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Summary: Buprenorphine initiation in the Emergency Department (ED) has been hailed as an evidence-based strategy to mitigate the opioid overdose crisis, but its implementation has been limited. This scoping review synthesizes barriers and facilitators to buprenorphine initiation in the ED, and uses the Consolidated Framework for Implementation Research and a critical lens to analyze the literature. Results demonstrate an immense effort across the U.S. and Canada to implement ED-initiated buprenorphine. Facilitators include multidisciplinary addiction teams and co-located, low-barrier, harm reduction-informed services to support transitions. Barriers include a failure to address structural stigma, client complexity, and an increasingly toxic drug supply. The literature also misses the opportunity to include the perspectives of service users, health administrators, and learners. Increased coordination of implementation efforts, and a shift to equitable and inclusive opioid agonist therapy initiation pathways are needed across the U.S. and Canada.

Introduction: Experience-based co-design (EBCD) is a structured methodology of conducting healthcare quality improvement bringing together people with lived experience of a condition, families or carers, and healthcare service providers. EBCD has been applied to mental health and substance use (MHSU) settings. This scoping review aimed to: (a) synthesize the literature on the application of EBCD in the MHSU service sector; and (b) map out key adaptations made to the EBCD process, as well as the perceived impacts of the process and considerations unique to the MHSU sphere. Methods: A scoping review methodology was applied. Systematic searches for articles describing EBCD projects in MHSU were conducted across six bibliographic databases for literature published between 2013 and 2023, together with gray literature searches and reviews of reference lists. Records were screened for relevance, resulting in 24 included articles. Data were extracted in a spreadsheet and using qualitative data analysis software. Results are reported descriptively and in table format. Results: EBCD is being conducted in the MHSU sector in a limited number of high-income, English-speaking countries, applied to both quality improvement and new intervention development. Extensive methodology adaptations are described, with some steps frequently removed from the process or modified. A number of positive impacts of EBCD are described, highlighting the development of service adaptations or new services, as well as positive interpersonal impacts among stakeholders. Conclusions: EBCD is a valuable approach to collaboratively co-designing quality improvement initiatives with users of MHSU services, families or carers, and service providers, although it is also applied to new intervention development. Those implementing EBCD should carefully consider the way planned adaptations may affect the information gathered, the implementation experience, and the co-designed solutions. It is important to apply trauma-informed practices to EBCD and follow recommendations for authentic engagement, to promote genuine participation in co-designing solutions.

Background: Narrative-based psychotherapies are strengths-based psychotherapeutic approaches that could be beneficial for people with mood disorders. This scoping review synthesizes the research on the outcomes of various modalities of narrative-based psychotherapies for adults with mood disorders. Methods: Scoping review methodology was followed. Relevant studies were identified via systematic database searches. Articles were eligible if they reported on the outcomes of narrative therapy, narrative therapy integrated with other treatment modalities, and other narrative-based psychotherapies delivered to adults with mood disorders, and were published in English or French. Eighteen reports were included in the review. Results: A small body of research has applied the original narrative therapy model, integrated narrative therapies, and other narrative-based psychotherapies to depressive disorders and, to a lesser extent, to bipolar disorder. Across studies and methodologies, these approaches are associated with improvements in mood symptoms and other metrics. Comparative research tentatively suggests that outcomes of narrative approaches may be similar to those of other psychotherapeutic approaches, across a range of populations. Conclusions: Narrative approaches to psychotherapy may constitute promising psychotherapeutic modalities for adults with mood disorders. However, these approaches are under-researched to date; ongoing research is justified to establish a more robust evidence base on the efficacy and effectiveness of narrative-based psychotherapies for mood disorders.