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Background Despite recent financial and policy support for harm reduction in the USA, information on the types of workers within organizations who design, implement, and actualize harm reduction services remains nascent. Little is known about how variability in the harm reduction workforce impacts referrals and linkages to other community supports. This exploratory mixed-methods study asked: (1) Who constitutes the harm reduction workforce? (2) Who provides behavioral health services within harm reduction organizations? (3) Are referral services offered and by whom? (4) Do referrals differ by type of harm reduction worker? Methods Purposive sampling techniques were used to distribute an electronic survey to U.S.-based harm reduction organizations. Descriptive statistics were conducted. Multivariate binary logistic regression models examined the associations (a) between the odds of the referral processes at harm reduction organizations and (b) between the provision of behavioral health services and distinct types of organizational staff. Qualitative data were analyzed using a hybrid approach of inductive and thematic analysis. Results Data from 41 states and Washington, D.C. were collected ( N  = 168; 48% response rate). Four primary types of workers were identified: community health/peer specialists (87%); medical/nursing staff (55%); behavioral health (49%); and others (34%). About 43% of organizations had a formal referral process; among these, only 32% had follow-up protocols. Qualitative findings highlighted the broad spectrum of behavioral health services offered and a broad behavioral health workforce heavily reliant on peers. Unadjusted results from multivariate models found that harm reduction organizations were more than 5 times more likely (95% CI [1.91, 13.38]) to have a formal referral process and 6 times more likely (95% CI [1.74, 21.52]) to have follow-up processes when behavioral health services were offered. Organizations were more than two times more likely (95% CI [1.09, 4.46]) to have a formal referral process and 2.36 (95% CI [1.11, 5.0]) times more likely to have follow-up processes for referrals when behavioral health providers were included. Conclusions The composition of the harm reduction workforce is occupationally diverse. Understanding the types of services offered, as well as the workforce who provides those services, offers valuable insights into staffing and service delivery needs of frontline organizations working to reduce morbidity and mortality among those who use substances. Workforce considerations within U.S.-based harm reduction organizations are increasingly important as harm reduction services continue to expand.

Background A shortage of behavioral health clinicians impedes access to mental health services nationwide in the U.S., with shortages most acute in federally designated Mental Health Professional Shortage Areas (mHPSAs). Retaining behavioral health clinicians currently working in mHPSAs is thus critical. This study sought to identify behavioral health clinicians’ assessments of various aspects of their work and jobs that are associated with their anticipated retention within mHPSA practices. Methods Data for this cross-sectional study were drawn from an annual feedback survey of clinicians when they complete federal education loan repayment support contracts for their work within mHPSAs, from 2016 to 2023. Clinicians’ assessments of various aspects of their work and jobs were measured with validated survey items with Likert-scaled response options, with most combined into scales for analyses. Bivariate and then adjusted associations with 5-year anticipated retention were assessed for clinicians’ assessments of various aspects of their work and jobs controlling for demographic, professional, and community characteristics. Results The 2,587 respondent behavioral health clinicians (67.5% response rate) included 42% licensed clinical social workers, 39% licensed professional counselors, 12% psychologists, and 7% licensed marriage and family therapists. Two-thirds of these clinicians worked in either community mental health centers or federally qualified health centers. 42% anticipated they would remain in their practices at least another five years. Five-year anticipated retention rates were nearly three times higher for clinicians who indicated satisfaction on global work and practice assessment measures than for clinicians neutral or dissatisfied on these measures. Five-year anticipated retention rates were also higher for clinicians who reported they had an effective and supportive administration, felt well and fairly compensated, had jobs that permitted a good work-life balance, and had jobs that allowed them to practice the full range of services they desired. Conclusions How behavioral health clinicians view their jobs within U.S. mHPSAs is important to their anticipated retention. Based on study findings, to promote their retention practice administrators should provide fair and adequate compensation, foster work-life balance, permit them to deliver the services they wish to provide, and value them and their input and maintain good relationships with them.

Background: Youth from marginalized groups may be less likely to receive quality health care services. Adverse Childhood Experiences (ACEs) are known to impact long-term health, but it is unclear if there is a relationship between ACEs and receipt of Family Centered Care (FCC)—one indicator of high-quality health care. To assess this relationship, this study used a nationally representative sample of youth from the National Survey of Children’s Health 2016–2017 combined data set. Caregivers of children who had at least one health care visit in the last 12 months (sub-sample n = 63,662) were asked about five indicators of FCC including if they felt the provider: (1) spent enough time, (2) listened carefully, (3) helped family feel like a partner, (4) provided information requested, and (5) showed sensitivity to culture. Methods: Logistic regression analyses examined the association between ACE score and each FCC quality indicator, as well between ACEs score and the overall FCC dichotomous score. Results: ACE exposure did not significantly predict access to a health care visit in the past 12 months. However, children with higher rates of ACEs were significantly less likely to receive FCC. Other factors that significantly predicted lower FCC included child race and ethnicity, insurance type, language in the home, and access to a regular health provider. Conclusions: Providers and health systems must identify, implement, and advocate for effective trauma-informed and care coordination interventions that ensure quality health care services for vulnerable children and families.

Federally qualified health centers (FQHCs) that provide comprehensive health services, including integrated behavioral health (IBH), transitioned to deliver care via telehealth during the COVID-19 pandemic. This study explored how FQHCs adapted IBH services using telehealth. A mixed-method design was used, pairing a survey disseminated to FQHC administrators with a structured interview. Of the 46 administrators who participated in the survey, 14 (30.4%) reported delivering IBH using telecommunication prior to the pandemic. Since COVID-19, almost all of the FQHCs surveyed used telecommunication to deliver IBH ( n  = 44, 95.7%). Nine interviews with FQHC administrators resulted in the four themes: telehealth was essential; core components of IBH were impacted; payment parity and reimbursement were a concern; and telehealth addressed workforce issues. Findings confirm the necessity of telehealth for FQHCs during COVID-19. However due to the lack of co-location, warm-handoffs and other core components of IBH were limited.

A substantial evidence base has established both that adverse childhood experiences (ACEs) deleteriously impact youth mental health outcomes and that racial biases in diagnosing youth are common among mental health professionals. However, the literature to date has hardly examined the relationship between ACEs and diagnostic disparities based on race. This study examines how racial disparities and ACEs contribute to childhood diagnoses of internalizing and externalizing disorders. Using data from the 2017 National Survey of Children’s Health, racial disparities in internalizing (i.e., depression, anxiety) and externalizing (i.e., behavioral/conduct problems) mental health diagnoses were analyzed using logistic regression. ACE score was a significant predictor of all three diagnoses and presented a dose–response relationship. Race was also found to be a significant predictor of diagnoses, as Black children were less likely to be diagnosed with anxiety or depression and more likely to be diagnosed with behavioral problems. Moreover, when examining racial disparities in mental health diagnoses by ACE score, the present study found that the severity of these disparities increased at higher ACE scores. Our study demonstrates that while ACEs are harmful for all children, providers’ identification of internalizing and externalizing disorders appears to occur differentially based on the race of the child they diagnose. These findings yield important insights about potential bias among healthcare providers, educators, and clinical social workers and warrant further research, training for professionals, and culturally responsive interventions. As such, we call on clinical social workers to lead the effort to address racial disparities within mental health services.

Objective: Behavioral and physical health services are increasingly being integrated, with care provided by interprofessional teams of physicians, nurses, social workers, and other professionals. The objective of this study was to describe the functions of social workers on interprofessional teams in primary care and to assess the impact of interprofessional teams that include social workers in integrated care settings. Method: We undertook a systematic review of randomized controlled trials (RCTs) of routine vs. integrated primary care where social workers served on interprofessional teams. A 5-phase search process to identify RCTs from 9 electronic databases and the gray literature published between 2000 and 2016 was used. We calculated effect sizes across identified studies and conducted 2 subsample meta-analyses for behavioral health outcomes. Results: The searches recovered 502 citations. After screening, 107 reports were retained for a full-text review, and 32 of those (from 26 RCTs) met study criteria. In the 26 RCTs, social workers engaged in 3 patient-centered activities: behavioral health treatment, care management, and referral for social services. Conclusion: Although mixed, the findings suggest that, compared to routine services, integrated primary care provided by interprofessional teams that include social workers significantly improves the behavioral health and care of patients.

Purpose To identify the strategies and interventions U.S. health systems implemented to reduce burnout and increase employee well-being during the first year of the COVID-19 pandemic. Methods A concurrent design included a scoping review of published literature on burnout interventions implemented for healthcare workers during COVID-19 and expert interviews with healthcare administrators involved in COVID-19 burnout response efforts (N = 5). Scoping review protocols included a-priori inclusion criteria, search terms, database selection, and data abstraction (N = 21 articles). Results The scoping review identified eight types of interventions; spanning individual, organizational, and community systems. Qualitative data supported scoping review findings and uncovered themes related to communication, role shifting, and wellness initiatives as forms of burnout prevention and reduction. Conclusion As COVID-19 continues, so too will worker stress, burden, and burnout. Health systems worked quickly and creatively to address the needs of the frontline healthcare workforce, yet more work is needed to sustain efforts over time.

Objective: This paper is a resource for applied researchers and journal reviewers who wish to learn more about propensity score methods, especially recent published recommendations for selecting and balancing covariates before conducting treatment effect analysis. Method: We reviewed and synthesized methodological studies of propensity score analysis from multiple disciplines in an effort to distill a cogent and defensible set of recommendations for research practice. Results: Selection of covariates for propensity score methods requires good understanding of empirical evidence and theory related to confounders of treatment assignment and the outcome, as well as clarity about the temporal relations among confounders, treatment, and outcome as measured in the data set in use. Some variables are not appropriate for inclusion in a propensity score model, and some data sets do not include sufficient variables for propensity score analysis. Achieving balance in the model covariates after conditioning on the propensity score should be an iterative process where models are respecified until proper balance is obtained. Important steps for propensity score methods include reporting results from iterative modeling and balance checks, and then defending the final sample conditioned on the propensity score before analysis of treatment effects. These steps are often overlooked in published research. Conclusion: Propensity score methods can be useful tools for reducing bias due to observed confounders. To credibly reduce bias, however, researchers must execute recommended practice for selecting and balancing covariates.

Mental health and substance use disorders, in combination referred to as behavioral health, significantly impact lives across the world and represent a considerable proportion of the global disease burden. The intent of integration of physical and behavioral health is to increase access to services while promoting treatment of the whole person. Because many countries are undergoing transformation of their healthcare systems, this paper offers a comparative analysis of integrated models of behavioral healthcare between the USA, the UK, and China. Integrated care occurs on a spectrum, and therefore, this paper outlines micro-, mezzo-, and macro-level systems that illustrate both opportunities and challenges in integrated healthcare systems in the context of the three countries. Further, the authors provide evidence of the ways in which social work professionals are deployed in certain settings as part of the trained workforce that provides integrated behavioral health services. The discussion examines ways of leveraging the strengths of the social work workforce to improve holistic well-being worldwide.