Connecticut Department of Mental Health and Addiction Services

Cognitive impairment represents one of the core features of schizophrenia, with an important negative impact of psychosocial functioning and limited pharmacological treatment options. However, psychosocial interventions targeting cognitive performance appear to provide significant benefits. The aims of the present randomized controlled trial were to compare two evidence-based approaches to treat cognitive impairment and a control condition. A total of 132 individuals diagnosed with schizophrenia were allocated to three treatment arms: a Cognitive Remediation intervention (Integrated Neurocognitive Therapy - INT, n=53), Physical Exercise (PE, n=37), and Treatment As Usual (TAU, n=42) and assessed at the beginning and at the conclusion of the treatment period (15weeks) with measures of symptoms severity, cognitive performance, and psychosocial functioning. Significant between-groups post-treatment effects were observed for Executive Functions, Social Cognition, and Global Cognitive Performance. Post-hoc analyses showed the superiority of INT over TAU on Executive Functions and Global Cognitive Performance. The superiority of INT over PE in Executive Functions and Social Cognition also emerged in the post-hoc analyses. No significant between-groups differences were observed regarding symptoms severity and functional outcomes. The results of this study confirm the effectiveness of cognitive rehabilitation, and in particular of INT as an evidence-based treatment for outpatients diagnosed with schizophrenia. Even though the effects on the outcomes in this study observed for PE were not statistically significant, the PE intervention might represent a valid approach in rehabilitation settings.

<title>Abstract</title> <bold>Background and Objectives:</bold> Medications for Addiction Treatment (MAT) are available and effective. Yet their utilization remains suboptimal, especially in community mental health settings. With persisting high mortality and morbidity related substance use disorders (SUDs), there is need to increase identification of SUDs, access to and utilization of MATs through capacity building among clinicians in clinical settings where patients already access care. <bold>Methods:</bold> We provided MAT training for clinicians in 10 Assertive Community Treatment (ACT) teams and rolled out SUD screening, assessment and treatment for their patients through a multi-component “MAT-In-ACT” intervention. Using a prospective quasi-experimental study design, participants who were positive for SUDs on standard questionnaires were evaluated and recommended for appropriate FDA-approved MATs and connected to a prescriber. <bold>Results: </bold>All 10 ACT teams implementedMAT-in-ACT intervention protocol with intervention fidelity of 80%. Of all active ACT clients (N=622), more than half (54.7%) agreed to participate in the study (n=340). Of these, 225 met the criteria for at least one SUD (66.2%) out of which 78 participants (34%) received at least one medication for addiction treatment. <bold>Discussion: </bold>This study successfully integrated SUD screening, assessment, and prescription of MATs by non-addiction specialists into community ACT programs for people with severe and persistent mental illness. <bold>Conclusion: </bold>Access to MATs can potentially be increased by focusing on existing community mental health care settings that traditionally do not prescribe them for their patients.

PurposeThis paper aims to describe the Recovering Citizenship Learning Collaborative (RCLC), a training, consultation and implementation effort for 13 local mental health authorities and two state hospitals.Design/methodology/approachThe learning collaborative used a Recovering Citizenship approach, which holds that recovery occurs in the context of people’s lives in their communities and society, that is, their citizenship. The RCLC was implemented by the Connecticut Department of Mental Health and Addiction Services (DMHAS) in the USA and the Yale Program for Recovery and Community Health along with lived experience leaders. The RCLC supported system change through training DMHAS staff on concepts of recovery and citizenship and developing agency action plans, with the long-term goal of improving citizenship-oriented care at the agency-level and recovery and citizenship-related outcomes for people receiving services.FindingsLessons learned include the importance of assessing organizational readiness for change, addressing leadership investment and attention to systemic barrier, and offering tools to promote structure and accountability. Next steps are supporting agency action plans through technical assistance, state-wide educational offerings and a resource library.Research limitations/implicationsSystemic barriers are considerable and must be addressed before system transformation is possible.Practical implicationsThe authors are hopeful that the RCLC has been part of overcoming those challenges and can be a tool for building foundations for improving citizen practices and people’s citizenship-related outcomes.Social implicationsNext steps are sustaining agency action plans, ongoing agency-specific technical assistance, ongoing state-wide educational offerings and a resource library.Originality/valueThe RCLC has provided tools and supports to build the foundation for improved citizenship practices and client outcomes at the multiagency system level.

People may use nonprescribed substances during an acute hospitalization. Hospital policies and responses can be stigmatizing, involve law enforcement, and lead to worse patient outcomes, including patient-directed discharge. In the United States, there is currently little data on hospital policies that address the use of substances during hospitalization. In this cross-sectional study, we surveyed clinicians at US hospitals with Accreditation Council of Graduate Medical Education (ACGME)-accredited addiction medicine fellowships about their current practices and policies and what they would include in an ideal policy. We had 77 responses from 55 out of 86 ACGME-addiction medicine fellowships (63.9%). Respondents identified policies at 21.8% of the institutions surveyed. Current responses to inpatient substance use vary, though most do not match what clinicians identify as an ideal response. Our results suggest that the use of nonprescribed substances during a hospitalization may be common, but a majority of hospitals likely do not have patient-centered policies to address this.

Data that inform preexposure prophylaxis (PrEP) implementation for women involved in criminal justice (WICJ) systems are scarce. In a survey of PrEP attitudes, acceptability, and barriers across the criminal justice system, incarcerated women (n = 48) were more likely than WICJ on probation (n = 125) to be eligible for PrEP (29% vs. 15%; p = .04) and willing to take PrEP if offered (94% vs. 78%; p = .01). In multivariate models, PrEP eligibility directly correlated with being incarcerated (adjusted odds ratio [aOR] 4.81, 95% confidence interval [CI] 1.76-13.1) and inversely correlated with Hispanic/Latina ethnicity (aOR 0.31; 95% CI 0.10-0.96). Recent partner violence exposure was associated with PrEP eligibility (aOR 3.29; 95% CI 1.54-7.02) and discordant risk perception (aOR 2.36; 95% CI 1.18-4.70). Findings demonstrate high potential for PrEP for all WICJ, though implementation efforts will need to address partner violence.

Objective: Behavioral health organizations must respond to the needs of increasing numbers of multicultural populations, as the world population continues to diversify. The goal of this research was to develop a measure to assess the multicultural competence of a behavioral health agency using a quick and efficient but comprehensive strategy that utilizes input from multiple staff members. Method: The Organizational Multicultural Competence Assessment (OMCA) was developed through a review of existing cultural competence assessment measures and item generation from researchers and policy makers. 469 staff from all departments of a U.S. state-operated and funded behavioral health facilities were asked by the CEO of their agency to complete the 45-item survey. Findings: Principal components analysis revealed seven factors that accounted for 64% of the variance in item responses: Governance, Policies, and Procedures; Staff Training and Service Delivery; Addressing Stigma and Discrimination; Accessibility of Services; Community Relationships; Quality, Monitoring, and Evaluation; and Human Resource Development. Items within factors showed high internal reliability. Conclusions and Implications for Practice: This measure may be used on an ongoing basis as a quality improvement tool to assess an agency or system's multicultural competence and adherence to the CLAS standards. Future research can investigate the relationship between scores on this measure and organization-level recovery oriented, client health, and person-centered outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background In the current opioid overdose epidemic, treatment retention among clients receiving medication-assisted treatment (MAT) for opioid dependence is a significant and growing concern among treatment providers, policymakers, and researchers. Methods: We examined a sample of clients enrolled in a federally funded MAT expansion program implemented in four sites in Connecticut. Program participants received MAT for their opioid use disorders (OUDs). All program sites utilized a person in recovery from OUD (a recovery support coach, RSC) as part of the treatment team. By performing bivariate analyses and multivariate logistic regression models, we evaluated the association of 6-month retention and program site, gender, age, race/ethnicity, and past month substance use. Results: At 6-month follow-up, 58.9% of participants were classified as “retained.” Multivariate logistic regression analysis revealed that participants who were older, reported no past month cocaine/crack use, or reported any illegal drug use other than cocaine/crack, were significantly more likely to be retained in treatment at follow-up. Conclusions: Retention rates were relatively high in these Connecticut sites compared to those examined in previous literature. Findings suggest that efforts for enhancing retention and successful treatment outcomes need to consider and potentially address the unique needs, problems, and risks of younger clients and clients with crack/cocaine involvement. The importance of drug use screening for those entering MAT is underscored. Future research needs to explore how levels of client involvement in adjunctive therapies may impact their retention.

Specific guidance on how to manage COVID-19 in forensic psychiatric institutions is necessary because these settings differ substantially from both acute-care psychiatric hospitals and correctional institutions. The challenges raised by COVID-19 in these settings are unique, given the nature of the patients treated, length of stay, and need to collaborate with various partners in the criminal justice system during both the admission and discharge planning processes. This column outlines these specific challenges, which are likely to recur in subsequent epidemics, and suggests potential strategies to address them.

Natural disasters impact people of every age in the communities where they occur, with older adults being a vulnerable subset of the population. Most disaster shelter volunteer nurses are experienced in addressing common health needs of older adult clients such as diabetes, hypertension, and pulmonary disease. These nurses also have the requisite training to respond to more acute medical events, including the symptoms of a heart attack or stroke. They provide care and comfort to those suffering from the distress, anxiety, and fear caused by disasters. However, they may be less adept at triaging and caring for older adults with mental health conditions such as delirium, depression, or dementia. The trauma associated with a disaster and relocation will challenge cognitive abilities in those with dementia, may exacerbate existing depression, or lead to the onset of delirium, which is a medical emergency. Older adults experiencing these conditions are at risk for harm and deterioration with serious short and long-term consequences. Since disaster shelter volunteer health care staff may not be well-versed in distinguishing between dementia, depression, or delirium, behavior observation, and safety considerations are critical determinants of whether it is possible to support the older adult in the shelter environment or it is necessary to transition to a higher level of care.