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Elements of equity, diversity, and inclusion (EDI) in diverse books support children’s intellectual, social, and emotional development. Public library storytime programs serve as venues to showcase books with characters of varied backgrounds, identities, and experiences who may or may not reflect those of the communities the libraries serve. Because storytime providers often rely on online resources to plan their programs, it is important to investigate the presence and quality of EDI elements in books recommended for storytimes by these resources. The present study analyzed the text, illustrations, and WorldCat metadata for a random sample of 481 children’s books recommended by six popular online resources for storytime planning. Results revealed an overall lack of EDI in the recommended books with few characters representing parallel cultures, living with a disability or chronic illness, practicing a religion other than Christianity, or communicating in a language other than English. The paper includes implications for storytime providers and library administrators in the areas of program planning, professional development, and program assessment.

Shared book reading in which children actively participate in the reading of a text via discussion or extratextual talk has been well-established as an activity to advance children’s literacy and language learning, and it is a characteristic practice of public library storytime programs. This study scrutinized the extratextual talk that occurred within the shared reading episodes of 15 public library storytime programs. Findings from this study confirm prior assertions that storytime programs hold the promise of advancing children’s early literacy development. With more than two-fifths of librarians’ extratextual utterances at an abstract level of understanding, storytimes serve as a favorable setting for advancing children’s inferencing skills and symbolic understanding. Results also point to areas that librarians might target for improvement including integration of questions requiring extended responses and attention to vocabulary.

Much research suggests that exposure to diverse books that feature the lived experiences of people with marginalized or underrepresented identities influences how children perceive their ow...

Joining a research-based trend in education, public library children’s librarians have begun to adapt and create programs designed to increase children’s early literacy and school readiness skills....

A recent trend in public libraries′ children’s services emphasizes the role of promoting school readiness. In order to gain a deeper understanding of the school readiness efforts present in storytime programs, this study observed and scored 68 public library preschool storytime sessions presented by 35 storytime providers across three states using the CLASS (Classroom Assessment Scoring System) measure. The CLASS evaluates adult-child interactions in learning environments within three domains related to positive outcomes in children’s school readiness: emotional support, classroom organization, and instructional support. Additionally, the study examined whether differences among CLASS scores were influenced by the population density of the library community, the storytime provider’s degree status and educational level, the provider’s prior teaching experience, the provider’s years of experience in children’s services, and the number of children participating in the storytime session. Results revealed that storytime providers score well in the CLASS’s emotional support and classroom organization dimensions but have room for improvement in the content-focused instructional support domain. Of the factors examined, only years of experience in children’s services was found to influence a provider’s CLASS score. These findings suggest that professional development programs should focus on preparing librarians to teach and model school readiness skills during storytime.

PURPOSE We developed and implemented a new model of collaborative care that includes a triage and referral management system. We present initial implementation metrics using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. METHODS Primary care clinicians in 8 practices referred patients with any unmet mental health needs to the Penn Integrated Care program. Assessments were conducted using validated measures. Patients were primarily triaged to collaborative care (26%) or specialty mental health care with active referral management (70%). We conducted 50 qualitative interviews to understand the implementation process and inform program refinement. Our primary outcomes were reach and implementation metrics, including referral and encounter rates derived from the electronic health record. RESULTS In 12 months, 6,124 unique patients were referred. Assessed patients reported symptoms consistent with a range of conditions from mild to moderate depression and anxiety to serious mental illnesses including psychosis and acute suicidal ideation. Among patients enrolled in collaborative care, treatment entailed a mean of 7.2 (SD 5.1) encounters over 78.1 (SD 51.3) days. Remission of symptoms was achieved by 32.6% of patients with depression and 39.5% of patients with anxiety. Stakeholders viewed the program favorably and had concrete suggestions to ensure sustainability. CONCLUSIONS The Penn Integrated Care program demonstrated broad reach. Implementation was consistent with collaborative care as delivered in seminal studies of the model. Our results provide insight into a model for launching and implementing collaborative care to meet the needs of a diverse group of patients with the full range of mental health conditions seen in primary care.

A greater understanding of factors that are associated with successful outcomes among patients receiving collaborative depression care services is needed. This study sought to examine the unique associations between 3 indices of social ties and changes in depressive symptoms among veterans receiving collaborative depression care management. Data on sociodemographics, behavioral health indices, perceived general health, perceived social support, frequency of negative social exchanges, and degree of social contact were extracted from the electronic health records of 868 veterans meeting criteria for at least moderate depressive symptom severity and enrolled in a Primary Care-Mental Health Integration (PCMHI) program. Veterans were on average 51.3 (SD = 15.9) years old and primarily male. Higher depressive symptoms at baseline were significantly correlated with less perceived social support, less frequent contact with family and friends, and greater frequency of negative social exchanges. Adjusted regression analyses revealed that only social contact was significantly related to changes in depressive symptoms over the course of care management, once controlling for covariates. The results highlight the value of taking multiple indices of social ties into account when providing depression care management services. Routinely assessing patients' level of social contact can potentially help tailor and inform intervention efforts aimed at reducing depressive symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Genomic testing has the potential to improve patient outcomes and reduce patient care costs by personalizing medication selection. Commercial pharmacogenetic (PGx) testing for psychotropic and other medications is widely available and promoted as a means to implement "precision medicine." Despite evidence that genetic variation affects the metabolism of psychotropic medications, the clinical utility of these test results has not been established. Moreover, implementing such testing in routine clinical care is complex, requiring informatics support and a systematic approach to patient and provider education. The PRIME Care program is designed to bridge this gap, applying both clinical trials and implementation science methods to conduct a program of research. It is centered on a large, pragmatic randomized clinical trial (RCT) in which 2000 Veterans with a major depressive disorder (MDD) and their health care providers are randomized together to receive PGx test results at the beginning of an episode of care or 6 months later. We hypothesize that providers who receive the PGx test results will prescribe an antidepressant guided by the PGx findings and Veterans whose care is guided by PGx testing will experience higher rates of remission from MDD. If the results of the trial replicate those of prior PGx studies, which provided preliminary evidence of the utility of PGx guided prescribing, it would strongly support using a precision medicine approach to treat MDD. This program of research is also evaluating dissemination influencers, other biomarkers (e.g., genetic variation associated with depression response), and the health care cost implications of PGx testing. ClinicalTrials.gov Identifier: NCT03170362.

This randomized clinical trial examines the effect of telephonic work-focused counselling combined with integrated care vs integrated care alone among veterans with depression treated at a large Veterans Health Administration medical center., Key Points Question Is a telephonic work-focused counselling program combined with the Veterans Health Administration’s mental health integrated care (IC) program superior to IC alone for improving the occupational functioning and depression symptom severity of employed veterans with depression and work limitations? Findings In this randomized clinical trial including 253 veterans, IC plus work-focused counseling resulted in significantly larger reductions in at-work productivity loss and depression symptom severity immediately after the intervention, and these effects were present 4 months later. Meaning These findings suggest that supplementing the IC program with this low-cost, work-focused intervention may help veterans with depression and work limitations achieve better occupational and clinical outcomes., Importance Thousands of working-age veterans with depression experience impaired occupational functioning. Objectives To test whether the Veterans Health Administration (VHA) integrated care (IC) program combined with telephonic work-focused counseling, known as Be Well at Work (BWAW), is superior to IC alone for improving occupational functioning and depression, to determine whether these effects persist 4 months later, and to determine whether the return on investment is positive. Design, Setting, and Participants In this randomized clinical trial conducted from October 21, 2014, to December 6, 2019, patients undergoing IC at VHA facilities were screened for eligibility and randomized to IC alone or IC plus BWAW. Blinded interviewers administered questionnaires before the intervention, immediately after completion of the intervention at month 4, and at month 8. Eligibility criteria were individuals 18 years or older who were working at least 15 hours per week in a job they had occupied for at least 6 months, were experiencing work limitations, and had current major depressive disorder or persistent depressive disorder. Exclusion criteria were individuals who could not read or speak English, had planned maternity leave, or had a history of bipolar disorder or psychosis. Data analyses were conducted from January 1, 2018, to December 6, 2019. Interventions Integrated care is multidisciplinary depression care involving screening, clinical informatics, measurement-based care, brief behavioral interventions, and referral as needed to specialty mental health care. Be Well at Work counseling involves 8 biweekly telephone sessions and 1 telephone booster visit after 4 months. Doctoral-level psychologists helped patients to identify barriers to functioning and to adopt new work-focused cognitive-behavioral and work-modification strategies. Main Outcomes and Measures The primary outcome was the adjusted mean group difference in changes from before to after intervention (hereafter, adjusted effect) in the percentage of at-work productivity loss, measured with the Work Limitations Questionnaire (range, 0%-25%). The secondary outcome was adjusted effect in the Patient Health Questionnaire 9-item symptom severity score (range, 0-27, with 0 indicating no symptoms and 27, severe symptoms). Results Of 670 veterans referred for participation, 287 veterans (42.8%) consented and completed eligibility screening, and 253 veterans (37.8%) were randomized. Among these 253 patients (mean [SD] age, 45.7 [11.6] years; 218 [86.2%] men; 135 [53.4%] white), 114 (45.1%) were randomized to IC and 139 (54.9%) were randomized to IC plus BWAW. At the 4-month follow-up, patients who received IC plus BWAW had greater reductions in at-work productivity loss (adjusted effect, −1.7; 95% CI, −3.1 to −0.4; P = .01) and depression symptom severity (adjusted effect, −2.1; 95% CI, −3.5 to −0.7; P = .003). The improvements from IC plus BWAW persisted 4 months after intervention (at-work productivity loss mean difference, −0.5; 95% CI, −1.9 to 0.9; P = .46; depression symptom severity mean difference, 0.6; 95% CI −0.9 to 2.1; P = .44). The cost per patient participating in BWAW was $690.98, and the return on investment was 160%. Conclusions and Relevance These findings suggest that adding this work-focused intervention to IC improves veterans’ occupational and psychiatric outcomes, reducing obstacles to having a productive civilian life. Trial Registration ClinicalTrials.gov Identifier: NCT02111811

Objectives The Veterans Health Administration has implemented annual screening for heavy drinking during primary care encounters using the 3-item Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire and made specialized services available to patients with alcohol use disorders (AUDs). We sought to identify the factors that influence whether a patient who has an elevated AUDIT-C score receives appropriate care in the context of an integrated mental health services program. We focused on higher AUDIT-C scores, as these are seen in individuals who are most likely to have a moderate-to-severe AUD and more severe alcohol-related consequences. Methods Utilizing electronic health record data, we conducted a four-year retrospective study of veterans at high-risk for an AUD, based upon an AUDIT-C score >=8 recorded during a primary care encounter at a Veterans Affairs Medical Center and its community-based outpatient clinics. Results In multivariate analysis, the predictors of treatment referral were younger age, being non-white, higher AUDIT-C score, and main campus location. Among patients referred for treatment, younger age and being white were associated with an increased likelihood of completing a pre-treatment assessment. Conclusions Efforts to increase the consistency of treatment referrals, according to established clinical guidelines, could enhance the effectiveness of AUDIT-C screening during primary care visits. Subgroups of patients who may benefit from such efforts include individuals with high-risk but sub-maximal AUDIT-C scores, older patients, and patients who are seen at community-based outpatient clinics.

OBJECTIVE: Recent clinical practice guidelines recommend the delivery of evidence-based psychotherapies for both substance use disorder (SUD) and posttraumatic stress disorder (PTSD) within the same treatment episode for patients with SUD/PTSD comorbidity. This randomized clinical trial evaluated the comparative effectiveness of integrating versus phasing evidence-based psychotherapies for SUD and PTSD among veterans with co-occurring SUD/PTSD. METHOD: 183 veterans with DSM-IV PTSD and SUD at two VA Medical Centers were randomized to one of two psychotherapies during which Motivational Enhancement Therapy [MET] for SUD and Prolonged Exposure [PE] for PTSD were either phased or integrated throughout treatment. Primary outcomes as evaluated by blinded assessors were percent days with drug use or heavy drinking and PTSD symptomology. We hypothesized integrated MET/PE (n = 95) would yield better SUD and PTSD-related outcomes at posttreatment than phased MET/PE (n = 88). RESULTS: In intent-to-treat analyses (n=183), both treatment groups achieved clinically (d=0.46 – 1.06) and statistically significant reductions in SUD (p < 0.01) and PTSD (p < 0.01) symptomology; the time by treatment interactions were not significant. Post-hoc analyses could not confirm statistical non-inferiority; between-group effect sizes suggest a lack of clinically-meaningful differences between the two treatment approaches (d=0.08 – 0.27). CONCLUSIONS: Our hypothesis that integrated MET/PE would result in better outcomes than phased MET/PE across a range of PTSD and SUD measures was not supported; both strategies for combining two single-disorder treatments for co-occurring SUD/PTSD yielded significant symptom reduction.

We conducted interviews with 16 postsecondary students at a large public university on pollination systems knowledge. A semi-structured interview protocol was developed with open-ended prompts to elicit student explanations of pollination systems. Congruent themes were developed through coding of the interview transcripts into low, medium, and high sophistication of responses. From this, we developed a framework of pollination knowledge informed by systems thinking models that describe structures of plants and pollinators, conservation behaviors, and the function of pollination systems. The framework described can be used to explain students’ understanding of pollination systems and identify strengths and gaps in this knowledge. We propose this framework may also be used as the basis for instrument development evaluating the impacts of educational programming designed to improve students’ pollination knowledge.

This study examined associations between three indices of social ties (perceived social support, frequency of negative social exchanges, and degree of social integration) and suicidal ideation among veterans referred by their primary care provider for a behavioral health assessment.The sample included 15,277 veterans who completed a mental health and substance use assessment on referral to a Primary Care-Mental Health Integration (PCMHI) program. Data on sociodemographic factors, mental health and substance use conditions (e.g., depression, anxiety, and substance use), perceived general health, the three indices of social ties, and suicidal ideation were extracted from clinical interviews.The mean±SD age of the sample was 51.3±15.9, most (89%) were men, and about half (48%) were white. Most met criteria for at least one mental health or substance use condition on PCMHI assessment, and 39% reported either low- or high-severity suicidal ideation, as measured by the Paykel Suicide Scale. Logistic regression analyses indicated that after adjustment for sociodemographic factors, perceived health, and comorbid mental health and substance use conditions, each of the three social tie indices was uniquely associated with higher odds of reporting suicidal ideation, compared with no ideation.Findings underscore the value of assessing multiple indices of social ties when examining suicidal ideation among high-risk veterans in primary care experiencing behavioral health issues. Incorporating an assessment of the quality of patients' social interactions and level of social integration into routine PCMHI practice has the potential to enhance screening and intervention efforts aimed at reducing suicidal ideation.

Background Posttraumatic Stress Disorder (PTSD) is a disabling illness suffered by many Veterans returning from war. Some Veterans believe that cannabis may be therapeutic for PTSD. The purpose of this study was to better understand the association between cannabis use and PTSD symptoms. Methods The study was a matched case-control cross-sectional evaluation of the psychiatric and sociocultural associations of cannabis use in Veterans with probable PTSD. Patient self-report measures were examined comparing cannabis users (cases) to non-users (controls) who were case-matched on age and gender. Results Results indicated that there were no significant differences between cases and controls in mean PTSD Checklist-Civilian version (PCL-C) scores (59.2 and 59.1, respectively). There was also no association between PTSD scores and frequency of cannabis use. It was also observed that cases were more likely to be non-Caucasian, financially challenged, and unmarried. Limitations The sample is a convenience sample of Veterans being referred for a clinical assessment and therefore, sampling biases may limit the generalizability of the results to other populations including Veterans not seeking health care in the Veterans Affairs (VA) system. Conclusions The results do not support the theory that cannabis use would be associated with less severe PTSD symptoms. Results do suggest important sociocultural differences in cannabis users compared to controls.

Date Presented 03/26/20 The study examined Medicare quality-measure data to determine the amount of rehabilitation services needed (e.g., therapy intensity and the length of stay) to maximize the improvement in self-care skills for older adults with an orthopedic hip condition in skilled-nursing facilities. Findings of the study can serve as a reference for OTs to plan intervention and justify the resources necessary to increase clients’ independence. Primary Author and Speaker: Chiung-ju (CJ) Liu Additional Authors and Speakers: Christine Kroll Contributing Authors: Courtney Hayden, Craig Wright, Erin Ingram, Lauren Barr, Niki Pierson, Ashley Suda

The association between the quality and nature of social relationships and suicidal outcomes across the lifespan is well established. However, social ties are rarely assessed in primary care and other clinical settings where older adults at high risk for suicide-related outcomes are seen. This study examined the unique associations between three indices of social ties (i.e., perceived social support, frequency of negative social exchanges, and degree of social integration) and death/suicidal ideation among 3,261 older veterans (aged 65+) who completed a clinical mental health/substance use (MH/SU) assessment upon referral to a Primary Care-Mental Health Integration (PCMHI) program. Data on sociodemographics, MH/SU conditions (e.g., depression, anxiety, and substance use), perceived health, the three indices of social ties, and death/suicidal ideation were extracted from clinical interviews. Veterans were on average 70.8 years old (+6.5 years) and primarily male. Approximately half were married and 60.3% were non-Hispanic white. Forty percent reported death ideation or suicidal ideation, as measured by the Paykel Suicide Scale. Logistic regression analyses revealed that, adjusting for covariates, while perceived social support was associated with a greater risk of reporting death ideation relative to no ideation, both social support and frequency of negative exchanges were uniquely associated with greater risk of reporting suicidal ideation relative to no ideation. Social integration was unrelated to odds of death or suicidal ideation. Findings underscore the value of integrating assessments of multiple aspects of social ties into routine PCMHI practice, as doing so has the potential to enhance suicide screening and intervention efforts.

Alcohol care management (ACM) is one model of embedding a behavioral health provider (BHP) into primary care clinics.1, 2 We previously reported on the effectiveness of a 6-month trial of ACM vs referral to outpatient specialty care (SC) for treatment engagement and reducing alcohol consumption.3 Though designed to empower patient/primary care provider (PCP) dyads to independently manage problematic alcohol use, the durability of ACM following the BHP’s departure is unknown: Here, we evaluate the post-intervention effects of ACM on drinking outcomes. It was predicted that, compared to SC referral, ACM-mediated improvements in alcohol consumption would persist over the 6 months following intervention.

Managed honey bee, Apis mellifera L., colonies are contracted to pollinate fruit and nut orchards improving crop quality and yield. Colonies placed in orchards are potentially exposed to pyrethroid insecticides used for broad-spectrum pest control. Pyrethroids have been reported to pose minimal risk to bees due to their low application rates in the field and putative repellent properties. This repellency is believed to alter foraging behavior with the benefit of preventing bees from encountering a lethal dose in the field. However, sub-lethal exposure to pyrethroids may adversely impact bee behavior potentially resulting in social dysfunction or disruption of foraging. This study quantified behaviors associated with sub-lethal exposure to orchard-applied pyrethroids including, lambda-cyhalothrin, esfenvalerate, and permethrin, using video tracking software, Ethovision XT (Noldus Information Technologies). Bee locomotion, social interaction, and time spent near a food source were measured over a 24-h period. Bees treated with a pyrethroid traveled 30–71% less than control bees. Social interaction time decreased by 43% for bees treated with a high sub-lethal dose of esfenvalerate. Bees exposed to a high sub-lethal dose of permethrin spent 67% less time in social interaction and spent more than 5 times as long in the food zone compared to control bees.

Alcohol use disorder is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments, few individuals with an alcohol use disorder are actively engaged in treatment. Available evidence suggests that primary care may play a crucial role in the identification of patients with an alcohol use disorder, delivery of interventions, and the success of treatment.The principal aims of this study were to test the effectiveness of a primary care-based Alcohol Care Management (ACM) program for alcohol use disorder and treatment engagement in veterans.The design of the study was a 26-week single-blind randomized clinical trial. The study was conducted in the primary care practices at three VA medical centers. Participants were randomly assigned to treatment in ACM or standard treatment in a specialty outpatient addiction treatment program.One hundred and sixty-three alcohol-dependent veterans were randomized.ACM focused on the use of pharmacotherapy and psychosocial support. ACM was delivered in-person or by telephone within the primary care clinic.Engagement in treatment and heavy alcohol consumption.The ACM condition had a significantly higher proportion of participants engaged in treatment over the 26 weeks [OR = 5.36, 95 % CI = (2.99, 9.59)]. The percentage of heavy drinking days were significantly lower in the ACM condition [OR = 2.16, 95 % CI = (1.27, 3.66)], while overall abstinence did not differ between groups.Results demonstrate that treatment for an alcohol use disorder can be delivered effectively within primary care, leading to greater rates of engagement in treatment and greater reductions in heavy drinking.

Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial.Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment.Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants' attitude toward counseling or psychotherapy.The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment.

This cross-sectional study investigated the relationship between psychiatric diagnosis and impaired work functioning among American service members returning from Operation Iraqi Freedom-Operation Enduring Freedom (OEF-OIF).Participants were 797 OEF-OIF veterans, of whom 473 were employed. They were referred for further psychiatric assessment by primary care providers at six Veterans Affairs medical centers and underwent a behavioral health interview that assessed psychiatric and health status and work impairment as measured by the Work Limitations Questionnaire (WLQ). The four WLQ subscales (mental-interpersonal demands, time management, output, and physical demands) and an aggregated measure of productivity loss were considered in the analysis. Associations between patient characteristics, psychiatric status, and work impairments were investigated with regression models.Major depressive disorder, posttraumatic stress disorder, and generalized anxiety or panic disorder were significantly associated with impairments in mental-interpersonal demands, time management, and output. Alcohol dependence and illicit drug use were associated with impairments in output and physical demands. On average these productivity losses were four times those found in a previous study of nonveteran employees with no psychiatric disorders.Veterans' ability to maintain gainful employment is a major component of successful reintegration into civilian life, and psychiatric disorders have a negative impact on work performance. This study demonstrated that multiple dimensions of job performance are impaired by psychiatric illness among OEF-OIF veterans. Delivery of empirically supported interventions to treat psychiatric disorders and development of care models that focus on work-specific interventions are needed to help veterans return to civilian life.