs increased. In contrast, the number of PSW visits in community-based intensive case management program decreased. Clients with opioid use disorders were more likely to have accessed PSW services following CCBHC implementation. Results reflect that CCBHC designation generally increased the number of PSW visits within this organization; however, changes in peer service utilization were primarily concentrated among individuals with opioid use disorders and within substance use and transitional aged youth programs. This study provides novel insight into how PSWers are being integrated into the CCBHC model.

Objective: Certified community behavioral health clinics (CCBHCs) are designed to provide comprehensive care for individuals with co-occurring mental and substance use disorders. The authors classified outpatient mental health treatment facilities on the basis of provision of services for clients with co-occurring disorders and assessed whether CCBHCs differed from other outpatient mental health facilities in services provided. Methods: The authors used latent class analysis to identify distinct services for clients with co-occurring disorders in 5,692 outpatient mental health facilities in the 2021 National Substance Use and Mental Health Services Survey. Nine indicators were included: treatment for clients with substance or alcohol use disorder co-occurring with serious mental illness or serious emotional disturbance, specialized programs or groups for such clients, medication-assisted treatment (MAT) for alcohol use disorder, MAT for opioid use disorder, detoxification, individual counseling, group counseling, case management, and 12-step groups. A multinomial logistic regression was used to estimate whether CCBHCs were associated with any identified classes after analyses controlled for facility characteristics. Results: A four-class solution provided a model with the best fit, comprising comprehensive services (23.4%), case management services (17.7%), counseling and self-help services (58.6%), and professional services (4.3%). Regressing class membership on facility type and covariates, the authors found that compared with community mental health clinics (CMHCs), CCBHCs were more likely to belong to the comprehensive services class than to the case management services, counseling and self-help services, and professional services classes. Conclusions: CCBHCs were more likely than other outpatient programs to offer comprehensive care, and CCBHC status of a CMHC facilitated enhanced service provisions.

BackgroundCannabis vaping is increasing in the United States. Among populations at-risk are sexual minorities (SM) who are more likely to vape cannabis compared to their heterosexual counterparts. Cannabis vaping has been associated with negative health outcomes and concomitant use of other substances with increased risk with more recent use.ObjectivesThis study examined the association between SM identification and recency of cannabis vaping (the last occasion that a participant used their vape device with cannabis) and number of puffs (the count of puffs that the participant took during their most recent use of their vape device with cannabis) using Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study.ResultsIn a weighted sample of participants who reported ever vaping cannabis (N = 5,331), 15% identified as SM, about 60% vaped cannabis in the past 3 or more days, and the mean number of puffs was 2 (SE = 0.17). Using multinomial logistic regression and zero-inflated negative binomial regression, the results showed that compared to heterosexual adults who reported not recently vaping cannabis, SM had higher probabilities of vaping cannabis in the past 3 or more days, 1-2 days, and the day of interview.ConclusionSM individuals were more likely to recently vape cannabis, placing them at higher risk for respiratory diseases and use of other substances. Public health researchers and practitioners need to identify reasons for cannabis vaping in this population and implement targeted public health messaging to inform SM communities of the potential health effects of cannabis vaping.

Objective: This study aimed to examine differences in community mental health visit notes before and after initiation of collaborative documentation, a practice in which clinicians and consumers jointly document clinical encounters. Methods: Using a clinical informatics approach, the authors sampled visit notes (N=1,875) from nine providers in one mental health clinic. The authors compared notes from before and after the implementation of collaborative documentation by using fixed -effects regression models, controlling for therapist -level effects. Results: Significant changes in visit note structure were found after the implementation of collaborative documentation. Most sections (N=6 of 10) contained more information (i.e., higher word and character counts) after collaborative documentation implementation, but sections describing a client's feelings were less likely to have any content (OR= 0.01, p<0.001). Conclusions: These findings demonstrate that collaborative documentation influences clinical notes, providing much -needed research about a widely adopted practice in community mental health settings.

PurposeUsing data from an online assessment of youth in the United States, this study examined factors associated with youth's indirect exposure to fentanyl; factors related to youth's level of knowledge of fentanyl; and sources of substance use information obtained by youth.MethodsThis is a secondary analysis of data from a cross-sectional online assessment of youth ages 13 to 18 in the United States in 2022. Participants self-reported on substance use knowledge and concerns, indirect exposure to substance use, access to substance use information and resources, the extent to which youth discussed drug use harms with someone, and COVID-related stress.ResultsAnalyses revealed that most youth did not have knowledge of fentanyl even though they reported indirect likely exposure to fentanyl. Youth concerned about alcohol or drug use in their own life were less likely to have knowledge of fentanyl and more likely to know someone who, if using drugs, would likely be exposed to fentanyl. A significant risk factor of indirect likely exposure to fentanyl was COVID-related stress. Prevalent sources of information included the internet, social media, friends or peers, and school classes.DiscussionWhile youth may have close proximity to fentanyl exposure and a degree of understanding of fentanyl, there is a general lack of knowledge of the substance, a critical gap that future substance use prevention initiatives could fill.

The importance of clinical supervision for supporting effective implementation of evidence-based treatments (EBTs) is widely accepted; however, very little is known about which supervision practice elements contribute to implementation effectiveness. This systematic review aimed to generate a taxonomy of empirically-supported supervision practice elements that have been used in treatment trials and shown to independently predict improved EBT implementation. Supervision practice elements were identified using a two-phase, empirically-validated distillation process. In Phase I, a systematic review identified supervision protocols that had evidence of effectiveness based on (a) inclusion in one or more EBT trials, and (b) independent association with improved EBT implementation in one or more secondary studies. In Phase II, a hybrid deductive-inductive coding process was applied to the supervision protocols to characterize the nature and frequency of supervision practice elements across EBTs. Twenty-one of the 876 identified articles assessed the associations of supervision protocols with implementation or clinical outcomes, representing 13 separate studies. Coding and distillation of the supervision protocols resulted in a taxonomy of 21 supervision practice elements. The most frequently used elements were: reviewing supervisees’ practice (92%; n = 12), clinical suggestions (85%; n = 11), behavioral rehearsal (77%; n = 10), elicitation (77%; n = 10), and fidelity assessment (77%; n = 10). This review identified supervision practice elements that could be targets for future research testing which elements are necessary and sufficient to support effective EBT implementation. Discrepancies between supervision practice elements observed in trials as compared to routine practice highlights the importance of research addressing supervision-focused implementation strategies.

ABSTRACT This report describes Rapid Access to Medication Assisted Therapy (RAM), an innovative, cross-system intervention, piloted in Central Vermont to address the opioid overdose epidemic, building on emergency department buprenorphine induction, and a Hub and Spoke delivery system. RAM utilizes transdisciplinary case coordination to facilitate integration among independent service providers and peer supports addressing the opioid overdose crisis in a rural area. Adopting a transdisciplinary process to guide interprofessional collaboration, RAM team members share professional duties across institutional and professional hierarchies and traditional roles. These shifts in professional orientation increase team capacity to provide care coordination and remove barriers to treatment. While care coordination traditionally rests in the social work domain, RAM distributes these tasks among members of each profession. RAM exemplifies the strength of transdisciplinary collaboration and highlights the leadership role social work can play in implementing systems navigation and care coordination.

Background: Delivering person-centered care is a key component of health care reform. Despite widespread endorsement, medical and behavioral health settings struggle to specify and measure person-centered care objectively. This study presents the validity and reliability of the Person-Centered Care Planning Assessment Measure (PCCP-AM), an objective measure of the extent to which service planning is person-centered. Methods: Based upon the recovery-oriented practice of person-centered care planning, the 10-item PCCP-AM tool rates service plans on the inclusion of service user strengths, personal life goals, natural supports, self-directed actions and the promotion of community integration. As part of a large randomized controlled trial of person-centered care planning, service plans completed by community mental health clinic providers were rated using the PCCP-AM. Reliability was tested by calculating inter-rater reliability across 168 plans and internal consistency across 798 plans. To test concurrent validity, PCCP-AM scores for 84 plans were compared to expert rater scores on a separate instrument. Results: Interrater reliability for each of the 10 PCCP-AM items as measured by Kendall's W ranged from W = 0.77 to W = 0.89 and percent of scores within ± 1 point of each other ranged from 85.7 to 100%. Overall internal consistency as measured by Cronbach's alpha across 798 plans was α = 0.72. Concurrent validity as measured by Kendall's W ranged from W = 0.55 to W = 0.74 and percent of item scores within ± 1 point of expert rater scores ranged from 73.8 to 86.8%. Conclusions: Findings demonstrated that the 10-item PCCP-AM was a valid and reliable objective measure of person-centered care. Using the service plan as an indicator of multiple domains of person-centered care, the measure provides a valuable tool to inform clinical supervision and quality improvement across programs. More psychometric testing is needed to strengthen the measure for research purposes.

The behavioral service system is searching for solutions to the opioid overdose epidemic, which has led to increased fatalities and substantial costs. This paper is a brief report on Certified Community Behavioral Health Clinics (CCBHC), a federal demonstration program designed to enhance behavioral health organizations' capacity to engage and care for people with substance use disorders through evidence-based practices and integrated health solutions. Designated CCBHC clinics provide a comprehensive range of mental health and substance use disorder services to vulnerable individuals and receive increased prospective funding from Medicaid. Preliminary evaluations have shown increases in accessibility, workforce, and capacity to provide substance use and mental health services. With social workers comprising the majority of mental health providers, this delivery system innovation expands opportunities for the profession to address the opioid epidemic.