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AbstractObjectivesMethodResultsConclusionsRaue and Sirey proposed a theoretical treatment engagement model for older adults outlining steps from identifying mental health problems, referral to specialty care, and involvement in treatment. Using this model as a guide, the current study aimed to explore patient perspectives of their experience in the process of referral and first meeting with geriatric mental health services. Furthermore, the current study aimed to identify opportunities to enhance patient engagement in these beginning steps of the treatment engagement process.Thirteen geriatric outpatients (7 psychology, 6 psychiatry) presenting with concerns of anxiety, depression, and/or stress were interviewed. Interviews were analyzed using the framework method.Themes emerged as suggested by Raue and Sirey’s model, including attitudes toward treatment (e.g. stigma), treatment expectations, and treatment preferences. In addition, new themes emerged related to modifiable individual factors (the patient as a passive recipient of care, mental health literacy, and ageism) as well as social influences on treatment engagement. Participants primarily noted opportunities for psychoeducation as a potential treatment engagement intervention to implement within the current referral system.This is the first study to examine the applicability of Raue and Sirey’s theoretical engagement model in a clinical sample. Findings both support and expand the model and offer several recommendations for improving treatment engagement for older patients. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) are highly prevalent and have deleterious effects on one's health and well‐being. Inpatient treatment for SUDs reduces patient relapse, which subsequently ameliorates these negative effects on the individual and society. Additionally, those who complete treatment are less likely to relapse compared to those who do not complete treatment. Thus, maintaining patient engagement in treatment and reducing the rates of those leaving against medical advice (AMA) is particularly important. Examining the factors and comorbidities that may contribute to treatment dropout has the potential to identify at‐risk patients in need of additional individualized intervention. The current study aimed to examine comorbid anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms as predictors of dropout AMA in a residential substance use treatment population. Results showed that patients with social anxiety were more likely to leave treatment AMA, while those with PTSD were more likely to complete treatment. Findings suggest that PTSD‐specific treatment, as offered in this facility, may help with patient retention, while group focused therapy may be distressing to those with social anxiety. Clinical implications of this research may include incorporating evidence‐based practice for social anxiety early during inpatient treatment to reduce anxiety such that patients may better engage with SUDs treatment. [ABSTRACT FROM AUTHOR]

The current study examined the construct of State of Surrender (SoS)—defined as a willingness to accept, without resistance, what is to come—and investigated SoS as a statistical mediator of the relationship between engagement in substance use treatment and meaning in life (MIL). Using a cross-sectional design, participants were 123 people involved with the legal system participating in a 6-month residential treatment program for substance use. Results showed that measures of treatment engagement, including treatment participation, counselor rapport, and peer support, were all positively associated with SoS scores (R² s ≥  21.16). Moreover, while controlling for time spent in treatment, SoS statistically mediated the positive association between aspects of treatment engagement and MIL. State of Surrender may be a targetable process in substance use treatment that aids in recovery by orienting clients toward what they find meaningful in life. Future directions and practical considerations are discussed. [ABSTRACT FROM AUTHOR]

Background: This pilot proof-of-concept study examined the feasibility and acceptability of the Daily Progress System (DPS), a web-based platform designed to improve treatment engagement and retention among clients in outpatient substance use treatment. Methods: The study included adults under justice supervision in the community (probation or parole) who were clients at an outpatient treatment program (N = 30; 60% males). Participants were instructed to utilize the DPS daily for 4 weeks. Incentives were paid to participants for using the platform. At the end of the study, they completed a post-satisfaction questionnaire. Results: Of the 30 participants enrolled in the study, 28 (93.3%) completed the post-satisfaction questionnaire. Overall, they were extremely satisfied with the platform as 21/30 (70.0%) logged into the DPS on a daily basis and completed at least 15 daily surveys or more over the 30-day study period and 27/28 (96.5%) would recommend that the participating treatment program use the platform as part of treatment for other clients. Conclusions: The DPS was well-utilized and perceived as valuable by this group of justice involved, low-income, underserved, and hard-to-reach individuals. Further research is needed to refine platform content and evaluate its ability to meaningfully enhance and extend the benefits of treatment. [ABSTRACT FROM AUTHOR]

Abstract Background The prevalence of psychosis has been shown to be disproportionately high amongst sexual and gender minority individuals. However, there is currently little consideration of the unique needs of this population in mental health treatment, with LGBTQA+ individuals facing barriers in accessing timely and non-stigmatising support for psychotic experiences. This issue deserves attention as delays to help-seeking and poor engagement with treatment predict worsened clinical and functional outcomes for people with psychosis. The present protocol describes the methodology for a scoping review which will aim to identify barriers and facilitators faced by LGBTQA+ individuals across the psychosis spectrum in help-seeking and accessing mental health support. Methods A comprehensive search strategy will be used to search Medline, PsycINFO, Embase, Scopus, LGBTQ+ Source, and grey literature. Original studies of any design, setting, and publication date will be included if they discuss barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with experiences of psychosis. Two reviewers will independently screen titles/abstracts and full-text articles for inclusion in the review. Both reviewers will then extract the relevant data according to pre-determined criteria, and study quality will be assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Key data from included studies will be synthesised in narrative form according to the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Discussion The results of this review will provide a comprehensive account of the current and historical barriers and facilitators to mental healthcare faced by LGBTQA+ people with psychotic symptoms and experiences. It is anticipated that the findings from this review will be relevant to clinical and community services and inform future research. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. Scoping review registration This protocol is registered in Open Science Framework Registries ( https://doi.org/10.17605/OSF.IO/AT6FC ).

Background: The prevalence of psychosis has been shown to be disproportionately high amongst sexual and gender minority individuals. However, there is currently little consideration of the unique needs of this population in mental health treatment, with LGBTQA+ individuals facing barriers in accessing timely and non-stigmatising support for psychotic experiences. This issue deserves attention as delays to help-seeking and poor engagement with treatment predict worsened clinical and functional outcomes for people with psychosis. The present protocol describes the methodology for a scoping review which will aim to identify barriers and facilitators faced by LGBTQA+ individuals across the psychosis spectrum in help-seeking and accessing mental health support. Methods: A comprehensive search strategy will be used to search Medline, PsycINFO, Embase, Scopus, LGBTQ+ Source, and grey literature. Original studies of any design, setting, and publication date will be included if they discuss barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with experiences of psychosis. Two reviewers will independently screen titles/abstracts and full-text articles for inclusion in the review. Both reviewers will then extract the relevant data according to pre-determined criteria, and study quality will be assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Key data from included studies will be synthesised in narrative form according to the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Discussion: The results of this review will provide a comprehensive account of the current and historical barriers and facilitators to mental healthcare faced by LGBTQA+ people with psychotic symptoms and experiences. It is anticipated that the findings from this review will be relevant to clinical and community services and inform future research. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. Scoping review registration: This protocol is registered in Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/AT6FC). [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Most young adults experiencing psychosis enter early intervention services (EIS) via inpatient and emergency departments. These experiences are suggested to negatively impact their views of treatment and engagement in EIS. However, limited research has examined the impact of young adults' prior help‐seeking experiences on these outcomes. The present study aimed to explore how young adults engaged in EIS have experienced initial help‐seeking and make sense of these experiences in the context of their current treatment.Using an interpretative phenomenological analysis approach, semi‐structured interviews were conducted with 12 young adults (mean age = 24.83) within their first 3–12 months of treatment in EIS. Interviews aimed to examine their experiences of help‐seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS.3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Help‐Seeking and Referral Experiences. Participants with referral pathways involving urgent care services described more adversity during their referral pathway and tended to describe help‐seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment.The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants' accounts. Sense making was further contextualized by participants' illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users' dignity and for EIS to provide opportunities for patients to process past negative mental healthcare experiences to strengthen engagement. [ABSTRACT FROM AUTHOR]

Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients' hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients' symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients' hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients' functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients' outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Opioid misuse has been a growing problem in the United States that has escalated into a national public health emergency. Despite substance abuse programs that offer assistance in the treatment of opioid use disorder (OUD), keeping clients engaged in recovery treatment can be very challenging. Relapse prevention is a priority concern due to the higher risk of overdose following a period of sobriety. Aims: This research compares two different approaches to treatment of OUD to assess relative treatment adherence. The purpose of this research is to establish whether a peer support-based treatment methodology, combined with increased medication-assisted treatment, provided by an outpatient facility is more effective than treatment-as-usual in improving client engagement in recovery treatment. Methods: The research analyzed data collected over a 6-month period by a facility. The retrospective review of data compared a total of 1,570 clients enrolled in a certified recovery services (CRSs) program versus individuals engaged in treatment-as-usual program. Inclusion criteria consisted of clients with at least one diagnoses of OUD who met level of care requirements. Results: Statistical t -test analysis revealed greater engagement in recovery services among those enrolled in the CRS program. Conclusions: The findings support the benefits of a peer support program as a treatment methodology for clients with OUD. This research will be of value in the design and development of future program policy and treatment guidelines. [ABSTRACT FROM AUTHOR]

This study examined the relationship between terminal referral source and subsequent urgent health service use in a Canadian early intervention service (EIS) for psychosis. Administrative health record data of emergency and inpatient mental health service use over a 2-year follow up from entry to EIS were retrospectively analyzed (n = 515). Negative binomial regression models were used to assess for the relationship between referral source and care outcomes. Compared to those referred from primary care services, the rate of urgent health care use was significantly greater for individuals referred to early intervention services from urgent care services while accounting for social and occupational functioning and psychotic symptom severity. Findings suggest that those referred from urgent services may be at an increased risk for subsequent urgent health care use while attending EIS for psychosis. Further research examining this relationship while incorporating additional relevant predictors is needed. [ABSTRACT FROM AUTHOR]

This study examines male (n = 2,612) and female (n = 2,644) clients entering SUD treatment who rated their quality-of-life (QofL) lower or higher and then examined thier recovery needs at program entry and at follow-up as well as return to substance use at follow-up. Results found that lower QofL ratings at program entry were associated with many recovery needs at both program entry and at follow-up. In the multivariate analysis, QofL ratings at program entry were significantly and uniquely associated with the average number of recovery needs at follow-up as well as return to use after controlling for recovery needs at program entry. Individuals who continued to rate their QofL lower at follow-up had lower SUD program satisfaction and engagement ratings and had more recovery needs, on average, at follow-up. Focusing on recovery needs and quality-of-life, which vary by person and context, may enhance recovery from substance use. [ABSTRACT FROM AUTHOR]

Behavioral parent training is the recommended intervention for young children with disruptive behavior and/or attention-deficit/hyperactivity disorder (ADHD). Parent–child interaction therapy (PCIT) is an empirically supported behavioral parent-training program for families of children ages 3–6 years old. Behavioral parent-training programs, including PCIT, rely on parents as the primary agents of therapeutic change. Parents who face barriers to adequate engagement with these programs may also struggle to implement the changes necessary for children's behavior to improve. Parental characteristics that may prevent treatment engagement, however, are seldom considered in the research literature or in clinical practice. The current case series describes engagement indicators in three mothers taking part in PCIT. Each mother has a history of diagnosed or suspected ADHD, and this series explores their ADHD-related symptoms as they relate to the treatment of their child's behavior. [ABSTRACT FROM AUTHOR]

Abstract Background Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City. Methods A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use. Discussion This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample. Trial registration Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.

Background: Treatment continuation is essential for the optimal management of patients with mental disorders in the community, but treatment and outcome are often undermined by the high rates of service disengagement and treatment non-adherence across all psychiatric diagnoses. The phenomenon may be even more relevant in rural settings. Aims: The aim of the present study was to explore attendance to treatment in first-contact patients in a community-based treatment setting in rural Greece and to explore the associations of treatment attendance with demographic and clinical factors. Method: Data were collected prospectively over a 3-year period, with 1-year follow-up interval. All first-contact cases with the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T), Northwest Greece were considered, but only clinical cases were processed. Results: The sample size consisted of 446 patients, with a mean age 65.4 ± 18.8 years. The rate of 12-month attendance to mental health treatment was 13.5% (60 out of 446 patients). Treatment attendance was found to be correlated with younger age, the diagnosis of schizophrenia-spectrum disorder, and patients' referral by other psychiatric services. First examination over the year 2019 had been significantly inversely associated with treatment engagement. Conclusion: Rates of subsequent attendance after initial assessment in a rural community mental healthcare setting were rather low in the present study. Several variables that have been previously associated with service engagement were found to be related in this study too, whereas other were not. Research on treatment engagement in rural treatment settings should be ongoing to reveal all associated factors. [ABSTRACT FROM AUTHOR]

The need to expand knowledge of family-based intervention for people with ASD has been observed. However, there is a lack of study in Chinese context such as Hong Kong exploring the use of multifamily therapy (MFT) for adults with ASD. The primary aim of the present study is to assess the feasibility of a process-oriented MFT in promoting family relationships for young adults with high functioning-ASD (HF-ASD) and their parents. We also sought to explore the therapeutic process factors of MFT that were deemed helpful by the family participants in our study. Two types of MFT—one online, the other face-to-face—were conducted from March to August 2021 for families with adults with HF-ASD in Hong Kong. In total, 13 families participated in our multi-method study. Among the results, cross-family therapeutic alliance and treatment engagement were positively associated with enhanced family relationships among participants. Significant differences emerged in changes in the cross-family therapeutic alliance and family relationships between the online and face-to-face MFTs. Two themes regarding the helpful aspects of MFT emerged: first, having a cross-family interactional context and, second, the authentic engagement of people with HF-ASD. Overall, our results imply that MFT, in either online or face-to-face mode, could be a feasible family group psychotherapy for adults with HF-ASD and their parents. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence of the need for treatment engagement between Persons with Severe Mental Illnesses (PwSMIs) and Mental Health Professionals (MHPs). This therapeutic process involves collaborative work between patients and MHPs, which improves the condition. Community nurses are uniquely positioned to facilitate this process as they act as the focal point of interaction between patients and the health system. Methods: This qualitative study explored the community nurses' experiences in treatment engagement with PwSMI through eight group interviews of 35 community nurses from District Mental Health Programs (DMHPs) across Karnataka (South India) from February 2020 to March 2020. The audio recordings of the interviews were transcribed and coded to arrive at themes and subthemes. Results: The major themes identified were factors influencing treatment engagement, strategies to tackle treatment nonengagement, and challenges in dealing with nonengagement. The reasons for nonengagement were lack of insight and lack of knowledge of sociocultural, logistic, and treatment-related factors. The DMHP teams contacted patients through phone calls, home visits, and liaisons with health workers and intervened with them through education and depot injections. The major challenges were difficulty conducting home visits, distances, the unavailability of medications, and the need for adequate infrastructure and human resources. Conclusion: Community nurses address a few factors of nonengagement, such as insight, sociocultural factors, and treatment-related factors. Addressing the systemic challenges and adequate training of nurses in intervening in the dropped-out PwSMIs would help to reduce the treatment gap. [ABSTRACT FROM AUTHOR]

Asian American (AA) families remain critically underrepresented in clinical trials for ADHD interventions. Little is known about AA families' engagement in and outcomes of behavioral treatment (BT). Comparing AA families to other minoritized (OM) families and White families, this study examined parental cognitions, treatment engagement, and child outcomes of BT for ADHD inattentive type (ADHD-I). Path analyses were conducted utilizing data from a randomized controlled trial of BT for ADHD-I (N = 199 children, ages 7–11). Racial/ethnic differences in pretreatment parental self-competence and treatment expectations were examined for AA (n = 29) compared to OM (n = 35) and White (n = 135) parents. Two additional path models were conducted to examine the relations among race/ethnicity, pretreatment parental cognitions, treatment engagement, and posttreatment child outcomes. Direct effects of race/ethnicity and parental cognitions on posttreatment child outcomes as well as their indirect effects via treatment engagement were estimated. At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations compared to OM and White parents. At posttreatment, AA parents reported fewer improvements in ADHD symptoms than White parents and lower global psychosocial improvement than OM parents. For all parents, treatment expectations positively predicted parent- and observer-rated treatment engagement, which in turn predicted child global psychosocial improvement. Path analyses indicated that the relationship between treatment expectations and posttreatment child global improvement was fully mediated by treatment engagement. These findings suggest that treatment expectations impede AA parents' engagement and success in BT. Implications for cultural adaptations of BT to improve AA families' treatment experience are discussed. [ABSTRACT FROM AUTHOR]

Background: Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City. Methods: A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use. Discussion: This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample. Trial registration: Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508. [ABSTRACT FROM AUTHOR]

The current study examined the construct of State of Surrender (SoS)—defined as a willingness to accept, without resistance, what is to come—and investigated SoS as a statistical mediator of the relationship between engagement in substance use treatment and meaning in life (MIL). Using a cross-sectional design, participants were 123 people involved with the legal system participating in a 6-month residential treatment program for substance use. Results showed that measures of treatment engagement, including treatment participation, counselor rapport, and peer support, were all positively associated with SoS scores (R2s ≥ 21.16). Moreover, while controlling for time spent in treatment, SoS statistically mediated the positive association between aspects of treatment engagement and MIL. State of Surrender may be a targetable process in substance use treatment that aids in recovery by orienting clients toward what they find meaningful in life. Future directions and practical considerations are discussed.

IntroductionAlthough research on the development and efficacy of adolescent substance use treatment has made recent strides, many models do not translate into practice, especially when working with underserved youth who often face barriers to treatment. Meal incentives, rolling admission, and transportation assistance may be promising approaches to decrease barriers, thereby increasing treatment engagement, retention, and completion. The purpose of this evaluation was two-fold: (1) to examine treatment engagement amongst diverse, underserved youth in an intensive outpatient program for substance misuse in an urban metropolitan area, and (2) to investigate the role of meal incentives, rolling admission, and transportation assistance in youth engagement.MethodsThe intervention was 8 weeks of Acceptance and Commitment Therapy and trauma-focused group intervention, combined with contingency management, meal incentives, and transportation assistance. Treatment engagement, retention, and completion was compared against selected demographic variables (i.e., race and insurance coverage) and at three phases of program implementation: cohort admissions with transportation assistance (phase 1); rolling admissions with transportation assistance (phase 2); and rolling admissions with transportation assistance and meal incentives (phase 3). Data was analyzed using two-way ANOVAs; identified interactions were probed.ResultsParticipants were 110 adolescents (ages 13–17) consecutively admitted to an intensive outpatient substance treatment program. Racial identities of participants were 40.0% Latinx, 3.6% Black, 0.9% American Indian or Alaska Native, 6.4% two or more races, and 49.1% White. A total of 67 of 110 (60.9%) youth had state-funded Medicaid or no insurance. Of the youth that engaged in treatment across all implementation phases, 68.7% were provided transportation assistance. Analyses illustrated no difference in outcomes based on selected demographic variables. The percentage of youth completing treatment was 22.7% and the average number of groups attended was 6.32 (SD = 6.49). Results showed a significant improvement in outcomes with the implementation of incentives such that engagement and retention in treatment was significantly higher for those in phase 3 compared to those in phase 1 (p

Therapist–client cognitive match upon key constructs such as treatment goals is purported to be an important component of culturally competent care. For adolescent clients, treatment may involve both youths and their parents, suggesting the need to consider both youth–therapist and parent–therapist perspectives. This longitudinal study examined broadband youth–therapist and parent–therapist treatment goal matching and mismatching in relationship to treatment engagement in a culturally diverse sample of 245 outpatient mental health service-using youth. Although goal matching/mismatching did not uniformly predict treatment engagement as measured by a total score, youth–therapist internalizing goal matching predicted better youth engagement, and parent–therapist externalizing goal mismatch marginally predicted worse parent engagement. When selected post hoc analyses examined relationships to four individual engagement dimensions, youth–therapist internalizing goal matches positively predicted youth Client–therapist interaction, Communication/Openness, Client’s perceived usefulness of therapy, and Collaboration with treatment, while parent–therapist externalizing goal mismatch negatively predicted parent Collaboration with treatment. Findings support the importance of cognitive match on treatment goals as well as the consideration of both parent and youth perspectives, matched and mismatched goals, internalizing and externalizing goals, and examining individual dimensions in addition to total scores of engagement.

A prior open trial of acceptance and commitment therapy (ACT) for comorbid social anxiety disorder (SAD) and depression showed clinically significant improvement over the course of 16 sessions. The aim of the current study was to test the feasibility and acceptability of ACT for this population in a pilot randomized trial within a routine practice setting. Patients (n = 26) were randomly assigned to 16 weeks of medication treatment as usual (mTAU) versus mTAU plus ACT (mTAU + ACT). Results showed that a significantly greater percentage of patients in mTAU not only dropped out of the study but also dropped out of treatment at the practice altogether, compared to patients in mTAU + ACT. Overall, results from this study suggest that having a comparison condition of mTAU alone in a randomized trial in a routine practice setting is not feasible and that patients with comorbid forms of SAD may require psychotherapy to remain engaged in treatment in standard clinical practice. Preliminary results for patients within the mTAU + ACT condition on treatment satisfaction and outcomes were comparable to results from the prior open trial, suggesting that ACT itself is worthy of further investigation. Further modifications to the study design may be needed to develop a feasible and acceptable comparison condition against which to test ACT for comorbid SAD in a routine practice setting. [ABSTRACT FROM AUTHOR]

Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients’ hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients’ symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients’ hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients’ functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients’ outcomes.

Purpose: Task sharing in psychological treatments has been recognized as an effective strategy for bridging the global mental health treatment gap. However, more research is needed to better support its implementation in routine care. Mental health services users' engagement with treatment is a crucial implementation factor, yet empirical evidence on its determinants remains sparse. The current study aims to investigate social support as a predictor of users’ session attendance, a key indicator of treatment engagement, within a task-shared psychological treatment. Methods: This is a secondary analysis of cohort study data from the Program for Improving Mental Health Care (PRIME) implemented in Sehore district, India, where trained non-specialist health workers delivered manualized treatment for depression and alcohol use disorder (AUD; n = 240 in depression cohort, n = 190 in AUD cohort). Quasi-Poisson regression models were used to assess the association between users’ perceived social support at baseline and treatment session attendance at 3-month follow-up, controlling for socio-demographic and clinical characteristics. Result: Within the depression cohort, a 4-point increase in social support score at baseline predicted a higher number of treatment sessions attended by 3-month follow up (IRR = 1.44, 95% CI: 1.06, 1.93). Within the AUD cohort, we noted insufficient statistical evidence for a weak association between users’ social support and the number of treatment sessions attended in adjusted analysis (IRR = 1.02; 95% CI: 0.69, 1.49). Conclusion: Our findings suggest that the implementation of task-shared psychological treatments for depression into routine care may be enhanced by strategies that activate or build upon the functional roles of users’ social support.

This article details various considerations in the development of a dialectical behavior therapy skills-informed weekly group intervention for psychiatric inpatients receiving treatment in an economically disadvantaged city safety-net hospital. The authors describe the impact of multiple compounding stressors, such as poverty, racial and ethnic discrimination, housing/food insecurity, complex trauma, education level, and other psychological and psychosocial stressors that informed the development of the intervention. Overarching goals of this intervention focused on treatment engagement, assurance that the intervention met best practices in trauma-informed care, and orienting treatment to focus on patient empowerment. Additionally, this article discusses the process of developing a group-based, DBT skills-informed intervention to be applicable to patients with diverse psychiatric diagnoses and varying levels of functioning on an inpatient unit. The benefits of this treatment approach as well as the considerations taken to adapt it to the multifactorial needs of the patient population are also discussed. [ABSTRACT FROM AUTHOR]

Mental health disorders and suicidality are rising among adolescents and young adults (A-YA) while rates of treatment engagement remain notoriously low. Emerging research supports the potential of music-based interventions to improve mental health, but their efficacy remains unclear for A-YA. This systematic review evaluates the evidence on music-based psychosocial interventions to improve engagement in treatment and/or mental health outcomes among A-YA. This review was prospectively registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-six studies were extracted. There was heterogeneity of designs, populations, measures, and outcomes. A typology of music-based interventions emerged, which is characterized by combinations of three broad categories: 1) Somatosensory, 2) Social-Emotional, and 3) Cognitive-Reflective. Most interventions are Socio-Cognitive and Holistically Integrated (combines all three) followed by Socio-Somatic. All interventions involved Social-Emotional processes. Results indicate that most studies report significant effects for mental health outcomes related to social and emotional improvements and reductions of internalizing symptoms for adolescents. Few studies targeted young adults and effects on engagement were rarely measured. There is a need for more studies that use rigorous methods. This review illuminated a need for interventions that are developmentally and culturally tailored to subgroups. Finally, the field is ripe from more studies that apply experimental therapeutics to conceptualize, operationalize, and test mechanisms of change to improve the understanding of how and for whom music-based interventions work. Recommendations for embedding these innovative strategies into research and practice for A-YA are discussed. [ABSTRACT FROM AUTHOR]

Premature termination is a common and enduring problem in clinical practice. Using data extracted from the medical records of 108 adults (Mage = 35.14, female = 63.9%) with prior therapy experiences, this study examined whether perceptions about the helpfulness of prior therapy predicted premature termination, defined as termination before achieving reliable change (RC) or clinically significant change (CSC) on the Outcome Questionnaire–45.2 (Lambert et al., 1996). In RC and CSC models, premature termination was, respectively, 3.05 and 3.06 times more likely among those with one or more prior unhelpful therapy experiences (vs. all helpful). In CSC models, premature termination was 4.04 times more likely among those with all prior unhelpful therapy experiences (vs. all helpful). Number of prior unhelpful therapy experiences was not a significant predictor of premature termination. Those who perceived all prior therapy as helpful attended significantly more therapy sessions than those who perceived all prior therapy as unhelpful. Findings suggest that the client perceptions of previous therapy may help predict premature termination. Individuals with a history of negative therapy experiences may benefit from interventions to improve engagement. Public Significance Statement: Findings from this study suggest that client perceptions of previous therapy may help predict whether a client prematurely terminates therapy. Specifically, this study found that perceiving prior therapy experiences as unhelpful predicted premature termination, defined as termination prior to achieving reliable change and clinically significant change on the OQ-45. Those who perceived all prior therapy as unhelpful attended the fewest therapy sessions, whereas those who perceived all prior therapy as helpful attended the most. Those with a self-reported history of unhelpful therapy may benefit from additional intervention to promote sustained engagement in treatment. [ABSTRACT FROM AUTHOR]

• Many families of children with ADHD do not seek evidence-based treatments (EBTs) • Bootcamp for ADHD (BC-ADHD) is designed to prepare parents to engage in EBTs. • BC-ADHD focuses on engaging families in EBTs early in the help-seeking process. • Results suggest that BC-ADHD may promote family empowerment in seeking services. • Results suggest that BC-ADHD may increase actual initiation of EBTs. Objective : Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method : Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results : Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions : BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments. [ABSTRACT FROM AUTHOR]

Financial incentives can facilitate behavior change and service engagement in health care settings, but research on their use with adults experiencing homelessness is limited. This study examined the effectiveness of financial incentives in improving service engagement and health outcomes among homeless adults with mental illness in Toronto. The authors of this randomized controlled trial recruited 176 participants receiving brief multidisciplinary case management services for homeless adults with mental illness after hospital discharge. In a 1:1 randomization design, 87 participants received a financial incentive of CAN$20 for every week they remained engaged with the service for up to 6 months. The remaining 89 participants received treatment as usual. The primary outcome was service contact rates for up to 6 months of follow-up. Secondary outcomes included self-reported health status, mental health symptoms, substance use, quality of life, housing stability, acute health service use, and working alliance. Negative binomial regression models, analyses of covariance, generalized estimating equations models, and Wilcoxon rank sum tests were used to examine differences between the financial incentive and treatment-as-usual groups across outcomes of interest. No significant differences were found between the financial incentive and treatment-as-usual groups in service contact rates or any of the secondary outcomes examined over the 6-month period. In low-barrier, brief case management programs tailored to the needs of adults experiencing homelessness, financial incentives may not affect service engagement or health outcomes. Further research is needed to identify the effect of financial incentives on engagement in other services, including housing-based interventions. [ABSTRACT FROM AUTHOR]

Background: Missed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments. Objective: To determine the effect of incorporating nudges into appointment reminder letters on measures of appointment attendance. Design: Cluster randomized controlled pragmatic trial. Patients: There were 27,540 patients with 49,598 primary care appointments, and 9420 patients with 38,945 mental health appointments, between October 15, 2020, and October 14, 2021, at one VA medical center and its satellite clinics that were eligible for analysis. Interventions: Primary care (n = 231) and mental health (n = 215) providers were randomized to one of five study arms (four nudge arms and usual care as a control) using equal allocation. The nudge arms included varying combinations of brief messages developed with veteran input and based on concepts in behavioral science, including social norms, specific behavioral instructions, and consequences of missing appointments. Main Measures: Primary and secondary outcomes were missed appointments and canceled appointments, respectively. Statistical Analysis: Results are based on logistic regression models adjusting for demographic and clinical characteristics, and clustering for clinics and patients. Key Results: Missed appointment rates in study arms ranged from 10.5 to 12.1% in primary care clinics and 18.0 to 21.9% in mental health clinics. There was no effect of nudges on missed appointment rate in primary care (OR = 1.14, 95%CI = 0.96–1.36, p = 0.15) or mental health (OR = 1.20, 95%CI = 0.90–1.60, p = 0.21) clinics, when comparing the nudge arms to the control arm. When comparing individual nudge arms, no differences in missed appointment rates nor cancellation rates were observed. Conclusions: Appointment reminder letters incorporating brief behavioral nudges were ineffective in improving appointment attendance in VA primary care or mental health clinics. More complex or intensive interventions may be necessary to significantly reduce missed appointments below their current rates. Trial Number: ClinicalTrials.gov, Trial number NCT03850431. [ABSTRACT FROM AUTHOR]

Background and Aims: Long‐acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that is generating positive outcomes. Negative effects are typically mild and transient, but can occasionally be serious, resulting in treatment discontinuation/non‐adherence. This paper aims to analyse patients' accounts of how they felt during the first 72 h after initiating LAIB. Methods: Semi‐structured interviews were conducted (June 2021–March 2022) with 26 people (18 males and 8 females) who had started LAIB within the previous 72 h. Participants were recruited from treatment services in England and Wales and were interviewed by telephone using a topic guide. Interviews were audio‐recorded, transcribed and coded. The concepts of embodiment and embodied cognition framed the analyses. Data on participants' substance use, initiation onto LAIB and feelings were tabulated. Next, participants' accounts of how they felt were analysed following the stages of Iterative Categorization. Results: Participants reported complex combinations of changing negative and positive feelings. Bodily experiences included withdrawal symptoms, poor sleep, injection‐site pain/soreness, lethargy and heightened senses inducing nausea ('distressed bodies'), but also enhanced somatic wellbeing, improved sleep, better skin, increased appetite, reduced constipation and heightened senses inducing pleasure ('returning body functions'). Cognitive responses included anxiety, uncertainties and low mood/depression ('the mind in crisis') and improved mood, greater positivity and reduced craving ('feeling psychologically better'). Whereas most negative effects reported are widely recognized, the early benefits of treatment described are less well‐documented and may be an overlooked distinctive feature of LAIB. Conclusions: During the first 72 h after initiating long‐acting injectable buprenorphine, new patients report experiencing a range of interconnected positive and negative short‐term effects. Providing new patients with information about the range and nature of these effects can prepare them for what to expect and help them manage feelings and reduce anxiety. In turn, this may increase medication adherence. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate a sample of family members, among whom individuals were undergoing inpatient treatment for substance use disorder and identify predictors of engagement in a family support program. A total of 159 family nuclei were analyzed; 36 (22.6%) completed the program and 123 (77.4%) did not complete the program. Compared to nonparticipants, participants were majorly female (91.9%), younger (43.3 years old, SD = 16.5), unemployed, homemakers, and not financially independent (56.7%). The results showed the predominant participation of wives (29.7%) and offspring (mostly daughters, 27.0%). Participants also reported a higher rate of depressive symptoms (p = 0.003) and worse quality of life, primarily environmental. The frequency of domestic violence was higher among participants than among nonparticipants (27.9% vs. 9.0%, p = 0.005). Engagement in family support programs is the first challenge to overcome. The nonparticipants' profile shows the need to adopt engagement strategies that encompass males and facilitate the participation of breadwinning family members. [ABSTRACT FROM AUTHOR]

This study examined the role of youth race, youth-therapist racial matching, and youth-reported therapist cultural understanding on early treatment engagement in mental health services. The sample included 1158 youths and 126 therapists. Approximately four weeks after the first therapy session, youths responded to a survey assessing five engagement dimensions. Cultural understanding was assessed by asking youths to rate within that questionnaire the extent their therapist "understands their culture and values." Three multivariate multiple regression models were conducted to assess the associations of race, racial matching, and cultural understanding with treatment engagement. Youth race and racial matching were not significant predictors of treatment engagement, whereas youth-reported therapist cultural understanding was a significant predictor of engagement. Cultural understanding had the highest average effect size across all treatment engagement dimensions (ηp2 =.36) compared with youth race (ηp2 =.00) and racial matching (ηp2 =.00). Race was examined as a moderator of the effects of racial matching and cultural understanding on treatment engagement and did not yield significant effect sizes. Findings suggest that increasing therapists' cultural understanding of their youth clients may be a promising strategy for engaging youths early in mental health services. [ABSTRACT FROM AUTHOR]

Purpose of review: Societal, cultural, and contextual norms about how men should be and behave (so called traditional masculinity ideologies; TMI) affect men’s presentation of depressive disorders, psychotherapy use, and treatment engagement. Only recently, however, male-tailored psychotherapy approaches for depressive disorders have been developed, which aim to systematically soften dysfunctional TMI. In this review, we outline the necessary groundwork as well as recent advances in research on TMI, men’s help-seeking, male depression, and their interrelatedness. Subsequently, we discuss the potential value of these findings for male-tailored psychotherapy for depressive disorders. Recent findings: A preliminary evaluation of a male-specific psychoeducation program found that a male-specific psychoeducation text could reduce negative affect as well as state shame and potentially elicit a shift from externalizing depression symptoms toward more prototypical depression symptoms. The James’ Place program, a male-tailored community-based service, improved suicidal men’s overall well-being, problems, functioning, and suicide risk. The Heads Up Guys! program, an eHealth resource aimed at depressed men, reported a high and increasing global interest in their website, with considerable visitor engagement. The Man Therapy online resource improved depressive symptoms, suicidal ideation, and help-seeking behavior. Finally, the Men in Mind program, an online training program for clinical practitioners, increased practitioners’ capacity to engage and support men in therapy. Summary: Male-tailored psychotherapy programs for depressive disorders, which are informed by recent advances in TMI research, may potentially increase therapeutic effectiveness, engagement, and adherence. While recent preliminary analyses of individual male-tailored treatment programs show promising results, extensive and systematic primary studies evaluating these programs are pending but greatly needed. [ABSTRACT FROM AUTHOR]

Objective: People with schizophrenia are much more likely than others to smoke tobacco, raising risks of disease and premature mortality. These individuals are also less likely to quit successfully after treatment, but the few existing clinical and observational studies have been limited by small sample sizes, and have generally considered specialized treatment approaches. In this analysis, we examine outcomes, service use, and potential explanatory variables in a large sample of people with schizophrenia treated in a general-population cessation program. Method: Our sample comprised 3,011 people with schizophrenia and 77,790 controls receiving free nicotine replacement therapy through 400 clinics and health centres. We analysed self-reported 7-day abstinence or reduction at 6-month follow-up, as well as the number of visits attended and self-reported difficulties in quitting. We adjusted for demographic, socioeconomic, and health variables, and used multiple imputation to address missing data. Results: Abstinence was achieved by 16.2% (95% confidence interval [CI], 14.5% to 17.8%) of people with schizophrenia and 26.4% (95% CI, 26.0% to 26.7%) of others (absolute difference = 10.2%; 95% CI, 8.5% to 11.9%; P < 0.001). After adjustment, this difference was reduced to 7.3% (95% CI, 5.4% to 9.3%; P < 0.001). Reduction in use was reported by 11.8% (95% CI, 10.3% to 13.3%) and 12.5% (95% CI, 12.2% to 12.8%), respectively; this difference was nonsignificant after adjustment. People with schizophrenia attended more clinic visits (incidence rate ratio [IRR] = 1.15, 95% CI = 1.12% to 1.18%, P < 0.001) and reported more difficulties related to "being around other smokers" (odds ratio [OR] = 1.28; 95% CI, 1.11% to 1.47%; P = 0.001). Conclusion: There is abundant demand for tobacco cessation treatment in this population. Outcomes were substantially poorer for people with schizophrenia, and this difference was not explained by covariates. Cessation remained much better than for unaided quit attempts, however, and engagement was high, demonstrating that people with schizophrenia benefit from nonspecialized pharmacological treatment programs. [ABSTRACT FROM AUTHOR]

• Mental health professionals' perspectives are important to intervention design. • The technology acceptance model can facilitate understanding of user perspectives. • Ease of use and utility are two features that can be used to evaluate interventions. • Professionals have helpful feedback on design features of a novel engagement system. User experiences are essential to the adoption of an intervention and can be integral to intervention design. We applied two concepts from the technology acceptance model (i.e., perceived ease of use, perceived utility) to understand how mental health professionals experienced a novel system of resources (i.e., engagement system) designed to improve problem identification, coordination, and treatment planning decisions related to addressing problems of low treatment engagement in school mental health services. We conducted a 1-hour focus group with 10 mental health professionals (provider n = 8, supervisor n = 2) using prompts to elicit their perspectives about the effort involved in using the engagement system and about the usefulness of the system in their work. The focus group was transcribed and segmented into 70 excerpts by trained coders. We analyzed the transcript using a consensual qualitative research approach. Ease of use was coded in 15 (39%) excerpts and utility was coded in 24 (61%) excerpts. The valences of excerpts were neutral (n = 18; 46%), positive (n = 10; 26%), and negative (n = 11; 28%). Thirty-nine (56%) excerpts discussed the engagement system. Excerpts pertained to problem identification (n = 18; 46%), coordination (n = 18; 46%), and treatment planning (n = 3; 8%). Findings revealed that resources and procedures were rated differently on their perceived ease of use and utility. Participants reported that the coordination resource had high utility and positively impacted their clinical practice and supervision, while the problem identification resources had low ease of use and were burdensome or difficult to use. Some lessons learned include the value of designing resources that provide structure to clinical decision processes yet allow for some flexibility, the need for simpler and automated procedures to reduce provider burden, and the importance of clear guidelines on how resources should and should not be used. We used this feedback to inform changes to the engagement system prior to testing in a randomized trial. This brief report highlights how applying the technology acceptance model to evaluate interventions can aid in the successful implementation of novel clinical interventions. [ABSTRACT FROM AUTHOR]

Evidence remains limited on culturally competent practices that enhance the engagement of Asian American immigrants in mental health services. This study examines engagement practices by social service providers in community-based organizations, using secondary qualitative data from six provider focus groups (N = 47) and five Chinese, Vietnamese, and Cambodian immigrant client focus groups (N = 36). Thematic analysis revealed that culturally attuned engagement involved provider (a) practice wisdom and (b) practice behaviors calibrated to the unique illness experiences of individual clients. The findings illuminate how cultural competent practice manifests in real-world contexts where providers encounter culturally anchored yet uniquely individualized illness experiences of Asian American immigrants. [ABSTRACT FROM AUTHOR]

Purpose of Review: Diabetes is a chronic condition that requires consistent self-management for optimal health outcomes. People with diabetes are prone to burnout, cognitive burden, and sub-optimal performance of self-management tasks. Interventions that focus on habit formation have the potential to increase engagement by facilitating automaticity of self-management task performance. The purpose of this review is to (1) clarify the conceptualizations of habit formation and behavioral automaticity in the context of health behavior interventions, (2) review the evidence of habit in relation to behaviors relevant to diabetes self-management, and (3) discuss opportunities for incorporating habit formation and automaticity into diabetes self-management interventions. Recent Findings: Modern habit research describes a habit as a behavior that results over time from an automatic mental process. Automatic behaviors are experienced as cue-dependent, goal-independent, unconscious, and efficient. Habit formation requires context-dependent repetition to form cue-behavior associations. Results of diabetes habit studies are mixed. Observational studies have shown positive associations between habit strength and target self-management behaviors such as taking medication and monitoring blood glucose, as well as glycemic outcomes such as HbA1c. However, intervention studies conducted in similar populations have not demonstrated a significant benefit of habit-forming interventions compared to controls, possibly due to varying techniques used to promote habit formation. Summary: Automaticity of self-management behaviors has the potential to minimize the burden associated with performance of self-management tasks and ultimately improve outcomes for people with diabetes. Future studies should focus on refining interventions focused on context-dependent repetition to promote habit formation and better measurement of habit automaticity in diabetes self-management. [ABSTRACT FROM AUTHOR]

Abstract Introduction and aims There is increasing interest and evidence for the use of cannabinoid medications in the treatment of cannabis use disorder, but little examination of the correlates of successful treatment. This paper is a secondary analysis of a randomised placebo-controlled trial of nabiximols for the treatment of cannabis use disorder (CUD), aiming to identify which client and treatment characteristics impact treatment engagement and outcomes. Method Bayesian multiple regression models were used to examine the impact of age, gender, duration of regular cannabis use, daily quantity of cannabis, cannabis use problems, self-efficacy for quitting, sleep, mental health, pain measures, and treatment group upon treatment engagement (retention, medication dose, and counselling participation) and treatment outcomes (achieving end-of-study abstinence, and a 50% or greater reduction in cannabis use days) among the 128 clients participating in the 12-week trial. Results Among the treatment factors, greater counselling attendance was associated with greater odds of abstinence and ≥ 50% reduction in cannabis use; nabiximols with greater odds of ≥ 50% reduction and attending counselling, and reduced hazard of treatment dropout; and higher dose with lower odds of ≥ 50% reduction. Among the client factors, longer duration of regular use was associated with higher odds of abstinence and 50% reduction, and lower hazard of treatment dropout; greater quantity of cannabis use with reduced hazard of dropout, greater odds of attending counselling, and higher average dose; greater pain at baseline with greater odds of ≥ 50% reduction and higher average dose; and more severe sleep issues with lower odds of ≥ 50% reduction. Males had lower odds of attending counselling. Discussions and conclusions These findings suggest that counselling combined with agonist pharmacotherapy may provide the optimal treatment for cannabis use disorder. Younger clients, male clients, and clients with sleep issues could benefit from extra support from treatment services to improve engagement and outcomes. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12616000103460) https://www.anzctr.org.au

Abstract Background Primary care is an ideal setting to connect individuals at risk for suicide to follow-up care; however, only half of the patients referred from the primary care attend an initial mental health visit. We aim to develop acceptable, feasible, low-cost, and effective new strategies to increase treatment initiation among at-risk individuals identified in primary care. Methods We will conduct a multi-phase, mixed-methods study. First, we will conduct a chart review study by using administrative data, including medical records, to identify characteristics of primary care patients at risk for suicide who do or do not attend an initial mental health visit following a referral. Second, we will conduct a mixed methods study by using direct observations and qualitative interviews with key stakeholders (N = 65) to understand barriers and facilitators to mental health service initiation among at-risk individuals. Stakeholders will include patients with suicidal ideation referred from primary care who do and do not attend a first mental health visit, primary care and behavioral health providers, and individuals involved in the referral process. We also will collect preliminary self-report and behavioral data regarding potential mechanisms of behavior change (i.e., self-regulation and social support) from patients. Third, we will leverage these findings, relevant frameworks, and the extant literature to conduct a multi-arm, non-randomized feasibility trial. During this trial, we will rapidly prototype and test strategies to support attendance at initial mental health visits. Strategies will be developed with subject matter experts (N = 10) and iteratively pilot tested (~5 patients per strategy) and refined. Research will be completed in the Penn Integrated Care Program (PIC), which includes fourteen primary care clinics in Philadelphia that provide infrastructure for electronic referrals, patient communication, and data access. Discussion We will leverage frameworks and methods from behavioral economics and implementation science to develop strategies to increase mental health treatment initiation among individuals at risk for suicide identified in primary care. This project will lead to an evaluation of these strategies in a fully powered randomized trial and contribute to improvements in access to and engagement in mental health services for individuals at risk for suicide. Trial registration ClinicalTrials.gov Identifier: NCT05021224

Purpose of reviewSocietal, cultural, and contextual norms about how men should be and behave (so called traditional masculinity ideologies; TMI) affect men’s presentation of depressive disorders, psychotherapy use, and treatment engagement. Only recently, however, male-tailored psychotherapy approaches for depressive disorders have been developed, which aim to systematically soften dysfunctional TMI. In this review, we outline the necessary groundwork as well as recent advances in research on TMI, men’s help-seeking, male depression, and their interrelatedness. Subsequently, we discuss the potential value of these findings for male-tailored psychotherapy for depressive disorders.Recent findingsA preliminary evaluation of a male-specific psychoeducation program found that a male-specific psychoeducation text could reduce negative affect as well as state shame and potentially elicit a shift from externalizing depression symptoms toward more prototypical depression symptoms. The James’ Place program, a male-tailored community-based service, improved suicidal men’s overall well-being, problems, functioning, and suicide risk. The Heads Up Guys! program, an eHealth resource aimed at depressed men, reported a high and increasing global interest in their website, with considerable visitor engagement. The Man Therapy online resource improved depressive symptoms, suicidal ideation, and help-seeking behavior. Finally, the Men in Mind program, an online training program for clinical practitioners, increased practitioners’ capacity to engage and support men in therapy.SummaryMale-tailored psychotherapy programs for depressive disorders, which are informed by recent advances in TMI research, may potentially increase therapeutic effectiveness, engagement, and adherence. While recent preliminary analyses of individual male-tailored treatment programs show promising results, extensive and systematic primary studies evaluating these programs are pending but greatly needed.

An Individualized Mental Health Intervention for ASD, ("AIM HI"), is a collaborative, caregiver-mediated and child-directed intervention for reducing challenging behaviors in children with autism spectrum disorder developed for delivery in community mental health programs. Using observational data from AIM HI sessions, the present study characterized the occurrence of two types of in-session caregiver behaviors: expressed concerns (i.e., expressing concerns about treatment strategies; expressing difficulty using skills; expressing difficulty completing homework) and participation engagement (i.e., asking questions; participating in session activities; showing commitment to therapy). Further analyses examined cultural differences in caregiver behaviors and associations between caregiver behaviors and clinician adherence. Participants included 39 caregiver-clinician dyads enrolled in a community effectiveness trial of AIM HI. Video recordings from 107 sessions during the first two months of treatment were coded for in-session caregiver behaviors and clinician adherence. Results indicated that expressed concerns were observed in 47% of sessions. When controlling for household income, Latinx caregivers were rated lower for expressing concerns about treatment strategies and demonstrated lower participation engagement behaviors in session compared with non-Latinx White caregivers, suggesting that cultural factors may impact verbal engagement in sessions. Finally, expressing concerns about treatment strategies, expressing difficulty using skills, and participation engagement were positively associated with clinician adherence. Findings suggest that some expressed concerns and participation engagement behaviors may be indicators of positive caregiver engagement in the context of a collaborative intervention, and lower levels of such caregiver engagement may actually impede clinicians' delivery of intensive evidence-based intervention in routine care.

Abstract Background Community Reinforcement and Family Training (CRAFT) is an intervention designed to help the concerned significant others (CSOs) of people with alcohol problems who are reluctant to seek treatment. It aims to improve the well-being of CSOs and teach them how to change their behavior in order to positively influence the “identified patient” (IP) to seek treatment. Methods The aim of the present pragmatic cluster-randomized trial was to compare the effectiveness of three formats for delivering CRAFT in real life settings: group sessions, individual sessions, and written material only (control group). Eighteen public treatment centers for alcohol use disorders were randomly assigned to deliver CRAFT in one of the three formats as part of their daily clinical routine. CSOs were recruited via pamphlets, general practitioners, and advertisements on social media. Trained clinicians delivered CRAFT in individual and group format, and self-administered CRAFT was limited to handing out a self-help book. The primary outcome was treatment engagement of the IP after three months. Results A total of 249 CSOs were found to be eligible and randomly assigned to receive CRAFT delivered in group, individual, or self-administered format. The three-month follow-up rate was 60%. At three months follow-up, 29% (n = 32) of the CSOs who received group/individual CRAFT reported that their IP had engaged in treatment. The corresponding rate for the CSOs who received self-administered CRAFT was lower (15%; n = 5) but did not differ significantly from the other group of CSOs (Odds ratio (OR) = 2.27 (95% CI: 0.80, 6.41)). Conclusion We hypothesized that CSOs receiving CRAFT in a group format would improve the most, but although our findings pointed in this direction, the differences were not statistically significant. Trial registration Clinical trials.gov ID: NCT03281057 . Registration date:13/09/2017.

Poor treatment engagement is an enduring problem in the care of patients with schizophrenia. Evidence suggests that targeted cognitive training (TCT) improves cognition and functional outcomes, but this time-consuming intervention might reduce patients' engagement in other treatment activities when implemented in real-world settings. This is especially true of residential care programs which encourage patients to engage in group therapies, self-care, and a wide variety of structured social, work, and other rehabilitation activities. This study aimed to determine whether TCT negatively impacts engagement in other psychosocial treatments. Patients with schizophrenia were recruited from a community-based residential care program and randomized to one of two intervention arms: treatment as usual (TAU; n = 22) or TAU augmented with TCT (n = 24). Psychosocial treatment engagement was tracked over 20 weeks. Treatment groups did not significantly differ on baseline variables or psychosocial treatment engagement in the 5 weeks prior to randomization. TCT had a positive effect on engagement (β = 0.112, p = 0.003), but there was no treatment-by-time interaction (β = -0.029, p = 0.672). Participants in TCT engaged in an average of 1.34 additional group therapies, 0.58 additional activities of daily living, and 0.84 additional rehabilitation activities per week in comparison to TAU participants. Baseline cognition was also a significant predictor of psychosocial treatment engagement. Overall, results suggest that TCT can be implemented in real-world settings without negatively impacting engagement in other psychosocial treatments. Additional studies are needed to determine what role nonspecific factors play in the positive impact of TCT.

Abstract Objective: While understanding racial/ethnic disparities in mental health services use is a growing priority in colleges and universities, little is known the attitudes that may contribute to these disparities. Methods: This study investigates the relationship between clinic diversity, ethnic-racial identity, discrimination, and treatment attitudes. College students n = 250 (Asian 21%, Black 11%, Latinx 23%, and White 45%) participated in an online experimental task rating hypothetical clinic websites that varied by clinician diversity and completed a series of self-report questionnaires. Results: Clinician diversity did not influence treatment attitudes, but discrimination and ethnic-racial identity were significantly related to treatment attitudes. Additionally, the relationship between public regard and treatment attitudes was moderated by race/ethnicity. Conclusions: By focusing on treatment attitudes rather than behaviors, this study addresses potential areas of intervention to address racial/ethnic disparities in college mental health. [ABSTRACT FROM AUTHOR]