The current authors respect Boffa and Houtsma's (see record 2027-56797-001) interest in their article (see record 2024-23207-001) and Boffa and Houtsma's passion for the topic of patient high-risk flags for suicide. They appreciate the opportunity to clarify their study's aims and conclusions, which appear to have been misinterpreted by Boffa and Houtsma. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Physical injury events can lead to significant distress, but early psychosocial intervention may promote coping and prevent the development of psychopathology. This study evaluates a pilot program built upon a partnership with a U.S. Level 1 trauma center to serve these purposes. It aimed to (a) identify demographic and clinical characteristics of patients who engaged in therapy as an indicator of who such a program can serve and (b) evaluate the program's feasibility by examining patients' reported mental health-related changes and feedback about the program. The program provided 4-6 weeks of flexible, trauma-informed, patient-tailored, cognitive behaviorally oriented psychotherapy that emphasized trauma psychoeducation, coping self-efficacy, and self-compassion to facilitate symptom reduction, psychological growth, and preparation for transitioning to longer term trauma-focused therapy when appropriate (i.e., stepped care). Of the 149 patients referred to the program, 38 engaged in therapy, and 16 completed pre- to postsurveys including open-ended items soliciting feedback about the program and validated quantitative measures. Patient feedback responses were subjected to thematic analyses related to facets of feasibility. Patients' feedback included suggestions and appreciation of the program's accessibility and flexibility as well as evidence supporting the program's feasibility, in terms of acceptability, demand, and limited-efficacy testing. Relatedly, substantial quantitative improvements in posttraumatic stress disorder symptoms, depressive symptoms, coping self-efficacy, self-compassion, and posttraumatic growth were observed. This work demonstrates the potential utility of brief stabilization therapy programs to meet postinjury psychosocial needs, and it highlights successes and challenges that may inform the development and implementation of future programs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Starting in 2008, the Veterans Health Administration required mental health (MH) provider integration in nursing homes, called Community Living Centers (CLCs), to promote access to quality MH services. This project aimed to understand MH practice patterns and service integration in the CLC and to identify facilitators and barriers to integrated MH services. CLC physician and nurse leaders, and MH providers, were invited to participate in national surveys in the fall of 2022. Survey questions were designed to assess MH provider staffing and workload, organizational alignment and resources, practice and services provided, training and resource needs, MH provider satisfaction and burnout, integration, and CLC team functioning and morale. Questions included structured and open-ended formats. A total of 107 CLC MH providers and 85 CLC leaders completed their respective surveys. Descriptive and bivariate analyses were performed with quantitative data, and conventional content analysis procedures were used to analyze open-ended text responses. Findings highlighted that CLC MH providers care for Veterans with complex presentations across a range of treating specialties requiring many specialized skills, and MH integration is important and valued by CLC leaders. Results support Veterans Administration MH integration efforts and highlight the need for and importance of MH services in the CLC. MH provider job satisfaction and burnout were significantly related to team functioning, morale, and support. Findings will inform ongoing development of CLC MH practice resources and serve as a baseline for further evaluation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The Department of Veterans Affairs requires integrated mental health (MH) services across programs, including 132 facility nursing homes (community living centers, CLCs). As part of a national survey of CLC MH providers in the fall of 2022, which aimed to characterize CLC MH practice patterns and service integration, information was also shared regarding the impact of the COVID-19 pandemic in CLC. The aim of this article was to present qualitative feedback from CLC MH providers regarding MH service integration and interdisciplinary teamwork in the CLC during the pandemic. Response rate to the entire survey was 48%. Out of the 107 survey participants, 82 responded to open-ended survey questions; of these, 71 (87%) were psychologists, and 11 (13%) were psychiatric providers. This analysis focuses on presents two major themes: (a) impact of the COVID-19 pandemic on CLC MH providers, staff, and veterans and (b) importance of team morale and functioning. In their feedback, CLC MH providers emphasized the importance of broad stakeholder engagement, including MH providers, in addressing a public health crisis in ways that optimize person-centered care, strong interdisciplinary team functioning, and support from leaders. Findings highlight the importance of MH integration in the nursing home setting, especially during times of crisis such as the pandemic. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Primary care (PC) represents a widely accessed health care service for youths and families in the United States. In recent years, there has been an increase in youth presenting to PC with suicidal thoughts and behaviors. This study aims to better understand current suicide prevention practices and provider perspectives regarding suicide prevention practices in PC with pediatric populations. Two studies (one using focus groups, the other using individual interviews) were conducted with 40 PC staff (including physicians and physician assistants, integrated behavioral health staff, nurses and nurse practitioners, and clinic leaders) from pediatric PC clinics in Washington State. Focus groups/interviews elicited feedback on current suicide care practices, staff and clinic needs, barriers, facilitators, and suggestions for improvement. Focus groups/interviews were recorded, transcribed, and analyzed using thematic analysis. Results were similar across clinics and highlight challenges and needs for pediatric PC including time limitations, lack of resources for parents, need for additional provider training in suicide prevention, need for team-based approaches, need for standardized and streamlined pathways for patients at different risk levels, and need for integrating screening and intervention components into existing workflows. Overall, results suggest that suicide care is difficult to implement within PC contexts. Understanding PC staff needs, barriers, and facilitators is imperative to adapt feasible suicide care pathways for PC. Results highlight important needs and key components for implementation strategies to target. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This study explores pathways into and out of the criminal justice system for Latinos with co-occurring mental health and substance use disorders, emphasizing missed and successful opportunities for intervention. Using a qualitative design, we retrospectively apply the Sequential Intercept Model-a framework for identifying points of intervention along the justice continuum-to 15 in-depth life history interviews with Latinos in South Texas. By incorporating adverse childhood experiences, mental health symptoms, and substance use onset, we map trajectories across all six intercepts, from community-based services through community corrections. Findings reveal that participants experienced long-term behavioral health issues that remained unaddressed until late-stage criminal justice involvement. Early intercepts, such as community contact, law enforcement, and court diversion, represented the most frequently missed opportunities. Our findings extend prior critiques by illustrating how cultural norms, discretionary policing, and stigma produce "invisible intervention points"-unrecognized points of potential intervention obscured by social and institutional barriers. Cultural stigma, fragmented service systems, and diagnostic exclusion further constrained access to early treatment. Spanish-speaking participants typically engaged only after incarceration or court-mandated referral, whereas English-speaking participants described earlier but untreated symptoms rooted in trauma and instability. Those who received structured care during reentry or community supervision reported greater stability and reduced recidivism. This study demonstrates the utility of serious mental illness as a retrospective analytic tool for assessing service gaps and guiding reform. Findings underscore the need for culturally responsive outreach and cross-agency coordination to reduce criminal justice involvement among Latino populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

One of the goals of training behavioral health providers in a treatment approach is for them to use the treatment with the full range of patients for whom the treatment is indicated. Whether certain training models are more effective than others in achieving this goal is unknown. The goal of this study was to examine the impact of behavioral health provider training in prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) on the use of PE and clinical outcomes among patients with different clinical presentations. Providers (N = 103) working at military behavioral health clinics were randomized to receive a 4-day PE workshop with or without weekly postworkshop consultation for their first two patients and then provided the treatment of their choice to 242 patients with PTSD. Poisson regression analyses and multilevel models tested the moderating effect of PTSD severity, comorbid disorders, anger, and suicidality on provider use of PE components and on patient change in PTSD severity. Results showed that both the presence of a comorbid substance use disorder (SUD) and the total number of comorbid anxiety disorders moderated the impact of provider training on the use of PE. Specifically, providers who did not receive PE consultation used few PE components across comorbid conditions, whereas providers who received consultation used more PE components with patients with comorbid SUD and fewer components with patients with comorbid anxiety disorders. In addition, comorbid SUD and suicidality moderated the impact of training on clinical improvement such that patients with comorbid SUD and patients with suicidality experienced greater PTSD improvement when treated by providers who did versus did not receive postworkshop consultation. Findings demonstrate the impact of postworkshop consultation on therapy implementation and clinical outcomes across common clinical presentations in a military treatment setting. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The objective of this work was to describe shared decision-making (SDM) domains within the context of a modular anxiety intervention provided in primary care behavioral health within a large organized care setting by (a) identifying patient and provider behaviors that exemplify each domain and (b) quantifying the frequency of these behaviors. Participants were 15 veterans (87% male) with anxiety symptoms randomized to the intervention. The intervention was designed as a brief, modular intervention specifically for primary care behavioral health and was delivered by using primary care behavioral health-trained study interventionists (N = 5). Using established SDM theory, deductive qualitative analysis identified and described SDM domains in audio recordings of initial intervention sessions. SDM-congruent behaviors occurred in all sessions with frequencies ranging from 13.3% to 100%. Common provider behaviors included the following: invites questions, validates, and asks the patient to share (recognition of areas of expertise); sets expectations, describes roles/treatments, provides psychoeducation, and links psychoeducation with the patient's specific symptoms (mutual sharing of information); asks about desired changes and preferred modules (discussion regarding treatment preferences); and agrees with the patient's choice (joint making of decision). Common patient behaviors included the following: readily responds and complies with instructions (recognition of areas of expertise), describes symptoms and gives examples (mutual sharing of information), lists goals (discussion regarding treatment preferences), and chooses an option (joint making of decision). A new domain, active listening (with behaviors such as uses listening sounds, uses reflection, and clarifies reports), was also identified. Findings enhance understanding of what SDM "looks like" in clinical practice by providing clear behavioral exemplars of SDM and may guide how to increase engagement in SDM during provision of patient-centered care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).