Abstract
Objective: To assess the attitudes and knowledge of behavioral health technicians (BHTs)
towards opioid overdose management and to assess the effect of online training on opioid
overdose response on BHTs’ attitudes and knowledge, and the confidence to identify and
respond to opioid overdose situations.

Design/Methods: Pre-intervention Opioid Overdose Knowledge Scale (OOKS) and Opioid
Overdose Attitude Scale (OOAS) surveys were administered electronically to five BHTs in
2020. Data obtained were de-identified. Comparisons between responses to pre-and post-surveys questions were carried out using the standardized Wilcoxon signed-rank statistical test(z). This study was conducted in a residential treatment center (RTC) with the institutional review board's approval from Arizona State University. BHTs aged 18 years and above, working at this RTC were included in the study.

Interventions: An online training was provided on opioid overdose response (OOR) and
naloxone administration and on when to refer patients with opioid use disorder (OUD) for
medication-assisted treatment.

Results: Compared to the pre-intervention surveys, the BHTs showed significant improvements
in attitudes on the overall score on the OOAS (mean= 26.4 ± 13.1; 95% CI = 10.1 - 42.7; z =
2.02; p = 0.043) and significant improvement in knowledge on the OOKS (mean= 10.6 ± 6.5;
95% CI = 2.5 – 18.7; z =2.02, p = 0.043).

Conclusions and Relevance: Training BHTs working in an RTC on opioid overdose response is
effective in increasing attitudes and knowledge related to opioid overdose management. opioid
overdose reversal in RTCs.

Keywords: Naloxone, opioid overdose, overdose education, overdose response program

Research has shown adverse childhood experiences (ACEs) have a lifelong negative impact on a person’s physical, mental, and social well-being. ACEs refer to experiences related to abuse, household challenges, or neglect that occur before the age of 18. Some of the effects of ACEs include anxiety, depression, increased stress, increase in high-risk behaviors, and early death. Mindfulness practices have been shown to be an effective tool in reducing some of these symptoms. In looking for ways to prevent or mitigate the effects of ACEs, it is important to provide tools and resources to the adults taking care of children including; parents, guardians, and teachers.

The purpose of this evidence based project (EBP) was to evaluate mindfulness and classroom environments after the implementation of a mindfulness intervention. The intervention consisted of a three day training followed by four weeks of mindfulness practice prior to beginning the school day. Ten preschool and Early Head Start teachers from seven classrooms at a school in inner city Phoenix participated in the project. Utilizing the Five Factors Mindfulness Questionnaire pre and post intervention, a paired sample t-test showed a significant increase in two factors of mindfulness. The CLASS tool was used to assess classroom environment pre and post intervention and showed significant improvement in five classes. These findings support ongoing mindfulness training and practice for preschool and Early Head Start teachers to improve classroom environments.

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.

Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.

Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.

Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.

Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.

Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders

Polypharmacy among psychiatric patients is a concerning trend. From 2007-2010, 58.2% of women and 41.8% of men reported taking five or more prescription drugs within the last 30 days (CDC, 2014). Negative outcomes include prescription drug abuse, side effects, interactions, treatment failure, patient dissatisfaction, and lack of treatment control. The associated practice challenges have led to the following PICOT question. In persons with mental health issues receiving care at an outpatient mental health clinic, does engaging in mindfulness practice versus no mindfulness practice change polypharmacy use over a 3-month period?

The project purpose was to evaluate the effectiveness of Insight Timer mobile mindfulness app at helping patients self-manage distressing symptoms and reduce polypharmacy. Over three weeks, mental health clinic nurse practitioners (NPs) voluntarily recruited patients (n=12) over age 18 using as needed prescriptions (PRNs), and agreed to use Insight Timer mobile mindfulness app for adjunct symptom management. Consenting participants downloaded the mobile app, and completed a brief questionnaire measuring PRN use at the start of app use, and PRN use at their next visit. A Wilcoxon signed-rank test indicated a 10-week mindfulness app trial did not significantly lower total PRN doses compared with pre-app dosing (Z = -.534, p = .593). Paired t-tests revealed no significant change in pre (M = 65.17, SD = 28.64) versus post (M = 67.75, SD = 20.22) OQ45 life functionality results (t(11) = -.420, p = .683) (d = .121) as a result of app use.

Clinically relevant results illustrated 83.33% of participants taking greater than nine PRN doses over the study period used the app six times or more in place of medication. High PRN users employed the app frequently in place of medication regardless of total PRN doses taken. Practice implications and sustainability recommendations include incorporating mobile app use in treatment plans for high PRN users and educating NP’s on the tangible benefits of mindfulness apps in reducing polypharmacy and easing symptom distress on an ongoing basis.
Keywords: mindfulness, mhealth, mobile apps, mobile smart phone, online, RCT, behavior change, polypharmacy.