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Background: Recent efforts to prepare healthcare professionals to care for patients/clients with substance use problems have incorporated SBIRT (Screening, Brief Intervention, and Referral to Treatment) into graduate education programs. This pilot study adds to the literature by examining the impact of an SBIRT interprofessional education approach for behavioral health graduate students and medical residents as planned by faculty from multiple professions at a state university. It measured changes in attitudes, abilities, skills, and knowledge in these interprofessionally trained students. Methods: Faculty in Counseling, Family Medicine, Internal Medicine, Nursing and Social Work departments collaborated to develop an interprofessional curriculum delivered through a small-group and active learning approach. Seventy-one residents and graduate students participated. Pre- and post-training surveys measured self-perceived attitudes, abilities, and skills along with objectively measured knowledge. Analysis examined pre- to post-training changes in scores. Results: Pre-training surveys yielded an 89% response rate; post-training, 85%. Self-perceived attitudes did not change significantly, except a 20% increase in how rewarded students felt while working with patients/clients with alcohol/drug use disorders (P < 0.01). Compared to baseline, there was a statistically significant increase in all items of self-perceived ability (P<0.01) and all items of self-perceived communication skills (P=0.04). Knowledge mean scores also increased significantly (P < 0.001) across both primary care and behavioral health student groups. Conclusions: Interprofessional training in SBIRT produced improvements in ability, skills, knowledge, and some attitudes. Such programs may inform providers who care for patients/clients with substance use problems, improving their personal experience and professional competence.

Although the Collegiate Recovery Community is increasingly seen as the treatment modality of choice for students in recovery, relatively few such programs have been established on small residential campuses. In this article we examine the possible reasons for this reluctance and suggest ways in which the standard model for a Collegiate Recovery Community, as represented by its three benchmark programs, can be modified and adapted to better fit the small residential campus environment. We summarize the problem and review the concept of a Collegiate Recovery Community, and we then explain and recommend 1) a bottom-up initiative for planning and 2) scaled-down resource demand and utilization. We provide a 5-point plan for a "bottom-up, scaled-down" Collegiate Recovery Community on a small residential campus.

Background: Most prefer to die at home, but the Medicare Hospice Benefit does not cover custodial care, making it difficult for terminally ill patients with housing insecurity and/or caregiver instability to access hospice care at home. Objectives: To examine the characteristics of patients who received end-of-life care in community-run, residential care homes (RCHs) operating under the social model hospice. Methods: A retrospective chart review of 500 residents who were admitted to one of three RCHs in Upstate New York over a 15-year period (2004-2019). Results: Patients served by the RCHs included 318 (63.6%) women and 182 (36.4%) men aged 34-101 (M = 77.8). The majority (94.9%) were Caucasian and most had cancer diagnoses (71.6%). Prior to admission, most (93%) patients resided in a private residence, and nearly half (47%) lived alone, but most (81.7%) had full- or part-time caregivers. Nearly all patients were admitted either directly from a hospital (47.5%) or private home (47.2%). Over half (52%) were admitted to RCHs within a month of hospice enrollment, and 20.1% enrolled concurrent with admission. While the average length of stay was 21 days, 50% died within 10 days of admission. Conclusions: Community-run RCHs represent a unique approach for improving access to hospice home care for patients with home insecurity and/or caregiver instability, yet most patients had prior caregiver coverage and were admitted from a hospital or home setting, suggesting there is a need for community care settings for patients unable to remain at home in the final weeks or days prior to death. [ABSTRACT FROM AUTHOR]

Most people wish to die at home yet significant barriers exist in accessing care in one's home, especially for individuals with caregiver and/or housing instability. Across the U.S., residential homes for the dying are opening to address gaps in end-of-life care by recruiting community members to serve as caregivers to hospice patients during their final days. This paper describes a blended-experiential training program, informed by both an evidence-based educational framework and transformative learning theory, that trains undergraduate students to serve as surrogate family members to hospice patients in residential care homes. This study analyzed data from a sample of undergraduate students (n = 35) who participated in an 8-week program. Applying Kirkpatrick's evaluation model, study results indicate the program provided essential knowledge and skills in end-of-life care, benefiting both student learning outcomes and resident care. [ABSTRACT FROM AUTHOR]

To be old and homeless is to face multiple stigmatized identities simultaneously. This qualitative study explored how older homeless adults construct their personal and social identities to manage this stigma. A series of semi-structured in-depth interviews and field observations were conducted over a period of two years with twenty homeless older adults affiliated with an outreach program in a Northeastern U.S. city. Results revealed three typologies of identity narration strategies that the participants used in their processes of identity negotiation and stigma resistance: (1) illumination of positive identities, (2) differentiation and hierarchy, and (3) adoption of other stigmatized but more "deserving" identities. Three case narratives are presented here as a means of illustrating the constructed typology of identity narration and negotiation strategies among older adults experiencing homelessness. Findings suggest ways we might honor individual narratives to eliminate the dividing practice of homelessness as "other" and reframe the discourse to better address older homelessness. [ABSTRACT FROM AUTHOR]

Background: Health-care providers report a lack of training in end-of-life care and limited opportunities exist to learn about the dying process in home settings where most prefer to die. Aim: To evaluate the effectiveness of a Community Action, Research, and Education (CARE) program designed to promote empathy and self-efficacy communicating with and caring for terminally ill patients. Methods: This mixed-methods study collected pre–post data from 18 undergraduates (7 men≤ 11 women) in a 8-week immersive program where they served as primary caregivers in residential homes for the dying providing 200 hours of bedside care to hospice patients during their final days. Quantitative measures assessed empathy using the Jefferson Scale of Empathy-Health Professions (JSE-HPS) version and self-efficacy using a 20-question palliative care skill assessment. Qualitative analyses were conducted on reflective journals to further assess knowledge, skill, and value development. Results: Paired t tests revealed significant increases in empathy (P <.05) and self-efficacy (P <.001) to provide end-of-life care. Thematic analysis of reflective journals further demonstrated specific instances of empathy and self-efficacy. Conclusions: Community-run residential homes for the dying offer a unique opportunity for skills training in end-of-life care. The opportunity to serve as a caregiver for the dying improved students' confidence and ability to provide empathic patient- and family-centered end-of-life care to hospice patients in their final days. [ABSTRACT FROM AUTHOR]

Objectives: Older minority subsidized housing residents represent a population that is particularly vulnerable to depression. Although research suggests that neighborhood characteristics influence older adults' mental health, it has not been explored in this target population. Drawing on social disorganization and social capital theories, this study's aim was to explore if perceptions of neighborhood safety are associated with depressive symptoms; and, whether a sense of community belonging has a mediating effect on this potential relationship. Methods: The data are from interviews with 216 older adults (50% Black, 45% Latino/a) living in a U.S. urban subsidized housing development. Results: Among participants, 80% identified feeling 'very safe' during the day while 63% expressed feeling 'very safe' at night in their neighborhood. Approximately 60% possessed a stronger sense of community belonging and 26% had clinically relevant depressive symptoms. Hierarchical regression analyses revealed that perceptions of feeling less safe in one's neighborhood were significantly associated with elevated levels of depressive symptoms; however, a greater sense of community belonging buffered (or had a significant mediating effect on) this relationship. Conclusion: The findings suggest the importance of continued exploration of the role of social capital in relation to feelings of safety in later life. [ABSTRACT FROM AUTHOR]

Objective: Depression is particularly prevalent in low-income and disabled older adults, and minority populations face a greater risk of poverty and earlier disability onset. Yet, little is known about the mental health of older subsidized housing residents, a population which is disproportionately composed of persons of color. The study’s aim was therefore to explore the prevalence and correlates of depression in this target population, with a particular focus on the role of loneliness. Method: Data are from interviews with 216 older subsidized housing residents, of which 50% identified as Black and 45% self-identified as Latino. Results: About 26% of participants met the criterion for depression. The hierarchical regression supported our hypothesis; after controlling for demographic, health, and stress variables, loneliness explained almost half of the total 49% of variance in depression. Discussion: Care models addressing social risk factors are needed to meet the aging-in-place challenges of subsidized housing residents. [ABSTRACT FROM AUTHOR]

There is a growing awareness that the adult homeless population is ageing, mirroring the general US population trend. Although men still outnumber women among the adult homeless population, there has been a dramatic increase in the number of women, including older women, seeking shelter each night. The concept of 'home' is widely associated with women and serves as a source of identity and social order. Thus, homeless older women represent an intersection of stigma. This qualitative study utilized narrative analysis to investigate the intersectionality of gender, age and homelessness among six homeless urban women in their fifties and early sixties. Findings highlight how older homeless women experience stigmatization within the context of multiple marginalized identities. Data illustrate the women's agency, resistance and resilience as they engage in 'identity work' to address the tension between how others view them and how they view themselves, and construct a sense of a valued life and self. [ABSTRACT FROM AUTHOR]

School-based health centers (SBHCs) benefit the overall health of underserved communities. In fact, there is an abundance of evidence suggesting the positive effects that SBHCs have on physical and mental health. However, research related to understanding the relationship of SBHCs to academic outcomes such as performance and school connectedness is sparse. The purpose of the current study was to (a) compare differences between elementary, middle, and high school student SBHC users and nonusers on school connectedness and (b) test the pathways between SBHC usage and academic performance. A structural equation model was tested and found significant pathways between SBHCs, school connectedness, and academic performance. [ABSTRACT FROM PUBLISHER]