Ohio Department of Mental Health & Addiction Services

Buprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined. To determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing. This prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list-controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Waiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity. The rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed. A total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10). In this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder. ClinicalTrials.gov Identifier: NCT04111939.

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Social deviance refers to actions or behaviours that violate social norms. Since the declassification of homosexuality and development of DSM-III, one of the aims of a definition of mental disorder has been to make explicit the distinction between mental disorder and social deviance. It is well-recognized that psychiatric disorders frequently manifest as violations of social norms, and the validity of the distinction between disorder and deviance has been of great interest to philosophers of psychiatry. This article provides an overview of some of the major conceptual strategies that have been discussed as a means of discriminating between mental disorder and social deviance, and the extent to which these strategies can be said to be philosophically successful. Specifically, we review DSM’s definition of mental disorder, notions of dysfunctions (commonsensical, clinical, naturalist), intrinsic and socially constituted distress, disability, 3E perspectives and functional norms, and ethical and political approaches to this question. Current philosophical strategies don’t offer a distinct dividing line between disorder and deviance, but they help illuminate the relevant considerations involved. It may be concluded that the distinction between disorder and deviance is not simply discovered but also negotiated between competing values.

ABSTRACTRecent studies on the impact of client suicide on mental health professionals focus on psychiatrists and psychologists, while,in the current mental health system in our country, most clients receive services from other clinicians. This research focuses on the impact of client suicide on social workers and counselors as well as organizational responses to client suicide/attempt. Data were collected via interviews and survey of 121 clinicians. Client suicide impacts clinicians adversely in many ways. Many participants felt their agency/practice could have done more to support them during post-suicide management. Data presented in this report have the potential to aid in the creation of needed workforce development initiatives.

The body of research and literature referred to as “evidence-based practice” (EBP) holds enormous potential for improving the outcomes of probation and parole. The commitment to EBP must not only reflect the principles that drive effective correctional intervention, but also incorporate the growing body of knowledge that speaks to the “science of implementation.” Efforts to date to adopt EBP reflect five important lessons for agencies to consider: the investment of time is a critical issue to successful implementation; training alone is not sufficient; the assessment of risk and need is the foundation of EBP; measurement is essential; and collaboration is a core strategy for successful implementation. If the retooling of community corrections towards EBP remains largely unfinished business, the obstacles to doing so are not insurmountable as substantial resources and significant experiences are available to draw upon.

Previous contextual analyses of recidivism are limited by a focus on traditional disadvantage indicators. The authors examine whether those indicators, including poverty, family composition, high school dropout, and unemployment explain disproportionate involvement in serious criminal recidivism among African American relative to White ex-prisoners. Given the fundamental necessity of finding employment after release, the authors move beyond traditional measures and investigate the availability of low-skill employment opportunity in the industries that prior research suggests are most likely to hire ex-prisoners (retail and manufacturing). To address the issue, the authors collected and geo-coded data for a representative sample of 1,568 Ohio ex-prisoners released on community supervision during the first six months of 1999. Contextual analysis reveals that race difference in serious recidivism is explained by low-skill employment opportunity in manufacturing and that it is contingent on levels of neighborhood disadvantage and unemployment.

ABSTRACT The purpose of this cross-sectional study was to examine the relationship of parents’ level of cultural competence with several factors. Exploratory regression analysis was utilized with a sample of transracial adoptive (TRA) parents of children born in Korea and China (n = 912). Results indicated that 16.2% of variance in a measure of TRA parents’ cultural competence was explained by families’ participation in postadoption support groups; parent's sex, that is, female; traveling to the child's country of origin for adoption; postadoption contact with adoption professionals; absence of biological children in the family; and families’ annual income over $75,000. Conclusions and implications for practice and research are discussed.