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Purpose: We aimed to help community stakeholders develop a shared understanding of the opioid crisis through qualitative system dynamics (SD) modeling to inform local strategies for prevention and treatment. Methods: As part of the HEALing Communities Study-New York State, we used secondary qualitative data from community stakeholder interviews and coalition meeting notes to develop qualitative SD models that elucidate the interdependencies and feedback structures underlying the opioid epidemic in each community. Results: The synthesized model revealed multiple balancing and reinforcing feedback loops that influenced the adoption and reach of evidence-based practices to reduce opioid overdose and fatality. Conclusion: SD modeling is a novel approach to helping community stakeholders to see the inter-connectedness of actors, factors and sectors and the need for multiple mutually reinforcing strategies to avert opioid overdose and fatality. Social workers could play a key role in linking actions across sectors in such a complex system. [ABSTRACT FROM AUTHOR]

Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender–loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops—medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia—that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444–S451. https://doi.org/10.2105/AJPH.2022.306725) [ABSTRACT FROM AUTHOR]

Objectives: Music therapy has been shown to be effective for reducing anxiety and pain in people with a serious illness. Few studies have investigated the feasibility of integrating music therapy into general inpatient care of the seriously ill, including the care of diverse, multiethnic patients. This leaves a deficit in knowledge for intervention planning. This study investigated the feasibility and effectiveness of introducing music therapy for patients on 4 inpatient units in a large urban medical center. Capacitated and incapacitated patients on palliative care, transplantation, medical intensive care, and general medicine units received a single bedside session led by a music therapist.Methods: A mixed-methods, pre-post design was used to assess clinical indicators and the acceptability and feasibility of the intervention. Multiple regression modeling was used to evaluate the effect of music therapy on anxiety, pain, pulse, and respiratory rate. Process evaluation data and qualitative analysis of observational data recorded by the music therapists were used to assess the feasibility of providing music therapy on the units and patients' interest, receptivity, and satisfaction.Results: Music therapy was delivered to 150 patients over a 6-month period. Controlling for gender, age, and session length, regression modeling showed that patients reported reduced anxiety post-session. Music therapy was found to be an accessible and adaptable intervention, with patients expressing high interest, receptivity, and satisfaction.Significance Of Results: This study found it feasible and effective to introduce bedside music therapy for seriously ill patients in a large urban medical center. Lessons learned and recommendations for future investigation are discussed. [ABSTRACT FROM AUTHOR]